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CV <3 > Lecture 16: PAD Part 2 > Flashcards

Lecture 16: PAD Part 2 Flashcards

1
Q

What are the essentials of diagnosing an acute arterial occlusion of a limb?

A
  1. Sudden pain in limb + absent limb pulses
  2. Neurologic dysfunction with numbness, weakness, or complete paralysis
  3. Loss of light touch = need to revascularize within 3 hours!!!!
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2
Q

What is a thrombus?

A
  • Stable atheroma with fibrous cap ruptures
  • Hx of intermittent claudication
  • Usually collateral development is present, so not as dramatic

The actual clot on the wall.

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3
Q

What is an embolus?

A
  • Anything that is too large to pass through its vessel
  • MCC: Afib
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4
Q

What are the 6 Ps of circulation?

A
  • Pallor
  • Pain
  • Pulseless
  • Paralysis
  • Polar/Poikilothermia
  • Paresthesias

Poikilothermia = inability to regulate temperature

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5
Q

How do we diagnose an acute occlusion of a limb and what is the best imaging if light touch is compromised?

A
  1. Clinical diagnosis
  2. Doppler is first-line.
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6
Q

When is CTA/MRA primarily used in evaluating acute occlusion of a limb?

A

In the OR

Takes a while so we don’t want to do it first.

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7
Q

What is the preferred imaging study to evaluate for an embolic source after treating an acute occulsion of a limb?

A

TEE with bubble study to check for a PFO

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8
Q

How soon do we need to revascularize a symptomatic arterial thrombosis?

A

3 hours!!

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9
Q

Once we have diagnosed acute arterial occlusion, what is the first step to begin managing it?

A

A/C using IV heparin bolus

Done after doppler probably

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10
Q

What is the next step in management of a stable arterial occlusion?

A

Determining whether is it is a PAD thrombus or an embolus

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11
Q

When is a AAA palpable and what is the treatment threshold?

A
  • 80% of 5cm ones are palpable.
  • Treat at 5.5cm
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12
Q

How does an AAA present prior to rupture usually?

A

Asymptomatic

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13
Q

What are the 3 primary symptoms/signs of a ruptured AAA?

A
  • Massive abd pain radiating to the back
  • Severe hypotension
  • Palpable abdominal mass
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14
Q

When is an AAA considered an actual aneurysm?

A

Must be greater than 3 cm

Normal aorta is 2cm

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15
Q

Who is AAA MC in, and where is it MC found specifically?

A
  • Men
  • Below the renal arteries, at the aortic bifurcation
  • Often includes common iliac arteries
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16
Q

What are the primary risk factors for developing an AAA?

A
  1. Male
  2. Smoker
  3. FMHx
  4. Age
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17
Q

What are the two major groups of AAAs?

A
  1. Fusiform: Circumferential expansion of the aorta
  2. Saccular: Outpouching of a segment.
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18
Q

How do we find most AAAs?

A

Incidentally

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19
Q

What is the first presenting symptom of an AAA?

A

Abdominal pain that is mild to severe and radiating to the back

It will hurt when u press it even a little

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20
Q

Why is an AAA rupture lethal?

A

Blood into the peritoneal cavity = PAIN

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21
Q

What is the diagnostic study of choice for initial screening to detect an aneurysm?

A

Abdominal US

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22
Q

When is CT scan indicated for AAA evaluation?

A
  • When you want to treat it because it may be near the 5.5cm threshold.
  • Helps with surgical planning once you add contrast.

Once it is approximately 5cm, do a CTA

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23
Q

What scan is typically done to routinely monitor AAA growth?

A

US

24
Q

When is AAA screening recommended per the USPSTF?

2023

A
  • Single screening at 65-75 for men with ANY smoking history
  • Consider screening if they have significant family hx/risk factors even if no smoking

Recommendation grade B

25
Q

How often do you screen AAAs?

A
  • 3-3.4 = 2y
  • 3.5-4.4 = 1y
  • 4.5-5.4 = q6 months + vascular referral

Via US

26
Q

When is elective repair of an AAA indicated?

A
  • > 5.5cm
  • Rapid expansion (> 0.5cm in 6 months)
  • Extreme symptoms regardless of diameter
27
Q

What are the indications for surgery to fix AAAs or aortic inflammation?

A
  1. > 5.5cm
  2. Compression of retroperitoneal structures
  3. Pain with palpation
28
Q

What are the pros/cons of open repair vs endovascular repair of an AAA?

A
  • Open: Good long-term results, more complications and longer recovery.
  • Endovascular: Better short-term, less complications, but leaks can occur more often.
29
Q

What is the leading cause of death post-AAA repair?

A

MI

30
Q

What are the essentials of diagnosis of a thoracic aortic aneurysm?

