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Cardiovascular system > Diseases of arterial system > Flashcards

Diseases of arterial system Flashcards

1
Q

What is aneurysm?

A

Dilation of all three layers of artery leading to increase in diameter

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2
Q

What are the branches of aorta?

A

hepatic artery and left gastric artery with splenic artery, superior mesentery artery, right and left renal artery, inferior mesentery

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3
Q

What is the most common location of abdominal aneurysm?

A

Below the two renal arteries

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4
Q

What are the causes of aneurysm?

A

Marfans syndrome, degenerative, infection (mycotic, syphilis) , trauma for false aneurysm

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5
Q

What are the risk factors of aneurysm?

A

Male, age, smoking, hypertension, family history

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6
Q

What are the symptoms?

A

Most are asymptomatic, increasing back pain, if it ruptures abdominal/back pain, peripherally shuts down, cold, decrease in urine output, hypo perfusion

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7
Q

What are the signs of aneurysm?

A

pulsatile and expansile mass on examination

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8
Q

Is there a screening program for aneurysm?

A

Yes, for men aged over 65, ultrasound examination

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9
Q

What are the three types of aneurysm based on size ?

A

small, medium and large

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10
Q

What is small aneurysm?

A

Size 3-4.4 cm, one year follow up

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11
Q

What is medium aneurysm?

A

4.5-5.5 cm, 3 months scans

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12
Q

What is large aneurysm

A

> 5.5 cm, refer to a surgeon

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13
Q

What is the unusual presentation of abdominal aneurysm?

A

Distal emboli, aortacaval fistula, aortoenteric fistula ureteric occlusion or duodenal obstruction

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14
Q

What is the treatment for aneurysm?

A

Surgery if it is bigger than 5.5 cm and patient if fit for surgery

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15
Q

What tests should be done before surgery?

A

Bloods, ECG, ECHO, pulmonary function test, myocardial perfusion, cardio-pulmonary exercise test

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16
Q

What investigations are used to assess the aneurysm?

A

CT or MRI

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17
Q

What are the two ways that aneurysm can be repaired?

A

endovascular repair EVAR or open surgery

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18
Q

What are the complications of EVAR?

A

endoleak, femoral artery dissection, rupture, distal emboli, damage to femoral artery or nerves around, wound infection, bleeding, kidney injury

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19
Q

What are the complications of open repair?

A

damage to bowel, ureter, veins, nerves, incision hernia, graft infection, distal emboli, real failure, colonic ischaemia, wound infection, wound dehiscence, bleeding, pain

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20
Q

What is the management of symptomatic aneurysm?

A

ABCD approach, examination of palsatile mass, CT if possible, massive transfusion protocol, urgent surgery

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21
Q

What are the two main types of aneurysm?

A

true and false

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22
Q

What is true aneurysm?

A

Involves all three arterial layers

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23
Q

What is false aneurysm?

A

rupture of parts of the wall with haematoma, that is contained by adventitia or surrounding tissue, does not involve all three layers, associated with inflammation, trauma or iatrogenic

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24
Q

Based on location what are the types of aneurysm?

A

ascending aorta aneurysm, aortic arch, descending aorta, or abdominal aneurysm

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25
Q

What are the symptoms of aneurysm near the root?

A

SOB, heart failure

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26
Q

What are the symptoms of ascending aorta aneurysm?

A

dysphagia and hoarseness

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27
Q

What are the symptoms of descending aorta or abdo aneurysm?

A

sharp chest or abdo pain, radiating to back, pulsatile mass

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28
Q

What is aortic dissection?

A

Dissection of one or two layers of the artery, another men is formed, it can propagate in antergrade or retrograde fashion, blood forces the layers apart

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29
Q

What are the two types of classification?

A

Standford and DeBakey classification

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30
Q

What is Standford classification of aortic dissection?

A

type A that involves ascending aorta regardless of origin, type B that involves descending aorta

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31
Q

What is DeBakey classification?

A

type 1 originate in ascending and propagate to aortic arch at least, type 2 is confined to ascending aorta only, type 3 originate in descending aorta

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32
Q

What are the causes of aortic dissection?

A

Hypertension, atherosclerosis, Marfan’s syndrome, trauma

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33
Q

What the major risk for aortic dissection?

A

Rupture, into lumen or into pericardium that can lead to cardiac tamponade

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34
Q

What are the symptoms or aortic dissection?

A

Tearing severe chest pain, can radiate to back, collapse due to tamponade, symptoms from acute aortic regurgitation

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35
Q

What are the signs of aortic dissection?

A

reduced or absent peripheral pulse, BP mismatch, soft diastolic murmur due to aortic regurgitation, pulmonary oedema, widened mediastinum

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36
Q

What does aortic dissection lead to histologically?

