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Cardiology > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

Peripheral vascular disease results from what causes?

A

Structural changes in vessel walls
Narrowing of vascular lumen
Spasms

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2
Q

Abnormal localized dilatation of an artery

Diameter has increased by at least 50% compared with normal

A

Aneurysm

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3
Q

What is the normal aortic diameter in men and women?

A

males = 2cm
females = 1.8cm

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4
Q

What percentage of aortic aneurysms originate at or below the renal arteries?

A

90%

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5
Q

List some risk factors for developing an aortic aneurysm?

A

Smoking
HTN
Increased lipids
obesity

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6
Q

What is the size of the artery have to measure to be considered an aneurysm?

A

> 3cm diameter

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7
Q

At what size of an aneurysm do we worry about rupturing?

A

> 5cm

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8
Q

> 10% of aortic aneurysms

Most are asymptomatic

Most are due to atherosclerosis (but also connective tissue disorders)

A

Thoracic Aortic Aneurysms

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9
Q

Regardless of the type of thoracic aortic aneurysm, rupture is catastrophic because why?

A

bleeding rarely contained

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10
Q

What is the imaging of choice for thoracic aneurysms?

A

CT scan

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11
Q

For abdominal aortic aneurysms:

Most useful and least expensive mode of diagnosis

Diagnostic study of choice for initial screening, with routine follow up

A

Abdominal ultrasound

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12
Q

For abdominal aortic aneurysms:

More accurately assess size and determines anatomy

Demonstrates arteries above and below aneurysm

Visualization is necessary for planning repair

A

Contrast-enhanced CT or CTA

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13
Q

What is the most common complication of an abdominal aortic aneurysm repair and the leading cause of death?

A

MI

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14
Q

Life-threatening condition

A true emergency requiring immediate control of BP to limit extent of dissection

Most common aortic catastrophe

A

Aortic Dissection

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15
Q

What is the pathophysiology of an aortic dissection?

A

spontaneous intimal tear creates false lumen between media and adventitia

Blood-filled channel divides medial layers of aorta, splitting intima from adventitia

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16
Q

Abuse of what substance is increasingly recognized as a predisposing risk factor for aortic dissections?

A

Cocaine abuse

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17
Q

What are the most common causes for dissection in patients ages <40?

A

Marfan syndrome

pregnancy

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18
Q

What is the most common location for aortic dissections?

A

Ascending thoracic aorta

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19
Q

List some risk factors for aortic dissections

A

HTN – 80%
Marfan Syndrome/coarctation of aorta
Pregnancy
Bicuspid aortic valve
Cocaine abuse

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20
Q

Which type of aortic dissections carry the worst prognosis?

A

Type A

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21
Q

What type of aortic dissections is described below?

Proximal

If ascending aorta involved

Arch proximal to the left of subclavian artery

2/3 of cases

A

Type A

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22
Q

What type of aortic dissections is described below?

Distal

If occurs beyond left subclavian artery

Proximal descending thoracic aorta just beyond left subclavian artery

Does not involve the ascending aorta

A

Type B

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23
Q

What is a key finding on a CXR to suspect an aortic dissection?

A

Widened mediastinum

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24
Q

What is the immediate diagnostic imaging study of choice in aortic dissections, especially in acute situations?

A

CT chest/abdomen

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25
Q

List some complications of aortic dissection

A

Pericardial tamponade
Stroke
MI
Renal failure
Limb ischemia
Aortic regurgitation
death

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26
Q

What is the mortality rate for untreated dissections?

A

> 90%

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27
Q

What is the most common complaint in peripheral artery disease?

A

Claudication

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28
Q

Development of occlusive atherosclerosic lesions in the extremities

Evidence of systemic atherosclerotic process

Formation of atherosclerotic plaques in large and medium-sized arteries

A

Peripheral Artery Disease

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29
Q

List some risk factors for the development of peripheral artery disease

A

Cigarette smoking
Diabetes mellitus
Dyslipidemia
Hypertension
Male gender
Increasing age

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30
Q

What is the hallmark of chronic venous insufficiency?

A

shallow, large ulcer located over the medial malleolus

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31
Q

In PAD, these ulcers found on physical exam suggest what source is affected- artery or vein?

