Lecture 21: Diseases of Aorta/Blood Vessels

Question 1

What is the most advanced manifestation of atherosclerotic disease?

Answer 1

Atheromatous embolizaton

Question 2

Two most common manifestations of atheromatous embolizaton

Answer 2

Livido reticularis and digital ulcers/gangerene

Question 3

Define aortic aneurysm

Answer 3

1.5x increased diameter (>3 cm) of aorta, typically between renal arteries and bifurcation

Question 4

Thoracic aortic aneurysm associated with…

Answer 4

Genetic diseases and valvular issues

Question 5

Abdominal aortic aneurysm associated with…

Answer 5

Traditional CV risk factors (atherosclerosis)

Question 6

Symptoms of aortic aneurysm (2). Can be…Dilation size for rupture risk and % survival if rupture

Answer 6

Pain, compression of adjacent structures; asymptomatic; >5 cm; 50%

Question 7

Define aortic dissection

Answer 7

Inherent weakening of wall leads to a tear in the wall layers

Question 8

Causes of aortic dissection

Answer 8

Genetic (Marfan’s), inflammatory arteritis, increased wall stress (drugs, trauma)

Question 9

Types of aortic dissection

Answer 9

A: tear into ascending aorta; B: after left subclavian artery

Question 10

Presentation of aortic aneurysm (5)

Answer 10

Acute pain, hemodynamic instability (type A), discrepant blood pressures, renal failure (if block), extremity pain/paralysis (if extends into legs)

Question 11

Define peripheral artery disease. Prevalence? Who gets it?

Answer 11

Atherosclerosis of aorta, iliac, lower extremity arteries; >15% in >55 years of age; associated with smoking and DM

Question 12

Two main clinical manifestations of PAD

Answer 12

1. Intermittent claudication (pain on exertion); 2. Critical limb ischemia (most severe manifestation: pain/parasthesia at rest)

Question 13

Do people with PAD always have symptoms?

Answer 13

Nope

Question 14

Where do symptoms of PAD develop?

Answer 14

One segment below blockage

Question 15

Where is the most common vessel to be blocked in PAD?

Answer 15

Femoro-popliteal

Question 16

What level is associated with DM or kidney disease?

Answer 16

Tibial-peroneal

Question 17

Symptoms of critical limb ischemia (5)

Answer 17

Rest pain, ischemic ulcerations, gangrene, elevation pallor, dependent rubor

Question 18

What is ABI? What is normal? Is obstruction less or more?

Answer 18

Ankle-Brachial Index = highest ankle systolic BP / highest brachial systolic BP; normal = 0.9 - 1.4, obstruction decreases ratio (

Question 19

Describe changing arterial pulse volume waveforms with increasing disease

Answer 19

Loss of dichrotic notch –> flattened peak, parvus and tardus –> severely flattened

Question 20

How can you find the level of the PAD?

Answer 20

Measure blood pressure along leg and find where drop occurs (segmental pressure)

Question 21

Can you use imaging to detect PAD?

Answer 21

Yes! MR and CT

Question 22

How do we decrease cardiac events and death with PAD? (lifestyle changes and meds = 5)

Answer 22

Stop smoking, control BP, control lipids, antiplatelet therapy, exercise, control diabetes

Question 23

How do we improve symptoms of PAD?

Answer 23

Walking program (walk to pain –> rest), pharma therapy (cilostazol), revascularization

Question 24

Reasons for acute arterial occlusion (6)

Answer 24

1. In-situ thrombosis, 2. Embolism, 3. Arterial trauma, 4. Vasculitis, 5. Hypercoagulable, 6. Severe venous thrombosis

Question 25

Symptoms of acute limb ischemia and mnemonic

Answer 25

6 P’s: pulseless, pain, paralysis, parasthesia, pallor, poikilothermia

Question 26

ALI management

Answer 26

Depends on extent of damage to tissue (from no immediate threat –> amputation)

Question 27

What is Buerger’s Disease: definition, symptoms, patients who get it

Answer 27

Segmental inflammation of medium-sized arteries and veins involving two or more limbs; TRIAD: superficial thrombophlebitis, Raynaud’s, distal arterial occlusion; associated with older men and tobacco use (essential)

Question 28

Raynaud’s: stage 1

Answer 28

Pallor

Question 29

Raynaud’s: stage 2

Answer 29

Cyanosis

Question 30

Raynaud’s: stage 3

Answer 30

Rubor

Question 31

What brings on Reynaud’s?

Answer 31

Cold exposure, emotional triggers

Question 32

Primary Raynaud’s…

Answer 32

Bilateral, 2 years, without cause, young females, doesn’t worsen

Question 33

Virchow’s triad

Answer 33

Stasis, vessel wall injury, hypercoaguability = thrombosis

Question 34

Symptoms of venous thrombosis (4)

Answer 34

Leg pain, swelling, erythema, palpable cord

Question 35

What is Phlegmasia Cerulea Dolans?

Answer 35

Turgid, blue, painful leg –> life and limb threatening emergency

Question 36

What is chronic venous insufficiency?

Answer 36

Incompetent valves that do not allow for normal venous return to heart

Question 37

More likely to get a PE with what kinda veins?

Answer 37

Proximal DEEP veins over distal MUSCULAR veins

Question 38

Symptoms of PE (5)

Answer 38

SOB, chest pain, hemoptysis, tachycardia, hypoxia

Question 39

What does a massive PE cause?

Answer 39

RV strain

Question 40

Treatment of chronic venous insufficiency. This could prevent what complication?

Answer 40

Compression stockings (to MAINTAIN edema control); lipodermatosclerosis