Peripheral Arterial and Venous Disease Flashcards
Outline deep veins
Found in the muscle
Flow aided by muscle contraction
Outline superficial veins
Found in the subcutaneous fat
Superficial veins always flow into deep veins by perforating veins, not the other way round
What is the purpose of fascia around a compartment?
When a muscle contracts it pulls the facia inward creating a -ve pressure
This aids blood flow in the veins
What are the deep veins in the leg?
- IVC
- Common iliac vein
- External iliac vein
- Femoral vein
- Popliteal
What are the superficial veins?
Long saphenous – drains into the femoral vein, anterior to the medial malleolus
Short saphenous – drains into the popliteal vein
What is the one constant vein in the body?
Long saphenous vein is ALWAYS anterior to the medial malleolus
What direction does blood flow in the aorta?
Nearly all the blood travels towards the periphery
Very small amount of blood is refracted back due to bifurcations
Does Doppler measure flow or velocity?
Velocity
Why is the velocity high in the common iliac than the aorta?
Same amount of blood flowing through a vessel that has no branches
What is the def of a varicose vein?
Tortuous twisted or lengthened vein
Vein wall is inherently weak, leads to dilation and separation of valve cusps = become incompetent
What are the symptoms of varicose veins?
Heaviness, tension, aching, itching
What are the complications of varicose veins?
Haemorrhage, thrombophlebitis (thrombosis prod inflam including pain)
Oedema, skin pigmentation (ferrous oxide), varicose eczema, lipodrmatosclerosis(hardened fat)
What causes venous ulceration?
Calf muscle failure venous hypertension venous ulcers
What causes calf muscle pump failure?
- Failure calf contraction = immobility, obesity
- Deep vein incompetence
- Volume overload
What is a retrograde circuit?
Superficial vein incompetence leading to ulceration
Valve incompetence setting up an incorrect circuit of blood flow
What is the pathophysiology of arterial vs venous thrombosis?
A = changes in lining of vessel wall
V = changes in blood flow
Why does stasis lead to venous thrombosis?
Normally stasis plus another ‘provocateur’ = oral pill, dehydration, cancer
What is natural collateral circulation?
Particularly common across joints – otherwise when flexed joint of flow would take place
Devel in response to stenosis
When there is acute ischaemia collateral circulation has no time to devel (need to reverse in 6 hours, hyperkalemia)
How does DVT present?
Calor, dolor, functio laesa, rubor, tumor
Pain, cannot walk, swelling, calf tenderness, distended warm veins
Why is surgery associated with DVT?
Immobility prior and post surgery
Surgery is trauma = body’s response includes a prothrombic state
What is acute limb ischaemia?
Impaired blood supply over period of minutes
No collateral blood devel
Commonest cause = embolism
Symp/signs = pain, paralysis, paraethesia, pallor, perishing cold, pulseless
What is fixed mottling?
Non-blanching skin
Thrombosed Hb
Outline chronic peripheral arterial disease?
Intermittent claudication = pain in muscles of lower limb elicited by walking commonly due to diseased superficial femoral artery
What are the arteries of the lower limbs?
External iliac artery
Common femoral artery (branching off – profunda femoris artery)
Superficial femoral artery
Popliteal artery
Divides into – anterior tibial artery, peroneal artery, posterior tibial artery
What is the mid-inguinal point?
Half way between ASIS and pubic synthesis
Femoral pulse felt here
What places can pulses be felt?
Femoral – mid-inguinal point
Popliteal – deep in popliteal fossa
Dorsalis pedal – lateral to extensor hallucis longus tendon
Posterior tibial – behind medial malleolus
What is critical ischaemia?
Rest pain = pain in foot at night when lying
Ulceration/gangrene
What is ischaemia?
Insufficient blood supply to cell, lack of O2, pH drops
Reversible
What are the diff types of ischaemic damage to the heart?
Unstable angina
Stable angina
MI
Outline referred pain
Visceral and somatic afferents synapse in similar place in spinal cord
Brain cant tell if pain is from skin or heart
What beats are irregularly irregular?
Ventricular/atrial ectopics
AF
What beats are regularly irregular?
2nd degree heart block
What is the cause of a bounding pulse?
Lowing of the diastolic pressure = widens pulse pressure = bounding
Why does raising the arm exaggerate a bounding pulse?
Increased pulse pressure as blood falls away more profoundly
Why is S2 normally split on inspiration?
On inspiration the chest wall moves out and the diaphragm flattens = -ve pressure = air rushes into the lungs and more blood drawn into the right side of the heart
= pulmonary valve closes after aortic valve = split second heart sound
Why are right-sided murmurs increased during inspiration?
-ve pressure = more blood drawn into the right side of the heart
Blood flowing though tricuspid and pulmonary valves increased = hear R-sided murmur better
Why are left-sided murmurs increased during expiration?
+ve pressure = more blood pushed out of the heart
More blood flowing through the mitral and aortic valve = hear L-sided murmurs better
