Peripheral Vascular/Arterial Dz Flashcards
bacteria causing Acute rheumatic fever
Group A streptococcus
What does acute rheumatic fever occur after
s. pyogenes pharyngitis
Diagnosis for Acute rheumatic fever
Jones critera (2 major or 1 major plus 2 minor and evidence of preceding S. pyogenes infection), antistryptolysin O titer, CRP, sed rate
Major manifestations of Acute Rheymatic Fever
SPECCial- subcutaneous nodules, polyarthritis, erythema marginatum, (Sydenhams) chorea, carditis
Minor manifestations of ARF
Fever, arthralgia, elevated ESR or CRP, EKG evidence of prolonged PR interval
Tx of ARF
TREAT STREP PHARYNGITIS. High dose salicylates, steroids
What is giant/temporal cell artiritis
vasculitis affecting large/medium arteries of head
cause of temporal cell arteritis
unknown, but most likely immune mediated
Patient presents with temporal headache that is bilateral, jaw pain, tongue hurts as well, and has been having difficulty seeing. complains of double vision. What are you suspicious of?
Giant/temporal cell arteritis
Patient presents with sandpaper like rash on stomach and polyarthritis. Also has fever, elevated ESR, and prolonged PR interval seen on EKG. What are you suspicious of?
ARF- check for evidence of preceding S. pyogenes infection with positive throat swab or raised antistreptolysin O titer
Diagnosis of temporal cell arteritis and tx
Biopsy with giant cells. Tx- long term corticosteroid- good prognosis with treatment
How much does aorta dilate in aortic aneurysm
dilation of aorta 1.5x its normal size
aortic aneurysm locations
aortic root aneurysm, thoracic aortic aneurysm, abdominal aortic aneurysm
symptoms in Aortic aneursym
ptnts asymptomatic until rupture
risk factors of aortic aneurysm
vascular disease, hypertension, dyslipidemia, tobacco abuse, marfan syndrome, ehlers-danlos
Diagnosis of aortic aneurysm
contrast CT, ultrasound
when is surgery indicated in aortic aneurysm
if rupture occurs. Or if AAA> or equal to 5.5 cm.
types of surgery in aortic aneurysm
open vs. endovascular repair
layers of tissue in aorta
tunica intima, media, and adventitia
aortic dissection
tear in inner wall of aorta causing blood to flow between muscular layers of tunica media, forcing layers apart
Patient presents with severe ripping/teraing with radiation to the back, HTN, tamponade, dyspnea, chest pain. Diagnosis?
aortic dissection
Diagnosis of aortic dissection
CXR- widening mediastinum, contrast CT, MRA (gold standard)
Classification of aortic dissection
Stanford A- proximal and Stanford B- distal. Stanford A- Debakey Type I and II. Stanford B- Debakey Type III
Debakey classification in aortic dissection
Debakey I includes ascending and descending aorta. Debakey II includes ascending only. Debakey Type III includes descending aorta only (distal Stanford B)
tx of aortic dissection
blood pressure control, BB, CCB. Type A- surgical repair. Type B- medical management
Patient presents with itching, hyperpigmentation, varicose veins, chronic edema. History of DVT. diagnosis and tx?
Venous insufficiency. conservative tx- massage, compression stockings, elevation. aggression- peripheral intervention
Most important tx in peripheral vascular disease
smoking cessation
45 year old patient presents with diabetes and HTN. Has been complaining of leg symptoms upon exertion, ischemic rest pain, and diminished pulse intensity. Suspicious of…
PAD
Patient 60 years old with atherosclerosis risk factor. What must you evaluate to r/o PAD?
Hx of walking impairment, claudication, and ischemic rest pain. Check pulses and rank 0-3.
5 different presentations of patients with PAD
Asymptomatic, classic claudication, atypical leg pain, critical limb ischemia, and acute limb ischemia
classic claudication symptoms
lower extremity symptoms most consistent upon exercise but relief with rest
atypical leg pain in PAD
lower extremity discomfort that occurs with exertion, but also at rest sometimes.
critical limb ischemia in PAD
leg pain even at rest, nonhealting wound, gangrene
acute limb ischemia
the five P’s- pain, pulselessness, pallor paresthesias, paralysis
Hemodynamic non-invasive tests in PAD
Resting ankle-brachial index, exercise ABI, segmental pressure examination, and pulse volume recordings
ABI
Ankle-brachial index= lower extremity systolic pressure/brachial artery systolic pressure
how sensitive and specific is ABI
sensitivity is 95%, specificity for PAD is 99%
Patient presents with exertional leg symptoms, nonhealing wounds, age 75, hx of smoking in diabetes. RIsk of…
PAD…High risk of CV ischemic events
which test assesses the funcitonal severity of claudication in PAD
exercise ABI
Arterial duplex ultrasound test useful in diagnosing PAD in that it
is useful to diagnose anatomic locations and degree of stenosis in PAD. Used to select candidates for endovascular intervention, surgical bypass, select sites of surgical anastomosis
Meds for PAD
Statin - to achieve target LDL cholesterol of less than 100 mg/dl. If hypertensive, add hypertensive meds. If atherosclerotic, add antiplatelet therapy, supervised exercise rehabilitation, revascularization
antiplatelet therapy in patients with atherosclerotic lower extremity PAD
ASA (75-325 mg) or Clopidogrel (75 mg/day)
supervised exercise rehabilitation in PAD
30-45 minutes 3 times per week for a minimum of 12 weeks
PAD patients with intermittent claudication
Cilostazol 100 mg PO twice a day- improves symptoms and increases walking distance (in absence of HF)
revascularization in patients with PAD
endovascular repair with stent/ballooning or surgical repair with bypass
PAD increases the risk of…
CAD, stroke, MI