A
  • Widened mediastinum on CXR
  • Rupture presents as sudden onset CP radiating to the back
31
Q

What is the primary underlying etiology for a thoracic aortic aneurysm? Rare etiologies?

A
  1. Primary: Atherosclerosis
  2. CT disorders like Ehlers-Danlos or Marfan
  3. Bicuspid aortic valve
32
Q

What are the common possible S/S of a thoracic aortic aneurysm?

A
  • Substernal/neck pain
  • Dyspnea, stridor, brassy cough, dysphagia
  • Distended neck veins
  • Hoarseness (left recurrent laryngeal)
  • Aortic regurg
33
Q

Why is a rupture of a thoracic aortic aneurysm catastrophic?

A

Nearly impossible to contain the bleed.

34
Q

What is the modality of choice to analyze a thoracic aortic aneurysm?

A

CT w/ con

35
Q

What are the backup imaging modalities for a thoracic aortic aneurysm?

A
  • MRA to exclude conditions that mimic thoracic aneurysms
  • Cath and echo to determine how other vessels are affected
36
Q

How large should a thoracic aortic aneurysm be to consider repair? What would make it more complicated? (location)

A
  • If it is descending: 5.5-6cm via endovascular grafting
  • Ascending/proximal is more complicated.
37
Q

What is the first step once a thoracic aneurysm is diagnosed?

A

Refer to CT/vascular surgery so they can monitor via TTE or CT chest.

38
Q

Controlling what factors is essential to lowering rupture/growth risk of a thoracic aneurysm?

A
  • Controlling BP
  • Managing risk factors (Atherosclerosis)
39
Q

What are the essentials of diagnosis of an aortic dissection?

A
  • Sudden searing chest pain radiating everywhere in a hypertensive pt
  • Widened mediastinum on CXR
  • Pulse discrepancy in extremities
  • Acute aortic regurg
40
Q

What is an aortic dissection?

A
  • Sponataneous intimal tear
  • Blood dissection into the media of the aorta
41
Q

What are the 2 aortic dissection types?

A
  • Type A: proximal to left subclavian
  • Type B: Proximal descending thoracic aorta BEYOND left subclavian

A for ascending aorta, B for beyond

42
Q

Who is aortic dissection MC in?

A

Men ):

43
Q

What are the risk factors for aortic dissection?

A
  • Age
  • Atherosclerosis
  • HTN
  • Blunt trauma
  • Aortic valve defect like AS
  • Aortic coarctation
  • Pre-existing aortic aneurysm
  • Pregnancy
44
Q

How does aortic dissection present?

A
  • Severe CP of sudden onset that radiates to the back/neck
  • Usually hypertensive
  • Disrupted perfusion to vital organs
  • Diastolic murmur resulting in regurg, HF, and tamponade
45
Q

What is typically seen on EKG for aortic dissection? CXR?

A
  • EKG: LVH
  • CXR: Widened mediastinum
46
Q

What is the immediate and modality of choice to image for suspected aortic dissection?

A

CT Chest + Abd w/ con

Low threshold if any HTN pt has CP + LVH

TEE is alternative, but longer to do than a CT

47
Q

When is BP control indicated for aortic dissection and the goal BP?

A
  • Indicated before diagnostics are completed
  • Goal: 100-120 SBP + lowering pulse pressure
48
Q

What are the first-line therapies for BP control in aortic dissection?

A
  • Labetalol
  • Esmolol (If pt may be risky to use BBs in)
  • Add-on: CCBs (Nicardipine) or nitroprusside

Esmolol has a short half-life, so it can be used to test BB tolerance.

49
Q

What is the DOC to manage the pain of aortic dissection?

A

Morphine

50
Q

When is surgery indicated for Type A or Type B dissection?

A
  • Type A: always surgery, via grafting
  • Type B: surgery if malperfusion of tissue is noted
51
Q

What are the essentials of diagnosis for thromboangiitis obliterans/Buerger disease?

A
  • Male smokers
  • Distal extremity ischemia
  • Thrombosis of superficial veins
  • SMOKING CESSATION
52
Q

What exactly is Buerger’s/thromboangiitis obliterans?

A

Segemental, inflammatory, thrombotic process seen in the small distal arteries and veins of extremities

Unique from atherosclerosis.

53
Q

Where is Buerger’s MC seen?

A

Plantar and digital vessels of the foot/leg

54
Q

What is the primary demographic of Buerger’s?

A

Male smokers > 40

55
Q

How do most people present with Buerger’s?

A
  1. Distal ischemic rest pain or ischemic ulcerations of lower extremities
  2. Superficial thrombophlebitis
56
Q

What is the main goal of testing in Buerger’s?

A

Ruling out everything else

57
Q

What is the best and only proven treatment for Buerger’s?

A

Smoking cessation

CV <3 (25 decks)

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