Small, deep, painful ulcers (may be painless in diabetics)

Trauma heels/toes

Discrete edges – “punched out”

Edges covered with crust

Infected erythematous

Rapidly developing

A

artery

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32
Q

In PAD, these ulcers found on physical exam suggest what source is affected- artery or vein?

Painless

Ankle/lower leg above medial malleolus

Reddened, thickened over medial malleolus

Cobblestone appearance

Occurs with slightest trauma

Slow developing

A

venous

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33
Q

What is the diagnostic study of choice in PAD?

A

Ankle-brachial index (ABI)

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34
Q

What reading is considered normal in the Ankle-brachial index (ABI)?

A

1.0-1.3: normal

Ankle pressure is equal to or slightly greater than that in the arms

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35
Q

What reading is diagnostic of PAD in the Ankle-brachial index (ABI)?

A

<0.9

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36
Q

What is the first line treatment of PAD?

A

Formal exercise program

37
Q

What therapy has shown in PAD to reduce CV morbidity and mortality?

A

ASA (anti-platelet therapy)

38
Q

What lifestyle modifications in PAD you should educate your patient about?

A

Smoking cessation
Lipid management
HTN management
DM management
Weight loss

39
Q

In PAD, this therapy is indicated after failed medical therapy, or cases of severe limb ischemia

Goal – heal ulcers, prevent limb loss

A

Revascularization

40
Q

Poorest prognosis is for those patients with PAD and what underlying disease?

A

Diabetes

41
Q

Abrupt total, or near-total occlusion of terminal aorta or common
iliac arteries poses immediate threat to life and limb

Caused by embolization or thrombus

Origin of arterial emboli usually cardiac, rarely originate from venous circulation

A

Acute Aortic Occlusion

42
Q

An arterial embolism from venous circulation is called what?

Clot passes through an abnormal intracardiac communication (ASD, VSD, PFO)

A

Paradoxical embolism

43
Q

What is the clinical presentation of an acute aortic occlusion?

A

Abrupt onset of severe pain
Diffuse cyanosis
Numbness
Paresthesia
Paralysis
Absent pulses of lower limbs

44
Q

What is the treatment of an acute aortic occlusion?

A

Anticoagulation

Immediate revascularization procedure: limb viability at risk

45
Q

In arterial embolism/thrombosis, most emboli arise from where?

A

the heart

46
Q

What is the most common cause of emboli arising from the heart?

A

Afib

47
Q

6 “Ps” of acute ischemia = sudden onset in affected limb

A

Pain (early)
Paresthesias (early)
Pallor
Pulselessness
Poikilothermia
paralysis

48
Q

What are the three causes of acute limb ischemia?

A

Embolic
thrombotic
traumatic

49
Q

What is the diagnostic imaging of choice in arterial embolism/thrombosis?

A

Doppler US

50
Q

In arterial embolism/thrombosis, immediate revascularization is essential within how many hours of symptom onset?

A

3 hours

51
Q

In arterial embolism/thrombosis, irreversible tissue damage and amputating starts after how many hours of symptom onset?

A

6 hours

52
Q

In arterial embolism/thrombosis prognosis, what is the percentage risk of resulting in an amputation?

A

10-25%

53
Q

In the absence of Afib, what percentage of emboli originate from proximal internal carotid artery?

A

90%

54
Q

What is imaging/screening modality of choice for occlusive cerebrovascular disease?

A

Duplex US is imaging/screening

55
Q

“intestinal angina”

Severe postprandial pain, weight loss due to fear of eating

Acute v. chronic intestinal ischemia

A

Visceral Artery Insufficiency

56
Q

Veins are high capacitance vessels and contain what percentage of total blood volume?

A

> 70%

57
Q

Dilated, tortuous superficial vessel in lower extremities

A

Varicose veins

58
Q

What is the most commonly involved vein in varicose veins?

A

Greater saphenouos vein

59
Q

What is the pathophysiology of varicose veins?

A

Intrinsic weakness of vessel wall
Increased intraluminal pressure
Congenital defects of valves

60
Q

List some risk factors for varicose veins

A

Female
Family history
Pregnancy
Prolonged standing or heavy lifting
History of thrombophlebitis
obesity

61
Q

What is the imaging of choice for varicose veins?

A

Duplex US

62
Q

What are some signs/symptoms of varicose veins?

