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Cardiovascular > Hypotension, Aneurysms, Varicose Veins, Dissection > Flashcards

Hypotension, Aneurysms, Varicose Veins, Dissection Flashcards

1
Q

What is aortic dissection associated with?

A 
HTN
Trauma 
Bicuspid aortic valve 
Marfans/ Ehlers 
Pregnancy 
Syphilis 
Males 60-80
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2
Q

S+S aortic dissection

A

Severe radiating chest pain
Tearing/ ripping pain
Aortic regurg
Varying pulse

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3
Q

Investigations for ?aortic dissection

A

ECG
CT angiogram - diagnosticUSS if urgent
CXR - widened mediastinum, larger aortic knuckle, pleural effusion, deviated trachea
ECHO (TOE)

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4
Q

Management of type A aortic dissection

A

Keep systolic 100-120

Needs surgery

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5
Q

Management of type B aortic dissection

A

Conservative management

Reduce BP - labetalol

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6
Q

Complications of aortic dissection

A

Backward tear - aortic incompetence/ regurg

Forward tear - unequal arm pulses/ BP

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7
Q

What is aortic dissection?

A

Tear in intimal layer of aortic wall, causing blood to flow between tunica intima + media
Progressing distally = anterograde
Progressing proximally = retrograde

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8
Q

What is the DeBakery classification?

A

For aortic dissection
Type 1- originates in the ascending aorta and propagates at least to the aortic arch
Type 2- confined to ascending aorta
Type 3 - originates distal to subclavian artery in the descending aorta

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9
Q

What is the stanford classification?

A

For aortic dissection
Group A- DeBakey 1+2 (ascending aorta +/- aortic arch/descending aorta)
Group B- DeBakey 3 (no involvement of ascending aorta)

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10
Q

What is an aneurysm?

A

Artery with dilatation >50% of its original diameter

AAA: >3cm dilatation

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11
Q

True vs false aneurysms

A 
True = abnormal dilatations involving all of wall
False = only involves adventitia
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12
Q

Investigations for ?AAA

A

USS to diagnose

CT with contrast if >5.5cm

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13
Q

Medical management of AAA - what is it + when is it appropriate

A

If AAA asymptomatic + <5.5cm
Monitor via duplex USS (3-4cm = yearly, 5-5.4cm 3 monthly)
Reduce CV RF

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14
Q

Surgical management of AAA

A

If >5.5cm, expanding >1cm per year or symptomatic
Open or endovascular repair
Disqualified from driving if >6.5cm

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15
Q

UK screening for AAA

A

Abdo USS for men in 65th year

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16
Q

Classical features of ruptured AAA

A

Flank/ back pain, hypotension, pulsatile abdo massVomiting, syncope

17
Q

Management of ruptured AAA

A

Crossmatch, treat shock but keep BP <100, surgery

18
Q

What is the definition of postural hypotension?

A

Drop of greater than 20 systolic

19
Q

Causes of postural hypotension

A

Venous pooling: severe varicose veins, prolonged standing
Impaired tone: diabetic neuropathy, Shy-Drager syndrome
Reduced tone: prolonged bed rest
Hypovolaemia: dehydration, exsanguination
Drugs: hypotensive agents, levodopa
Addisonian disease: Addisons, hypopituitarism, abrupt cessation of steroids

20
Q

Pathology of aneurysms

A

Degradation of elastic lamellae, leukocytic infiltrate, enhanced proteolysis + smooth muscle cell loss

21
Q

What is the normal diameter of the aorta?

A

2cm

22
Q

RF for AAA

A 
Fam hx
Males
Increasing age 
HTN
COPD
Hyperlipidemia
23
Q

How does an unruptured AAA present?

A

Incidental finding on examination of scans
Pain in back, abdo, loin or groin
Pulsatile abdo swelling
Distal embolisation producing features of limb ischaemia
Ureterohydronephrosis
Retroperitoneal fibrosis

24
Q

Types of AAA surgical repair

A 
Open repair 
Endovascular repair (using stent-graft system)
25
Q

What are varicose veins?

A

Dilated, tortuous superficial veins, an indication of lower extremity venous insufficiency

26
Q

Pathology of varicose veins

A

Caused by incompetent valves in affected vein, causing reflux of blood + high venous pressure

27
Q

RF for varicose veins

A 
Increasing age
Fam hx 
Females 
Pregnancy
Obesity
Prolonged standing or sitting 
Hx of DVT
28
Q

S+S of varicose veins

A

Pain, aching, discomfort, swelling, heaviness, itching

29
Q

Complications of varicose veins

A

Bleeding, thrombophlebitis, DVT, venous skin changes, ulceration

30
Q

Management of varicose veins

A

Lifestyle advice, elevate legs and avoid sitting/ standing for long periods
Refer to secondary care
Consider compression stockings

Cardiovascular (15 decks)

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