Lecture 2 - Cardio Vascular

Question 1

What are some Common Presenting Complaints of patients with vascular problems due to the heart?

Answer 1

Chest Discomfort
Breathlessness
Palpitation
Pre-syncope/syncope
Peripheral Oedema
Limb Pain

Question 2

What are some examples of Peripheral Arterial Disease?

Answer 2

Acute ischemia
Chronic ischemia
Raynaud’s Phenomenon

Question 3

What are some examples of Peripheral Venous Disease?

Answer 3

DVT
Varicose Veins
Chronic Venous Insufficiency

Question 4

What are some Red Flags for Limb Pain ?

Answer 4

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)

Question 5

What is Acute ischemia is characterised by?

Answer 5

Sudden, Severe Limb Pain 
Generalised pain
Weak/absent pulse
Coolness
Pallor
Delayed capillary refill

Question 6

What are the 6 P’s of Acute Ischemia?

Answer 6

Painful (becoming painless)
Parasthesia
Paralysed
Pale
Pulseless
Perishing cold

Question 7

What is Sub Acute Limb Pain?

Answer 7

Limb pain that may have been going on for some time

Question 8

Give some examples and their characteristics of Sub Acute Limb Pain.

Answer 8

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

Question 9

Peripheral arterial disease is often suggested by …….

Answer 9

Intermittent Limb Pain

Question 10

What are some consequences of PAD?

Answer 10

Chronic skin changes:
Atrophy 
Hair loss
Pale colour
Ulceration

Question 11

How does prolonged hypertension damage organs?

Answer 11

Through arteriosclerosis. (degeneration of arteries by thickening of vessel walls and accumulation of Ca causing loss of elasticity and blood flow)

Question 12

What is the difference between hypertensive emergency and hypertensive urgency?

Answer 12

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

Question 13

Why is DVT an important pathology to be aware of?

Answer 13

Can be life threatening due to potential pulmonary embolism

Question 14

What are some risk factors of DVT?

Answer 14

Immobility (Recent surgery, Bed rest, Prolonged travel)
Age > 60 years
Pregnancy
Obesity
Malignancy
Thrombophilia
Personal or family history of venous thromboembolism
Oral contraceptives 
HRT

Question 15

How is TIA different from ischemic stroke ?

Answer 15

• Neurological deficits usually begin suddenly then resolve completely
• Much shorter duration, last < 5mins but can
  last up to an hour

Question 16

How do we determine when to refer a patient who had TIA and may be at risk of a stroke?

Answer 16

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

Question 17

Describe the TIA Risk chart

Answer 17

(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)

Question 18

What are some stroke symptoms ?

Answer 18

Face droop
Arms weak
Speech difficulty

Question 19

What could be some symptoms of an AAA?

Answer 19

Steady, deep, boring, visceral pain in the lumbosacral area

Question 20

How large does the diameter of the aorta need to be to be classified as AAA?

Answer 20

≥ 3cm

Question 21

How could you cause yourself to have an AAA?

Answer 21

Often after isometric strain (e.g. lifting)

Always consider AAAs in elderly patients with sudden-onset back/abdominal pain

Question 22

What is Raynaud’s Phenomenon ?

Answer 22

An exaggerated vasomotor response in response to cold or emotional stress

Question 23

Describe the development of Raynaud’s Phenomenon

Answer 23

1. Exposure to cold, fingers turn white due to digital arterial spasm
2. Fingers turn blue (cyanotic) as blood becomes desaturated
3. On rewarming, fingers turn red due to reactive hyperaemia – causing pins and needles

Question 24

What causes Chronic Venous Insufficiency ?

Answer 24

History of DVT
Valvular insufficiency
Decreased muscle contraction

Question 25

What are the consequences of prolonged venous hypertension?

Answer 25

Tissue oedema
Inflammation
Hypoxia
Advanced signs include stasis dermatitis and ulcers

Question 26

What causes lymphedema?

Answer 26

Obstruction or destruction of lymph vessels due to factors such as:

• surgery
• radiation therapy
• trauma
• obstruction by a tumour

Question 27

Describe the 3 stages of oedema in lymphedema.

Answer 27

Stage 1
Oedema is pitting, and the affected area often returns to normal by morning.

Stage 2
Oedema is non-pitting, and chronic soft-tissue inflammation causes early fibrosis.

Stage 3
Oedema is brawny and irreversible, largely because of soft-tissue fibrosis.