A

Many are asymptomatic (cosmetic problem - dilated, tortuous veins beneath the skin in thigh and leg visible upon standing)

Burning

Bursting

Bruised

Dull, aching heaviness or a feeling of fatigue with prolonged standing

Elevation relieves symptoms

Worsened with prolonged standing/volume overload states

Signs of chronic venous insufficiency (Brownish pigmentation and thinning skin above ankle)

63
Q

Thrombus tends to propagate in what direction?

A

direction of blood flow

64
Q

What are the two kinds of venous thrombosis?

A

Superficial thrombophlebitis

Deep vein thrombosis (DVT)

65
Q

Thrombus formation within superficial or deep vein

Initially thrombus composed of platelets and fibrin

Later RBCs become interspersed within fibrin

A

Venous Thrombosis

66
Q

Benign disorder

Inflammation and thrombosis of superficial vein

Tender, erythematous, indurated lesion in the course of a superficial vein

A

Superficial Thrombophlebitis

67
Q

What superficial vein is most commonly affected in superficial thrombophlebitis?

A

Long saphenous most common

68
Q

What symptoms suggest septic phlebitis (requires urgent treatment) in cases of superficial thrombophlebitis?

A

Fever, chills, pain at site

69
Q

What are the risk factors for superficial thrombophlebitis?

A

Short term venous catheterization
May occur as a complication of an in-dwelling IV catheter
Varicose veins or thromboangiitis obliterans (Berger’s disease)
Pregnancy or post-partum
Trauma
Abdominal cancer

70
Q

Superficial thrombophlebitis is associated with occult DVT in what percentage of cases?

A

20%

71
Q

What is the treatment for uncomplicated superficial thrombophlebitis?

A

Symptomatic: Local heat, rest, ASA or anti-inflammatory (NSAIDs)

72
Q

Deep venous thrombosis most common location?

A

veins of calves

73
Q

For a DVT, why do you need a high index of suspicion?

A

50% of patients are asymptomatic

74
Q

DVTs result in what two major consequences?

A

Pulmonary embolism – main/serious complication

Post-phlebitic syndrome

75
Q

Virchow’s triad - what are the components?

A

Stasis
Vascular damage
Hypercoagulability

76
Q

Calf pain produced by dorsiflexion of foot

Nonspecific and unreliable sign – only 50% reliable

A

Homan’s sign

77
Q

Byproduct fibrin degradation

Highly sensitive for DVT/PE, but not specific

A

D-Dimer

78
Q

What is the study of choice for DVTs?

A

Venous compression duplex ultrasonography

79
Q

What is the target INR for Warfarin?

A

INR 2.0-3.0

80
Q

What is the treatment for DVT and why?

A

Prevents extension of thrombus and PE/prevents additional clot formation

Allow the body’s autolytic system to lyse the clot

81
Q

DVT with or without PE requires minimum of how many months of anticoagulation?

A

3 months

82
Q

What is the preferred initial anticoagulation treatment for a DVT that does not require monitoring?

A

LMWH

83
Q

When to use an IVC filter in a patient with DVT?

A

high risk patients or if anticoagulation is contraindicated

84
Q

Why does Warfarin need to be bridged with LMWH?

A

Warfarin can induce a hypercoagulable state during the first few days of administration

85
Q

Caused by functionally inadequate valve leaflets

Scarred, thickened, or in dilated vein that results in abnormally high hydrostatic force transmitted to subcutaneous tissues and veins of the lower legs

Causes pronounced edema, creating secondary changes

A

Chronic Venous Insufficiency

86
Q

What are the risk factors for chronic venous insufficiency?

A

History of DVT/phlebitis
History of leg trauma
Obesity
Superficial venous reflux/varicose veins
Neoplastic obstruction of pelvic veins
Congenital AV fistula

87
Q

What is primary presenting symptom in chronic venous insufficiency?

A

Progressive pitting edema of the lower leg

88
Q

What is the management of chronic venous insufficiency?

A

Bed rest

Leg elevation

Graded compression stockings

Exercise

Wet saline compresses for weeping stasis dermatitis

Unna boot, ace wrap, wet to dry saline dressings, hyperbaric chamber
for wound treatment

Antibiotics and antifungals when indicated

Cardiology (13 decks)

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