Peripheral Arterial Diseases Flashcards
True or False: Atherosclerotic Peripheral Arterial Disease (PAD) and Coronary Arterial Disease (CAD) are the same: smoking, diabeetus, dyslipidemia, and HTN.
True
What causes the injury in PAD?
ischemia from reduced blood flow
Since ischemia can happen in PAD, what is the type of necrosis that can form as a result of ischemia?
Gangrene
What is the term when pain that is exeasterbated by walking and relived by rest (a common sign of PAD)?
Claudication
Where is the area of claudication if you have stenotic distal aorta or iliac arteries?
butt, hips, thighs, or calves
Where is the area of claudication if you have stenotic femoral or popliteal arteries?
calves
Where is the area of claudication if you have stenotic subclavian or axillary artieries?
arms
What is the first thing you should check if you suspect PAD?
Pulses
What is the next vital sign u should take on the arms and ankles?
BP
How much lower is the BP from the ankles to the arms to indicate PAD?
0.9
What class of drugs can u give for the Tx for PAD?
antiplatelets and ASA
What is the drug u can give to increase exercise capacity in PAD?
Cilostazol
What is the drug u can give to treat the claudiaction in PAD?
Pentoxifylline
This is the condition where emboli or thrombi break off and lodge in an artery somewhere else in the body.
Acute arterial occlusion
What are the 5 P’s for the Sx for AAO?
Pain, pallor, paralysis, paresthesias, and pulselessness
This is the condition marked by granulomatous vasculitis of medium/larger vessels and weakness in pulses.
Takayasu arteritis
Where is the granulomatous vasculitis typically located to cause Takayasu arteritis?
aortic arch branch pooints
Who does Takayasu arteritis typically involve?
Young asian women
aka ella baek
What is elevated on lab values for takayasu arteritis?
ESR
This condition occurs in females > 50, has granulomatous vasculitis, and typically afects the carotid and temportal arteries.
Giant cell arteritis
Where is the claudication in giant cell arteritits?
awesome typo. not fixing
Jaw
What things must u do to Dx giant cell arteritis?
biopsy of a long piece of the vessel and see giant cells with intimal fibrosis
What is a big complication of giant cell artertiis?
blindness (opthalmic artery can be involved)
Is the ESR elevated or dperessed in giant cell arteritis?
Elevated
This is the condition where there is necorsis of medium vessels, involving gangene, and autoamputation of the fingers and toes.
Tromboangiitis Obliterans (Buerger’s disease)
What is the biggest risk factor for Buergers disease?
smoking
What is the triad of Sx for Thromboangiitis Obliterans?
- disteal arterial occlusion
- raynauds
- migrating superficial bein thrombophlebitis
What is the most important treatment for Buergers disease?
Smoking cessation
What is the color change in Raynauds when someone is exposed to stress or cold?
white –> blue (cyanosis) –> red (hyperemia)
This form of Raynauds is when you women gets vasoconstriction in repsonse to cold or emotional stress, and can sometimes lead to fibrotic changes and mild crap like that.
Primary raynauds
What conditions give vascular insufficiencies that can leads to raynauds (which is a good warning sign of these diseases)?
SLE, scleroderma, Buergers, or atherosclerosis
These 2 diseases cause Ag-Ab complexes, which cause vasculitis.
SLE and polyarteritis nodosa
What type of reaction can cause this same Ab-complement vaculitis?
Drug hypersensitivity
What class of infections can cause vasculitis?
Viral
What % of people with polyartertitis nodosa have an underlying hep B infection?
30%
remember the HBsAg can cause type III hypersensitivity rxns through immune complexes????
These are a group of autoantibodies that are directed against enzymes of neutrophils primary granules, monocyte lysosomes and endothelial cells.
ANCAs
What does the “p” and “c” mean in p-ANCA and c-ANCA?
perinuclear or cytoplasmic
Which 2 conditions have a + MPO-ANCAs?
microscopic polyangiitis + churg-strauss
Wegeners granulomatous has what type of + ANCA?
+ PR3-ANCA
Which immune cell is the mediator to giant cell arteritis?
T cell
Which layer of the vessel thickens in giant cell arteritis?
intima
Thickening of the intima in giant cell arteritis causes what problem with the lumenal diameter?
gets smaller
What is the DOC for giant cell arteritis?
corticosteroids
This is the condition where there is systemic vasculitis of small or medium sized muscular arteries, typically in the renal and visceral vessels.
Polyarteritis nodosa
What is the damage done to the small and medium sized arteries in polyarteritis nodosa?
segmental TRANSMURAL necrotizing inflammation
Weakening of the arterial walls can lead to what condition as a result of polyarteritis nodosa?
aneurysms
What type of necrosis is seen with polyarteritis nodosa?
fibrinoid
What age of people geet polyarteritis nodosa?
young adults
What are the clinical Sx to polyarteritis nodosa?
malaise, fever, wt loss, HTN, abd pain + melena, muscle aches and peripheral neuritis
What is the DOC for polyarteritis nodosa?
corticosteroids + cyclophosphamide
Case: a 3 year old male presents with acute febrile illness, edema of the hands and feet, erythema of the hands, and cervical lymph node enlargement. What type of autoimmune rxn is he having?
Kawasaki syndrome (mucocutaneous lymph node syndrome)
Which arteries are especially important (and loved) by Kawasaki, which cause an MI by rupture or thrombosis?
Coronary arteries
How much of the vessel is thickened in Kawasaki syndrome as a result of the pronounced autoimmune inflmamation?
The entire vessel
What are the 2 drugs u can give for the Tx of Kawasaki syndrome?
IVIG + ASA
This is the condition where there is necrotizing vasculitis affecting the capillaries, arterioles, and venules.
microscopic polyangiitis
In microscopic polyangiitis, which ANCA’s are usually implicated?
MPO-ANCA’s
True or False: in microscopic polyangiitis, most lesions are pauci-immune (do not have immune complexes).
True!
What type of necrosis forms in microscopic polyangiitis?
Fibrinoid
true or false: in microscopic polyangiitis, there is usually granulomatous inflammation assocated with the fibrinoid necrosis.
FALSE. usually there is no granulomatous inflmmation
What are the clinical Sx of microscopic polyangiitis?
hemoptysis, hematuria, proteinuria, bowel pain or bleeding, muscle pain or weakness, and palpable cutaneous purpura.
What are the 2 drugs u can give for the Tx of microscopic polyangiitis?
cyclophosphamide + steroids
This is the condition where there is acute necrotizing granulomas of the upper or lower respiratory tract, necrotizing granulomatous vesculitis of the airway, AND focal necrotizing crescentic glomerulonephritis.
Wegeners
What type of hypersensitivity reaction is Wegeners?
T-cell mediated
93% of wegeners pts have which + ANCA?
PR3-ANCA
The granulomas that form in the airways in Wegeners have what pattern of necrosis?
Central necrosis with accompanying vasculitis
What is the early and late mophology of the renal lesions in Wegeners?
Early- focal necrosis with thrombosis
Late- diffuse necrosis + parietal cell proliferation form crescents
What are the 3 drugs used to treat Wegeners?
Steroids, cylophosphamide and TNF-antagonists
What forms in the medium and small vessels in Buergers?
Microabscesses
This is localized arteritis caused by direct invasion of infectious agents.
Infectious vasculitis
In infectious vascultiis, the infections can weaken arterial walls and form what type of aneurysms?
Mycotic aneurysms (remember??)
