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UM - Cardiovascular Conditions > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

Define aneurysm

A

Abnormal stretching in the wall of an artery, vein or heart w/diameter of 50% greater than normal

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2
Q

How is an aneurysm named?

A

According to the site of the aneurysm

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3
Q

What are risk factors to having an aneurysm?

A

CAD (atherosclerosis), HTN, Age > 60, Smoking, Male, Family History

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4
Q

Can an aneurysm be asymptomatic? If no, what are symptoms?

A

Yes it can be, but it also has symptoms:
- Aortic regurgitation
- abrupt/severe chest, abdomen, back, or flank pain
- pulsating mass in abdominal aorta
- numbness in LE
- MI, CVA, paraplegia, renal failure
- Excessive fatigue w/walking
- poor distal pulses
- LBP, increased BP and blood in urine = renal A Aneurysm

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5
Q

What are common locations for an aneurysm?

A

Abdominal aortic
Thoracic aortic
Cerebral

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6
Q

Which type of aneurysm is a hole in the tunica intima and media, but not the adventitia?

A

pseudoaneurysm

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7
Q

which type of aneurysm forms a sac off of the main artery?

A

Saccular

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8
Q

which type of aneurysm is an enlargement of the entire artery?

A

Fusiform

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9
Q

What is a dissecting aneurysm?

A

When you remove the aneurysm while still keeping the integrity of the artery as best as they can

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10
Q

What is the onset of an aneurysm?

A

Onset: Gradual (if it is fast, likely a pseudoaneurysm)

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11
Q

What is the course of an aneurysm?

A

Incidents typically increase w/increasing age

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12
Q

What is the prognosis of an aneurysm?

A

Depends on the size & sx:
- small = better prognosis
- larger sx = increased chance of complications
- large and not diagnosed = may lead to death

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13
Q

What are some medical tests that can be done for an aneurysm?

A

*Ultrasound
Radiographs
MRI/CT
Doppler Imaging

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14
Q

What is the pharmacological management of an aneurysm?

A

Statins (to keep cholesterol in check)
Beta blockers and ACE inhibitors for BP

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15
Q

List the surgeries that can be done for an aneurysm

A
  • Endovascular stent graft/coiling
  • Clipping
  • Flow diverters
  • Screens or dissections
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16
Q

What should we do if we believe we palpate an aneurysm?

A

Immediately refer to physician or ER

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17
Q

What are possible complications from an aneurysm?

A
  • A thrombus could form in the stagnant blood and could break off and impede distal flow
  • Rupture could lead to blood in retroperineum (AAA) or pleural cavity and mediastinum, leading to uncontrolled bleeding, and then circulatory collapse
  • Could continue to expand leading to a risk of rupture
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18
Q

At what size is someone a surgical candidate for aneurysm?

A

5 cm

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19
Q

What is a coil sx for an aneurysm?

A

They go in and release a coil into the artery to fill up the space so blood cannot flow into it

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20
Q

what is the risk with an endovascular stent?

A

It could fall out of place and continue to fill

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21
Q

What are possible causes of a pseudoaneurysm?

A
  • Trauma
  • Inflammation
  • Iatrogenic causes
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22
Q

What should PT Assessment do we do for Aneuyrsm?

A
  • ID risk factors
  • Vitals at rest and with activity
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23
Q

What are the signs of a rupture (aneurygsm)?

A

Tachycardia, Low BP, and severe sudden abdominal pain

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24
Q

T or F: You should avoid exercise if a patient has a small AAA

A

False - it is safe to exercise and should be encouraged

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25
Q

What is PVD based on?

A

The underlying conditions (Inflammation, arterial occlusion, venous disorders, or vasomotor disorders)

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26
Q

Is PVD primarily UE or LE?

A

LE, but can be in the UE as well

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27
Q

What are all the names for PAD?

A

Peripheral artery disease
arteriosclerosis obliterans
peripheral artery occlusive disease

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28
Q

What is PAD?

A

Atherosclerosis or arteriosclerosis closing the artery lumen

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29
Q

What are the risk factors for developing PAD?