A

It leads to cystic medial necrosis, loss of muscle fibres and elastin with accumulation of mocupolysaccharides

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37
Q

What is the treatment of aortic dissection?

A

Type A requires surgery, type B BP control by sodium nitroprusside, beta blockers

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38
Q

What is Takayasu’s arteritis?

A

Inflammation of large blood vessels mainly aorta and its branches, leads to fibrosis, stenosis, thrombosis, aneurysm is also possible, there is huge narrowing of the lumen

39
Q

What is the treatment of Takayasu’s arteritis?

A

steroid treatment, surgery

40
Q

What is cardiac syphilis?

A

Syphilis is a sexually transmitted disease, has few stages, primary chancre, secondary rash, tertiary is the cardiac syphilis, which is most commonly syphilitic aneurysm (saccular of ascending aorta) that can cause aortic regurgitation

41
Q

What are the possible congenital abnormalities of the aorta?

A

Coarctation and bicuspid aortic valve

42
Q

What is bicuspid aortic valve ?

A

Congenital malformation where the aortic valve has only three leaflets, it is prone to aortic regurgitation and stenosis, also aorta is prone to aneurysm, dissection, monitored with ECHO, MRI, repair aneurism if it is bigger than 4.5 cm

43
Q

What is aortic coarctation?

A

Narrowing of the aorta close to where ductus anteriosus is formed, it can be preductal (Turner’s) or postductal

44
Q

What are the signs of aortic coarctation?

A

hypertension of upper extremities, weak pulses in lower lips, and cyanosis, rib notching, before subclavian artery coarctation there is radial-radial delay, right radial femoral delay, after subclavian right and left radial-femoral delay, systolic murmur over coarctation, bruit over collateral

45
Q

What are the symptoms of aortic coarctation?

A

cold legs, claudication, symptoms of cardiac failure, hypertension, headache

46
Q

What is the treatment for the coarctation of aorta?

A

Ballon dilation, surgery

47
Q

Describe the anatomy of arteries of lower limb

A

Descending aorta splints into left and right common iliac arteries, they then split into internal and external, external iliac then becomes common femoral and splits into deep and superficial femoral, superficial becomes popliteal and splits into anterior tibial and posterior tibial, posterior than gives off branch of peroneal artery, anterior then forms dorsalis pedis

48
Q

What is critical limb ischaemia?

A

It is a disease of peripheral arteries which are severely blocked, there is reduced supply of blood to limbs

49
Q

What can cause critical limb ischaemia?

A

Atherosclerosis, vasculitis, Burgers disease (clot formation in the smaller arteries)

50
Q

What are the risk factors for critical limb ischaemia?

A

male, age, smoking, hypertension, diabetes, hypercholesterolaemia

51
Q

How can be critical limb ischaemia be classified?

A

Using Fontaine classification, there are 4 stages

52
Q

What is the stage I of CLI?

A

Asymptomatic stage, incomplete obstruction

53
Q

What is stage II of CLI?

A

Mild claudication pain in limbs, IIA walking distance greater than 200m, IIB less than 200m

54
Q

What is stage III ?

A

Rest pain, in feet and especially during the night, due to postural changes

55
Q

What is stage IV ?

A

Necrosis and gangrene

56
Q

What are the symptoms of CLI?

A

pain or numbness in feet, especially on exercise or at rest and during the night, open sores that do not heal properly

57
Q

What are the signs of CLI?

A

cold, shiny, smooth and dry skin, pale and hair lost, thickened toe nails, open sores, skin infections, dry and black skin -gangrene, reduced sensation, reduced or absent pulses, increased capillary refill time

58
Q

What investigations should be performed to diagnose CLI?

A

hand droppler test, Buerger’s test, ankle brachial pressure index measurement, duplex scan, CT/MRA (angiogram)

59
Q

What is ankle brachial pressure index?

A

It is ankle pressure over brachial pressure, normally the ratio is 1, the smaller the index the later stage of disease

60
Q

What is Buerger’s test?

A

It is test for ischaemia, with supine patient the legs are elevated to 45 degrees, and held there for 2 min, pallor suggest ischaemia, the smaller the angle for legs to become pallor the poorer the arterial supply, if the angle is smaller than 20 degrees, there is severe ischaemia. In second stage the legs are hang over the edge of bed, the legs are slow to regain colour, bright red foot is the end result, this is due to loss of autoregulation

61
Q

What is the treatment of critical limb ischaemia ?

A

BP medication, antiplatelets, statins, exercise programs to encourage formation of collateral circulation, diabetic control, smoking cessation, angioplasty, surgical bypass, amputation

62
Q

What is surgical bypass treatment for CLI?

