CVS - Peripheral Arterial and Venous Disease Flashcards

1
Q

Does doppler of peripheral vessels give flow?

A

No it gives velocity and direction

Can infer flow

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2
Q

Which way is flow in veins in the leg?

A

Superficial to deep

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3
Q

What are the veins called that flow goes from superficial to deep?

A

Perforators

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4
Q

What is the one constant vein in the body? Where might you find it e.g. for venupuncture

A

Long saphenous vein?

Anterior to medial malleolus

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5
Q

Is the short saphenous and long saphenous deep or superficial

A

Superficial

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6
Q

How does blood flow from superficial to deep and up the leg?

A

When calves relaxed - blood pulled from superficial into deep.

When calves contract blood pushed towards heart

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7
Q

How much does the calf pump reduce during exercise?

A

80%

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8
Q

What is a varicose vein?

A

Tortuous twisted or lengthened veins

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9
Q

What is the pathophys of varicose veins?

A

Vein wall is WEAK

Leads to dilation and separation of valves –> valved become incompetent

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10
Q

What are four symptoms of varicose veins?

A

Heaviness
Aching
Itching
Tension

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11
Q

What is itching in skin mediate by?

A

Nearly always histamine

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12
Q

What are the complications of venous insufficiency (7)?

A

Vein - Haemorrhage, thrombophlebitis

Venous hypertension - oedema, pigmentation (haemosiderin), varicose eczema, lipodermatosclerosis (hard fat), venous ulceration

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13
Q

Why do you get haemosiderin skin pigmentation in venous insufficiency?

A

Increased capillary permeability –> RBCs leak out

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14
Q

Does venous thrombosis cause pain

A

Yes due to inflame response

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15
Q

What in particular leads to venous ulceration?

A

Venous hypertension from calf muscle pump failure

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16
Q

What are causes of calf muscle pump failure?

A

Immobility
Obesity
Superficial vein incompetence (retrograde flow)
Deep vein incompetence
Reduces hip/knee/ankle movement e.g. in fracture?

17
Q

What is virchows triad

A

Changes in vessel wall
Changes in blood flow
Changes in coagulability

18
Q

Which of the virchows is most relevant for arterial vs venous thrombosis?

A

Arterial - Vessel wall

Venous - flow of blood (stasis)

19
Q

Stasis + what = venous thrombosis?

A

E.g. surgery, contraceptive pill, dehydration, cancer

20
Q

What is the difference in thrombi components/pathways (intrinsic extrinsic) of arterial vs venous thrombi?

A

Arterial - platelets and both pathways

Venous - Fibrin intrinsic initially then both

21
Q

Does DVT produce an inflamm response? What are the signs?

A

Yes

Calor
Dolor
Function Laesa
Rubor
Tumor
22
Q

What are the signs/symptoms of DVT

A

Pain
Swelling
Blue-red skin colouration

Calf tenderness
Muscle induration
Skin warmth
Skin discolouration
Distended warm superficial veins
Oedema
Pyrexia
23
Q

What about surgery predisposes you to DVT?

A

Immobility

Hypercoaguable due to trauma of surgery

24
Q

Most common cause of acute limb ischaemia?

A

Emboli from heart, AAA or trauma

25
How long have you got to reverse acute limb ischaemia?
6 hours
26
What are the 6 Ps of acute limb ischaemia?
``` Pain Pallor Pulseless Paralysis Perishing cold Paraesthesia ```
27
What does a fixed mottled legs represent?
Patchy cyanosis --> Irreversible iscahemia --> amputate
28
Why do you need to amputate?
Because K+ builds up and if leg reperfused will go to heart and cause cardiac arrest
29
Where is most common cause of PVD causing claudication?
Superficial femoral artery
30
Where is most common place to feel pain in claudication?
Calf
31
Where might you feel a pulse to assess if there is one in PVD (4)?
Femoral Popliteal Dorsalis Pedis - just lateral to extensor hallucis longus Posterior tibial - just behind medial malleolus
32
What artery would you expect to see occlude if having buttock claudication?
Internal iliac
33
Superficial femoral artery occlusion - where would you feel pulse/not feel pulse/ feel claudication?
Claudication - calf Pulse in femoral artery present Pulse in popliteal and pedal pulses
34
What is rest pain? Why at night (3)?
Pain in foot at night at rest Night because: decreased gravity lying down, decreased cardiac output at night, warmed foot=metabolic needs
35
Why would you get ulcers over tibia in particular?
Blood supply isn't great there anyway