A

Smoking
Diabetes
HTN
High cholesterol
Age
Race

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30
Q

What are the signs and symptoms of PAD?

A
  • intermittent claudication –> pain at rest if severe
  • elevated foot blanching
  • elevated then dependent slow color change
  • Dependent position turns red (rubor)
  • wound (round, distal, pale, dry, and painful)
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31
Q

What is intermittent claudication? What are the 3 criteria?

A

Aching or cramping that occurs when walking, typically at the same distance/level of activity
1) pain in a mm (calf) described as a cramp
2) only develops w/exercise
3) Disappears when exercise stops

32
Q

What is critical limb ischemia?

A

Rest pain associated w/low ABI and a non-healing wound

33
Q

What is the earliest and most frequent presenting symptom in patients w/LE PAD?

A

Intermittent claudication

34
Q

What is the Fontaine classification used for? What are the scores?

A

For PAD classification
1) Asymptomatic
2a): Intermittent claudication after >200 meters
2b) intermittent claudication before 200 meteres
3) Pain at rest
4) Ischemic ulcers or gangrene forms

35
Q

What are surgeries used for chronic critical limb ischemia?

A

Endarterectomy
Bypass
Percutaneous catheter interventions (angioplasty + stent)

36
Q

What is the most common bypass? Least common?

A

most: femoropoliteal
least: femorotibial

37
Q

What are medical tests for PAD?

A

Non-diagnostic:
- ABI
- Pulses

Other:
- arteriogram (diagnostic)
- duplex US
- CT, MRI

38
Q

What are labs for PAD?

A
  • blood glucose
  • cholesterol
  • triglycerides
  • HDL/LDL
  • hemoglobin
39
Q

What are pharmalogical interventions for PAD?

A
  • Anti-hyperlipidemic meds
  • Anti-platelet therapy (asprin, plavix)
  • Glucose control
  • Anti-hypertensiev therapy (Diuretics, Beta block, alpha adrenergic block, ACE inhib)
40
Q

What is the pharmalogical intervention for intermittent claudication?

A

Pentoxyifylline

41
Q

What is the PT assessment we can do for PAD?

A
  • Vitals
  • ABI
  • The 5 Ps
  • skin (trophic changes)
  • gait
  • balance
  • functional mobility
42
Q

What is true of BP if someone has PAD of UE?

A

SBP will be 15-20 mmHg lower in involved arm

43
Q

What are the 5Ps (For PAD?)?

A

pain
pallor
pulses
paresthesia
paresis

44
Q

What UE condition is a sign of chronic O2 deprivation from PAD?

A

Clubbing of the fingers

45
Q

What UE signs do you want to look for w/PAD?

A
  • nicotine stains
  • clubbing
  • capillary refill time
  • pulses
  • skin color
46
Q

What LE signs do you want to look for w/PAD?

A
  • color
  • hair distribution
  • Temp
  • capillary refill time
  • changes in color w/changes in leg position
  • ulcers, varicose veins, edema
47
Q

What are some measurements for circulation?

A
  • Pulses
  • Capillary refill time
  • ABI
  • Venous filling time
  • Rubor on dependency
  • Edema (sometimes)
48
Q

What is capillary refill?

A
  • rate at which blood refills empty capillaries
  • should be w/in 2-3 seconds
49
Q

What does it indicate if capillary refill time is greater than normal?

A

dehydration
shock
PVD
hypothermia

50
Q

What is the equation for ABI?

A

Systolic ankle/ systolic brachial

51
Q

How do you interpret ABI?

A

=< 0.40 = Severe PAD
0.41-0.90 = mild-moderate PAD
0.91-10.00 = borderline
1.01 -1.40 = normal
>1.40 = noncompressable artery

52
Q

What is venous filling time and what is it used for?

A

Elevate legs above heart >1 min and have pt sit up w/legs over end of bed to assess arterial flow by evaluating the time it takes the veins to refill after emptying

53
Q

How do you grade venous filing time?

A

0: <15 sec
1+: 15-30 sec
2+: 30-45 sec
3+: 45-60 sec
4+: >60 sec

54
Q

What is dependent rubor? What is it indicative of?

