Lecture 2 - Cardio Vascular Flashcards
(27 cards)
What are some Common Presenting Complaints of patients with vascular problems due to the heart?
Chest Discomfort Breathlessness Palpitation Pre-syncope/syncope Peripheral Oedema Limb Pain
What are some examples of Peripheral Arterial Disease?
Acute ischemia
Chronic ischemia
Raynaud’s Phenomenon
What are some examples of Peripheral Venous Disease?
DVT
Varicose Veins
Chronic Venous Insufficiency
What are some Red Flags for Limb Pain ?
Sudden, severe pain
Dyspnea
chest pain
Diaphoresis
Crepitation, tenseness, foul discharge, bullae, necrosis
Risk factors for deep vein thrombosis
Neurologic deficits
Signs of acute limb ischemia (e.g., coolness, pallor, pulse deficits, delayed capillary refill)
Signs of systemic toxicity (e.g., delirium, tachycardia, shock, pallor)
What is Acute ischemia is characterised by?
Sudden, Severe Limb Pain Generalised pain Weak/absent pulse Coolness Pallor Delayed capillary refill
What are the 6 P’s of Acute Ischemia?
Painful (becoming painless) Parasthesia Paralysed Pale Pulseless Perishing cold
What is Sub Acute Limb Pain?
Limb pain that may have been going on for some time
Give some examples and their characteristics of Sub Acute Limb Pain.
Sub Acute Limb Pain usually has inflammation: Redness Tenderness Swelling Warmth
Examples:
- Cellulitis:
Specific/localised symptoms , patient looks unwell due to infection.
- DVT :
General, circumferential swelling
may not present with redness or warmth – it may even be asymptomatic
Peripheral arterial disease is often suggested by …….
Intermittent Limb Pain
What are some consequences of PAD?
Chronic skin changes: Atrophy Hair loss Pale colour Ulceration
How does prolonged hypertension damage organs?
Through arteriosclerosis. (degeneration of arteries by thickening of vessel walls and accumulation of Ca causing loss of elasticity and blood flow)
What is the difference between hypertensive emergency and hypertensive urgency?
Hypertensive emergency:
Evidence of end-organ damage (e.g. coronary ischemia, disordered cerebral function, cerebrovascular events, pulmonary oedema and renal failure. Rapid rise of BP
Hypertensive urgency
No evidence of end-organ damage
BP should be lowered more slowly, but patients still need to be assessed rapidly
Why is DVT an important pathology to be aware of?
Can be life threatening due to potential pulmonary embolism
What are some risk factors of DVT?
Immobility (Recent surgery, Bed rest, Prolonged travel) Age > 60 years Pregnancy Obesity Malignancy Thrombophilia Personal or family history of venous thromboembolism Oral contraceptives HRT
How is TIA different from ischemic stroke ?
- Neurological deficits usually begin suddenly then resolve completely
- Much shorter duration, last < 5mins but can
last up to an hour
How do we determine when to refer a patient who had TIA and may be at risk of a stroke?
By using the risk chart - If a patient has 4 or more points they are at an increased risk of a stroke, so they need to be referred immediately
Describe the TIA Risk chart
(ABCDD)
Age:
60 years (+1 point)
Blood Pressure:
≥140/90 (+1 point)
Clinical Features: Unilateral weakness (+2 points) Speech disturbance without weakness (+1 point)
Duration of symptoms: ≥60 minutes (+2 points) 10-59 minutes (+1 point)
Diabetes mellitus: (+1 point)
What are some stroke symptoms ?
Face droop
Arms weak
Speech difficulty
What could be some symptoms of an AAA?
Steady, deep, boring, visceral pain in the lumbosacral area
How large does the diameter of the aorta need to be to be classified as AAA?
≥ 3cm
How could you cause yourself to have an AAA?
Often after isometric strain (e.g. lifting)
Always consider AAAs in elderly patients with sudden-onset back/abdominal pain
What is Raynaud’s Phenomenon ?
An exaggerated vasomotor response in response to cold or emotional stress
Describe the development of Raynaud’s Phenomenon
- Exposure to cold, fingers turn white due to digital arterial spasm
- Fingers turn blue (cyanotic) as blood becomes desaturated
- On rewarming, fingers turn red due to reactive hyperaemia – causing pins and needles
What causes Chronic Venous Insufficiency ?
History of DVT
Valvular insufficiency
Decreased muscle contraction