Disorders of Arterial / Venous Circulation Flashcards
Idiopathic cause of PAD more commonsly seen in the Middle & Far East; occurs mostly in smokers and young males
Buerger disease (thromboangiitis obliterans)
Fatigue, pain or weakness in involved extremity or digit
Claudication
Triad of bilat hip claudication, erectile dysfunction, absent femoral pulses
Leriche syndrome (aortoiliac occlusive dse)
ABI <___ is diagnostic of PAD
0.9
Definitive test for PAD
Arteriography
Only effective tx for Buerger disease
Smoking cessation
Most common site of aneurysm
Abdominal aorta (for peripheral, popliteal)
Diameter that defines abdominal aortic anuerysm (AAA)
> 3 cm
Most common location of rupture of AAA
retroperitoneum
Triad of AAA
Pulsatile mass
Hypotension
Abdominal pain
Rupture in the IVC may manifest as…
painless hematuria
Periumbilical ecchymoses
Cullen sign
Flank ecchymoses
Grey-Turner sign
MRI and aortography have no place in the emergent evaluation of possible ruptured AAA. TRUE or FALSE?
TRUE
Thoracic aortic aneurysm is defined by a thoracic aorta dm > ___cm
> 4.5 cm
Most appropriate dx test for unstable TAA patients
Transesophageal echocardiography (TEE)
Most common predisposing risk factor for aortic dissection
Uncontrolled HTN
Ddx in patients w/ new AR murmur & acute chest pain
Proximal aortic dissection
Type __ dissections usually present as ripping chest pain. Hypotension is possible d/t tamponade
Type A
Type __ dissections usually present as back pain. They result in asymmetric blood pressure in the LE, refractory HTN d/t renin secretion or paraparesis
Type B
Test with sn but poor sp, hence helpful in ruling out dissection
D-dimer
Diagnostic test of choice for aortic dissection
CT angiogram
Goals of tx for aortic dissection
SBP 100-120 & HR <60 bpm
(esmolol used)
Most common site of acute arterial embolism
bifurcation of common femoral artery
6 Ps of acute arterial occlusion
Pain
Pallor
Paresthesias
Pulselessness
Paralysis
Poikilothermia
Finding seen in doppler UTZ for acute arterial occlusion
uni/ biphasic (N: triphasic)
Test used to differentiate thromboembolism vs thrombosis
Arteriography
Treatment for acute thromboembolism
Heparin + Fogarty Catheter embolism
Tx for thrombosis-in-situ with limb-threatening ischemia
Heparin + embolectomy + bypass grafting
Tx for arterial thrombosis w/o limb-threatening ischemia
Heparin +/- thrombolysis
Clinical dx made in px presenting w acute pain in a pulseless extremity
Limb-threatening ischemia
Virchow triad in DVT
vessel wall damage
venostasis
hypercoagulable state
Pain in calf or posterior knee with passive dorsiflexion of foot
Homans sign
Massive iliofemoral thrombosis causing acute, massive edema d/t venous insufficiency, severe pain & cyanosis
Phlegmasia cerulean dolens (painful blue leg)
Massive iliofemoral thrombosis causing arterial spasm and a swollen, pale leg
Phlgemasia alba dolens (painful white leg)
Criteria used to establish dx of DVT (score >3 indicates high pretest risk)
Wells
Study of choice in DVT
Duplex ultrasound (95% sp/sn)
Test that indicated presence of a clot within the past 72 hours
D-dimer
Gold standard for dx of DVT
Venography
Tx for DVT
Immediate anticoagulation
(LMW heparin needs dose adjustment in renal failure)
Most common source of pulmonary embolism
thrombus in the LE deep venous system
In PE, the MC complaint is dyspnea but the symptom w strongest association is:
Hemoptysis
ECG changes in PE involves any evidence of R heart strain
S1 Q3 T3 pattern (S in lead I + Q wave in lead III + T wave inversion in lead III)
CXR finding in PE where there is pleural-based, wedeg-shaped density indicating infarcted lung
Hampton hump
CXR finding with dec vessel markings distal to embolus (oligemia)
Westermark sign