A

After elevating leg above level of heart, pt sits up over side of bed. Will turn white –> pink –> purple/red color
- sign of critical limb ischemia

55
Q

What is the grade system for pitting edema?

A

1+ (trace): slight depression
2+ (mild): 0.0-0.06 cm w/rebound <15 sec
3+ (Moderate): 0.06-1.3 cm w/rebound 15-30 sec
4+ (severe): 1.3-2.5cm w/rebound >30 sec

56
Q

What is the onset and course of PAD?

A

Gradual

57
Q

What is the prognosis for PAD?

A

Higher risk CAD
Higher risk amputation
Revascularization and stents may help

58
Q

List the OM used for PAD

A
  • ACD
  • ICD
  • self-reported walking limitations
  • peak VO2
  • QOL Questionnaire
  • 6MWT
59
Q

What is the maximal walking time absolute claudication distance (ACD)?

A

The longest amount of time and distance a person can go with pain from claudication

60
Q

What is the pain-free walking time initial claudication distance (ICD)?

A

The amount of time (and distance) a person can go without pain from claudication

61
Q

What are some interventions for PAD?

A
  • meds to control risk factors
  • meds to improve caludication
  • sx
  • exercise
62
Q

What are some components of an exercise program for PAD?

A
  • 3x/week
  • => 30 minuets
  • walk until onset OR moderate pain
  • rest until subsides
  • Repeat
  • Increase grade once reach 10 minutes
63
Q

What are the types (primary and secondary) of Raynaud’s phenomenon?

A

Primary = idiopathic = no known cause
Secondary = other cause:
- connective tissue disease
- hand-arm vibration syndrome
- extrinsic vascular compression
- large vessel disease
- certain drugs
- other (hypothyroidism)

64
Q

What is the histology/etiology or raynaud’s phenomenon

A

Intermittent episodes of small artery constrictions of the extremities

65
Q

What are some risk factors of raynaud’s phenomenon?

A
  • anxiety
  • exposure to cold
  • younger women
  • smoking
  • other diseases (SLE, RA)
66
Q

What are Raynauds signs and symptoms

A
  • Color changes
  • reduced skin temperature
  • may be painful if prolonged time
  • numbness, tingling, achy pain
  • may be unilateral or bilateral
67
Q

What is the onset and course of raynaud’s phenomenon

A

Onset: 20-50 years old
Course: Lifetime

68
Q

What is the prognosis of Raynaud’s phenomenon?

A
  • prolonged may destroy tissue of the digits
  • primary vs secondary (secondary = poorer prognosis)
69
Q

What are some medical tests for Raynaud’s phenomenon?

A
  • clinical presentation
  • symptoms lasting 2 years
  • tests to rule out possible autoimmune involvement
70
Q

What is thrombiangitis Obliterans (Buerger’s Disease)

A

An inflammatory occlusive vascular disease that affects both arteries and veins that can be accompanied by thrombi or clots

71
Q

What are risk factors for Buerger’s Disease

A

Younger men
Smoker/tobacco product user

72
Q

What differential Dx do you need to do for Buerger’s disease?

A
  • arteriosclerosis oblieterans (PAD)
  • traumatic arterial thrombosis
  • popliteal arterial entrapping syndrome
  • occlusive vasculopathy due to SLE or sclerodera
  • Behcet’s disease
73
Q

What are the s/s of Thrombiangitiis Obliterans (Buerger’s Disease)

A
  • pain and tenderness of affected parts of the body (w/pain at rest)
  • episodic and segmental
  • UE or LE (but > 2limgs)
  • pain in arches of foot and palm of hand
74
Q

What is the onset and course of Buerger’s Disease

A

Insidous onset and unkown course w/possible amputation

75
Q

What is the prognosis of Buerger’s Disease

A
  • Lifetime once diagnosed, but not life threatening
  • Dependent on stopping tobacco usage
76
Q

What are some medical tests for Thrombiangitiis Obliterans (Buerger’s Disease)

A
  • arteriography
  • histological exam of blood vessles
  • doppler (thrombus threat)

UM - Cardiovascular Conditions (5 decks)

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