A

Bypassing the blockade, they can be anatomical, axillary, or extra anatomical, veins or synthetic materials can be used

63
Q

When should be the invasive interventions performed?

A

When there is severe ischaemia, pain at rest, ulceration and gangrene

64
Q

Where can be legs amputated?

A

Occasionally amputation is the only option, digits, transmetatarsals, symes, below knee, through knee, above knee, hip disarticulation, hindquarter

65
Q

What is acute limb ischaemia?

A

Sudden reduction or loss of blood supply to the limbs caused by embolus or thrombus

66
Q

What are the possible causes of ALI?

A

arterial emboli from MI, AF, proximal atherosclerosis,thrombosis from atherosclerotic artery, trauma, dissection, acute aneurysm

67
Q

What is the presentation of acute limb ischaemia?

A

Onset of symptoms is usually less than 6 hours, there are 6P, pain, pallor, paraesthesia, paralysis, pulseless, perishingly cold

68
Q

What is compartment syndrome?

A

It can be associated with acute limb ischaemia, it is muscle ischaemia, inflammation, oedema and venous obstruction, tense and tender compartment, increased creatine kinase

69
Q

What is the treatment for ALI?

A

Analegesia, anticoagulation and possibly surgery, if the limb is not salvageable palliation, if it is salvageable do embolectomy or trombolectomy or thrombolysis or bypass surgery

70
Q

What investigations needs to be done?

A

Bloods, ECG

71
Q

When does irreversible ischaemia occur in ALI ?

A

After 6-8 hours

72
Q

What are the two complications of acute limb ischaemia ?

A

compartment syndrome, myoglobinuria

73
Q

What is diabetic foot disease?

A

Foot ulcers of foot id diabetes, there might be infections, skin breaks, other injuries too

74
Q

What are the causes of diabetic foot disease?

A

Neuropathy and common injuries, patients are less careful, do not have the protective mechanism, mechanical imbalance and pressure points from incorrectly placing foot while walking, microvascular peripheral arterial disease as they are more prone to atherosclerosis, oedema

75
Q

What is the most important procedure for diabetic foot disease?

A

Prevention, good foot care, wound care, there is little intervention that can be done

76
Q

What are common signs?

A

misshaped foot, many fractures and dislocations, open breaks, pressure points, ulcers later on, incorrect walking

77
Q

What are the symptoms?

A

neuropahty, so patients do not feel pain, they might only notice the breaks and ulcers

78
Q

What investigations should be performed?

A

For osteomyelitis, gas gangrene, necrotic fasciitis

79
Q

What is the treatment for diabetic foot disease?

A

possibly angioplasty, stenting, bypass surgery is possible, amputation is very common

80
Q

What are the possible techniques to view anatomy of the vessels?

A

plain films, ultrasound, CT, MRI with contracts, contract angiography

81
Q

What are the possible techniques to gain functional overview of vessels?

A

radionuclide imaging, MRI functional imaging, ultrasound, pressure measurements

82
Q

What is the commonly used contract for X ray and CT?

A

Iodinated contrast agents

83
Q

What are the possible disadvantages of iodinated contrast agents?

A

Renal failure, allergic reaction, disturbance in thyroid function, disturbance in clotting, seizures, pulmonary oedema, can also cause metallic taste, feeling of warmth, micturition, nausea, discomfort

84
Q

What is catheter angiography?

A

Visualisation of blood vessels using contrast that is directly injected to the location using catheter

85
Q

What is the contrast that is used in MRI?

A

Gandolinium

86
Q

Give an example of positive contrast?

A

It is showing as a dark, iodinated contests are examples

87
Q

Give an example of negative contrast agent

A

CO2, it is showing as white, useful in patents with poor renal function or sensitivity to iodine

88
Q

Give few examples of interventional radiology

A

angiography, angioplasty, embolisation, catheter thrombolysis, drainage of abscess, neprhostomy, vertebroplasty

89
Q

What is the disadvantages in interventional radiography?

A

May require prophylactic antibiotics

90
Q

Describe ultrasound imaging

A

red towards to probe, blue blood traveling away from the probe, no radiation, noninvasive, quick, but operator dependent

91
Q

Describe radionuclide imaging

A

uses radioactive contrast that can be injected, good for blood loss and perfusion, e.g. in PE, GI bleeding, kidney perfusion, insensitive, nonspecific, radiation

92
Q

Describe CT angiogram

A

sensitive, info about other structures, radiation dose, IV injection of contrast, expensive

93
Q

Describe MRI angiography

A

sensitive, specific, no radiation, no nephrotic contrast, expensive, complex machinery

Cardiovascular system (18 decks)

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