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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
What is PVD based on?
The underlying conditions (Inflammation, arterial occlusion, venous disorders, or vasomotor disorders)
26
Is PVD primarily UE or LE?
LE, but can be in the UE as well
27
What are all the names for PAD?
Peripheral artery disease arteriosclerosis obliterans peripheral artery occlusive disease
28
What is PAD?
Atherosclerosis or arteriosclerosis closing the artery lumen
29
What are the risk factors for developing PAD?
Smoking Diabetes HTN High cholesterol Age Race
30
What are the signs and symptoms of PAD?
- 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)
31
What is intermittent claudication? What are the 3 criteria?
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
What is critical limb ischemia?
Rest pain associated w/low ABI and a non-healing wound
33
What is the earliest and most frequent presenting symptom in patients w/LE PAD?
Intermittent claudication
34
What is the Fontaine classification used for? What are the scores?
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
What are surgeries used for chronic critical limb ischemia?
Endarterectomy Bypass Percutaneous catheter interventions (angioplasty + stent)
36
What is the most common bypass? Least common?
most: femoropoliteal least: femorotibial
37
What are medical tests for PAD?
Non-diagnostic: - ABI - Pulses Other: - arteriogram (diagnostic) - duplex US - CT, MRI
38
What are labs for PAD?
- blood glucose - cholesterol - triglycerides - HDL/LDL - hemoglobin
39
What are pharmalogical interventions for PAD?
- Anti-hyperlipidemic meds - Anti-platelet therapy (asprin, plavix) - Glucose control - Anti-hypertensiev therapy (Diuretics, Beta block, alpha adrenergic block, ACE inhib)
40
What is the pharmalogical intervention for intermittent claudication?
Pentoxyifylline
41
What is the PT assessment we can do for PAD?
- Vitals - ABI - The 5 Ps - skin (trophic changes) - gait - balance - functional mobility
42
What is true of BP if someone has PAD of UE?
SBP will be 15-20 mmHg lower in involved arm
43
What are the 5Ps (For PAD?)?
pain pallor pulses paresthesia paresis
44
What UE condition is a sign of chronic O2 deprivation from PAD?
Clubbing of the fingers
45
What UE signs do you want to look for w/PAD?
- nicotine stains - clubbing - capillary refill time - pulses - skin color
46
What LE signs do you want to look for w/PAD?
- color - hair distribution - Temp - capillary refill time - changes in color w/changes in leg position - ulcers, varicose veins, edema
47
What are some measurements for circulation?
- Pulses - Capillary refill time - ABI - Venous filling time - Rubor on dependency - Edema (sometimes)
48
What is capillary refill?
- rate at which blood refills empty capillaries - should be w/in 2-3 seconds
49
What does it indicate if capillary refill time is greater than normal?
dehydration shock PVD hypothermia
50
What is the equation for ABI?
Systolic ankle/ systolic brachial
51
How do you interpret ABI?
=< 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
What is venous filling time and what is it used for?
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
How do you grade venous filing time?
0: <15 sec 1+: 15-30 sec 2+: 30-45 sec 3+: 45-60 sec 4+: >60 sec
54
What is dependent rubor? What is it indicative of?
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
What is the grade system for pitting edema?
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
What is the onset and course of PAD?
Gradual
57
What is the prognosis for PAD?
Higher risk CAD Higher risk amputation Revascularization and stents may help
58
List the OM used for PAD
- ACD - ICD - self-reported walking limitations - peak VO2 - QOL Questionnaire - 6MWT
59
What is the maximal walking time absolute claudication distance (ACD)?
The longest amount of time and distance a person can go with pain from claudication
60
What is the pain-free walking time initial claudication distance (ICD)?
The amount of time (and distance) a person can go without pain from claudication
61
What are some interventions for PAD?
- meds to control risk factors - meds to improve caludication - sx - exercise
62
What are some components of an exercise program for PAD?
- 3x/week - => 30 minuets - walk until onset OR moderate pain - rest until subsides - Repeat - Increase grade once reach 10 minutes
63
What are the types (primary and secondary) of Raynaud's phenomenon?
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
What is the histology/etiology or raynaud's phenomenon
Intermittent episodes of small artery constrictions of the extremities
65
What are some risk factors of raynaud's phenomenon?
- anxiety - exposure to cold - younger women - smoking - other diseases (SLE, RA)
66
What are Raynauds signs and symptoms
- Color changes - reduced skin temperature - may be painful if prolonged time - numbness, tingling, achy pain - may be unilateral or bilateral
67
What is the onset and course of raynaud's phenomenon
Onset: 20-50 years old Course: Lifetime
68
What is the prognosis of Raynaud's phenomenon?
- prolonged may destroy tissue of the digits - primary vs secondary (secondary = poorer prognosis)
69
What are some medical tests for Raynaud's phenomenon?
- clinical presentation - symptoms lasting 2 years - tests to rule out possible autoimmune involvement
70
What is thrombiangitis Obliterans (Buerger's Disease)
An inflammatory occlusive vascular disease that affects both arteries and veins that can be accompanied by thrombi or clots
71
What are risk factors for Buerger's Disease
Younger men Smoker/tobacco product user
72
What differential Dx do you need to do for Buerger's disease?
- arteriosclerosis oblieterans (PAD) - traumatic arterial thrombosis - popliteal arterial entrapping syndrome - occlusive vasculopathy due to SLE or sclerodera - Behcet's disease
73
What are the s/s of Thrombiangitiis Obliterans (Buerger's Disease)
- 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
What is the onset and course of Buerger's Disease
Insidous onset and unkown course w/possible amputation
75
What is the prognosis of Buerger's Disease
- Lifetime once diagnosed, but not life threatening - Dependent on stopping tobacco usage
76
What are some medical tests for Thrombiangitiis Obliterans (Buerger's Disease)
- arteriography - histological exam of blood vessles - doppler (thrombus threat)

UM - Cardiovascular Conditions (5 decks)

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