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Cardiology > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What are the primary determinants for determining blood pressure?

A

Volume status
Sympathetic nervous system
RAAS

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2
Q

The release of catecholamines (epi, norepi) will have what effect on HR?

A

Increase Ca and depolorization which will increase HR

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3
Q

An increase in thyroid will increase metabolism and body temperature and have what effect on HR?

A

Increase HR

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4
Q

Where are baroreceptors located?

A

Aortic arch and carotid arteries

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5
Q

Adrenal medulla will be inhibited during times of HTN which will decrease the production of what?

A

Catecholamines

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6
Q

Is nicotine a vasoconstrictor or vasodilator?

A

Vasoconstrictor

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7
Q

How does smoking increase BP?

A

Causes both vasoconstriction and increased HR, nicotine causes catecholamine release

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8
Q

In the setting of OSA, hypoxemia and hypercarbia will increase what leading to increased HTN?

A

Catecholamine

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9
Q

Hypertensive emergency is acute end-organ damage due to

A

elevated BP

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10
Q

What is the vasa vasorum?

A

Vessels that feed the layers of the thicker/larger vessels

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11
Q

What is the pathophysiology of aortic dissection?

A

Increase in sheer stress will lead to trauma to vessel wall and tear through the intima, creating a false tract between intima and media

m/c associated with HTN, smoking, advanced age, and hyperlipidemia

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12
Q

What are some downstream effects of an aortic dissection and the false lumen that is created?

A

False lumen can rupture
Create a reentry site to connect with true lumen
Enlarge or compress
Hematoma can form

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13
Q

What are risks for developing an aortic dissection?

A

HTN

Connective tissue disorders (Marfan’s and Ehlers-Danlos syndrome)

Bicuspid aortic valve

Coarctation of aorta

Trauma

Iatrogenic sources

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14
Q

What is the presentation of aortic dissection?

A

Sudden onset pain
Classically “tearing” pain
Pain in the back
Pain can migrate
Sense of doom

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15
Q

What will you find on physical exam for an aortic dissection?

A

Aortic insufficiency murmur
Pulse deficit
HTN
Hypotension
Stroke Symptoms

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16
Q

What type of aneurysm is most likely in an aortic aneurysm?

A

Fusiform

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17
Q

What is the ruptured AAA triad?

A

Abdominal or back pain
Hypotension
Pulsatile abdominal mass

Only a 1/3rd of patients will present with all three

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18
Q

Where is a DVT most likely to develop?

A

Lower extremities, especially the calf

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19
Q

What type of aneurysm is most likely to occur in IVDU?

A

Septic aneurysm in the tricuspid valve

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20
Q

What is a bruit?

A

Audible sound due to narrowing and increased turbulence

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21
Q

Is compartment syndrome considered a type of vasculature issue?

A

Yes, tissue perfusion caused by the difference between arterial BP and venous pressure

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22
Q

What is venous insufficiency?

A

Blood flow interruption in the venous system due to valve incompetence, reflux, and/or venous obstruction

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23
Q

What is the initial treatment for claudication?

A

Walking program which will result in new vessel growth (angiogenesis)

24
Q

Veracious veins increase your risk for

A

DVT

25
Q

What layers are involved in a true aneurysm?

A

All three layers are involved

26
Q

Does a pseudoaneurysm involve all three layers of the vessel?

A

No, more of a hematoma with fibrous covering

27
Q

What are the high risks for developing an aortic aneurysm?

A

Family History (20%)
Atherosclerosis
Smoking
HTN
Hyperlipidemia

28
Q

What genetic connective tissue disorders can lead to thoracic aortic aneurysm?

A

Ehlers-Danlos and Marfans

29
Q

What is the more common aortic aneurysm?

A

Abdominal aortic aneurysm

30
Q

What are the high risks associated with abdominal aortic aneurysms?

A

Family History
Atherosclerosis
Men
Caucasian
Age > 65
Smokers
HTN
Hyperlipidemia

31
Q

What is the typical presentation of an aortic aneurysm?

A

Many are asymptomatic until dissection/rupture or found incidentally

32
Q

In a symptomatic aortic aneurysm what are the presenting symptoms?

A

+/- pulsatile abdominal mass
+/- abdominal bruit
+/- back/abdominal pain

33
Q

What are the symptoms in an ruptured thoracic aortic aneurysm?

A

Tearing back pain, hypotension, shock

34
Q

What are the symptoms in a ruptured abdominal aortic aneurysm?

A

Severe abdominal pain, flank pain, hypotension, syncope, and potential leg ischemia

35
Q

What is the test of choice for initial assessment/screening of a thoracic aortic aneurysm?

A

CTA

36
Q

What is the test of choice for initial assessment/screening of an abdominal aortic aneurysm?

A

Ultrasound, but CTA more reliable for sizing, pre-operative assessment

37
Q

What are the steps in management of modifiable risk factors in aortic aneurysms?

A

Control BP, lipid lowering, smoking cessation

38
Q

On annual surveillance for growth, what is the annual average rate of growth for an aortic aneurysm?

A

0.1-0.3 cm per year

39
Q

When is operative intervention indicated in aortic aneurysms?

A

Size of > 5.5 cm or rapid growth (0.5+ cm per year)

40
Q

What is the pathophysiology of an aortic dissection?

A

Tear in the intima, blood enters space between the intima and media. Creates a false lumen which propagates under pressure.

41
Q

What are the three most common locations of aortic dissections?

A

Aortic root
Aortic arch
Just distal to subclavian artery

42
Q

What type of murmur will be heard in aortic dissection upon presentation?

A

New aortic regurgitation murmur (diastolic murmur)

43
Q

What are the tests of choice for diagnosing aortic dissection?

A

CTA or TEE, EKG and CXR should be done initially

44
Q

What are the CXR indications for aortic dissection?

A

Widened mediastinum, hemothorax, mediastinal shift

45
Q

What should be the first medication in medical management of aortic dissection?

A

HR control with Beta Blockers (CCBs second line)

46
Q

What is the pathophysiology of peripheral arterial disease?

A

Vessel disease leading to decreased LE arterial perfusion, primarily caused by atherosclerosis

47
Q

What is the most characteristic symptom in peripheral arterial disease (PAD)?

A

Intermittent claudication

48
Q

What will be present on physical exam with PAD?

A

Cool, pale skin
+/- erythema when dependent
Hairlessness
Muscle atrophy
Reduced or absent peripheral pulses
Delayed cap refill
Ulcerations

49
Q

Where are ulcerations more common with peripheral arterial disease compared to venous insufficiency?

A

In PAD more likely to occur on the lateral malleolus whereas in venous insufficiency the medial malleolus is more common

50
Q

What test should be done to confirm diagnosis of peripheral artery disease?

A

Ackle-brachial index (ABI), PAD when < 0.9 (normal .9-1.3)

51
Q

What is the medical treatment in PAD?

A

Antiplatelet therapy (ASA, dipyridamole, clopidogrel)

Treat claudication with Cilostazol (vasodilator)

52
Q

What most commonly develops secondary to PAD?

A

Acute arterial occlusion

53
Q

What are the 5 P’s in acute arterial occlusion?

A

Pain
Pallor
Pulsenessness
Polar sensation
Paresthesias

54
Q

What is the work-up for acute arterial occlusion?

A

Diagnosis is primarily clinical with doppler to confirm absent peripheral pulses

55
Q

What is hematochezia?

A

Bright red blood from lower GI bleed

Cardiology (15 decks)

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