Peripheral Vascular Disease Flashcards by Heather White

What are the primary determinants for determining blood pressure?

Volume status
Sympathetic nervous system
RAAS

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

Increase Ca and depolorization which will increase HR

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

Increase HR

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Where are baroreceptors located?

Aortic arch and carotid arteries

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

Catecholamines

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Is nicotine a vasoconstrictor or vasodilator?

Vasoconstrictor

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How does smoking increase BP?

Causes both vasoconstriction and increased HR, nicotine causes catecholamine release

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

Catecholamine

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Hypertensive emergency is acute end-organ damage due to

elevated BP

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What is the vasa vasorum?

Vessels that feed the layers of the thicker/larger vessels

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What is the pathophysiology of aortic dissection?

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

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

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What are risks for developing an aortic dissection?

HTN

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

Bicuspid aortic valve

Coarctation of aorta

Trauma

Iatrogenic sources

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What is the presentation of aortic dissection?

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

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

Aortic insufficiency murmur
Pulse deficit
HTN
Hypotension
Stroke Symptoms

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

Fusiform

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What is the ruptured AAA triad?

Abdominal or back pain
Hypotension
Pulsatile abdominal mass

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

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Where is a DVT most likely to develop?

Lower extremities, especially the calf

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

Septic aneurysm in the tricuspid valve

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What is a bruit?

Audible sound due to narrowing and increased turbulence

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Is compartment syndrome considered a type of vasculature issue?

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

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What is venous insufficiency?

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

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What is the initial treatment for claudication?

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

Veracious veins increase your risk for

DVT

What layers are involved in a true aneurysm?

All three layers are involved

Does a pseudoaneurysm involve all three layers of the vessel?

No, more of a hematoma with fibrous covering

What are the high risks for developing an aortic aneurysm?

Family History (20%) Atherosclerosis Smoking HTN Hyperlipidemia

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

Ehlers-Danlos and Marfans

What is the more common aortic aneurysm?

Abdominal aortic aneurysm

What are the high risks associated with abdominal aortic aneurysms?

Family History Atherosclerosis Men Caucasian Age > 65 Smokers HTN Hyperlipidemia

What is the typical presentation of an aortic aneurysm?

Many are asymptomatic until dissection/rupture or found incidentally

In a symptomatic aortic aneurysm what are the presenting symptoms?

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

What are the symptoms in an ruptured thoracic aortic aneurysm?

Tearing back pain, hypotension, shock

What are the symptoms in a ruptured abdominal aortic aneurysm?

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

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

CTA

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

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

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

Control BP, lipid lowering, smoking cessation

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

0.1-0.3 cm per year

When is operative intervention indicated in aortic aneurysms?

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

What is the pathophysiology of an aortic dissection?

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

What are the three most common locations of aortic dissections?

Aortic root Aortic arch Just distal to subclavian artery

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

New aortic regurgitation murmur (diastolic murmur)

What are the tests of choice for diagnosing aortic dissection?

CTA or TEE, EKG and CXR should be done initially

What are the CXR indications for aortic dissection?

Widened mediastinum, hemothorax, mediastinal shift

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

HR control with Beta Blockers (CCBs second line)

What is the pathophysiology of peripheral arterial disease?

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

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

Intermittent claudication

What will be present on physical exam with PAD?

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

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

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

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

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

What is the medical treatment in PAD?

Antiplatelet therapy (ASA, dipyridamole, clopidogrel) Treat claudication with Cilostazol (vasodilator)

What most commonly develops secondary to PAD?

Acute arterial occlusion

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

Pain Pallor Pulsenessness Polar sensation Paresthesias

What is the work-up for acute arterial occlusion?

Diagnosis is primarily clinical with doppler to confirm absent peripheral pulses

What is hematochezia?

Bright red blood from lower GI bleed