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2a- Cardiology > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

1
Q

What is the commonest cause of vascular disease?

A

Atherosclerosis

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2
Q

What is the pathophysiology of vascular disease?

A
  • Atherosclerosis
  • Inflammatory
  • Vasospastic
  • Compression
  • Traumatic
  • Pro-thrombotic conditions
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3
Q

What is the most potent risk factor in PAD (peripheral artery disease)?

A

Smoking

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4
Q

What are the modifiable risk factors of PAD?

A
  • Smoking
  • Hypertension
  • Diabetes
  • Hypercholesterolaemia
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5
Q

What are the non-modifiable risk factors of PAD?

A
  • Age
  • Sex
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6
Q

What are types of acute lower limb ischaemia?

A
  • Acute
  • Acute on chronic
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7
Q

What is seen in acute ischaemia?

A
  • 6P’s (pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia)
  • embolus (–>AF, MI)
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8
Q

What is seen in acute on chronic ischaemia?

A

thrombus

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9
Q

What is seen in chronic ischaemia?

A
  • IC
  • Rest pain
  • Tissue pain
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10
Q

What is IC?

A

Intermittent claudication
- pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest
- Taking breaks between walking distances

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11
Q

What is rest pain?

A
  • End stage of chronic ischaemia
  • Not receiving enough blood, constantly in pain, constantly in ischaemia
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12
Q

Describe tissue lost?

A
  • Arterial ulceration, ulceration
  • Insufficient blood to survive
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13
Q

What is carotid plaque?

A

Plaque ulceration and embolisation

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14
Q

How can you treat carotid plaque?

A
  • Can be removed by carotid endarterectomy
    • Can be under local anaesthetic
    • Isolate 3 vessels with a clamp
      • Internal, external, carotid
  • Clean out vessels
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15
Q

What are the 2 types of stroke?

A
  • Ischaemic
  • Haemorrhagic
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16
Q

How many strokes are ischaemic and how many are haemorrhagic?

A
  • Ischaemic 60%
  • Haemorrhagic 30%
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17
Q

What are the 2 types of aneurysm?

A
  • True
  • False
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18
Q

What are true aneurysms caused by?

A

Weakening of the arterial wall leading to dilatation

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19
Q

Where is the most common location for a true aneurysm?

A

infra-renal aorta

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20
Q

What are false aneurysms caused by?

A
  • Mycotic aneurysms caused by weakness in wall by infection
  • Bleeding within walls of the artery
  • Can pop and rupture
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21
Q

What are investigations that can be done for peripheral vascular disease?

A
  • Angiograms
  • Bloods – Lipids, Glucose, Renal function, Vasculitic screen, Clotting, FBC
  • ABPI (ankle-brachial pressure index)
  • Duplex
  • Cross sectional Imaging
22
Q

What’s a drawback about angiograms?

A
  • Static scan so doesn’t give idea about flow
  • Duplexes give an idea about flow
23
Q

What are the advantages of MRA over CTA?

A
  • CT radiation
  • Nephrotoxicity higher for CT
  • CT relies on pump (heart) to move dye
  • MRA better for measuring distal flow in small vessels
24
Q

What are treatments for peripheral vascular disease?

A
  • Risk factor modification
  • Antiplatelets
  • Statin
  • Stop smoking
  • Good control of BP
  • Good control of DM
  • ACE inhibitors?
  • Exercise programme
25
Q

What are invasive treatments for peripheral vascular disease in lower limbs?

A
  • Endo-vascular
    • Stenoses
    • Short occlusions
    • DEB (Drug-eluting balloon)
    • DES (Drug-eluting stents)
    • Once stent is inserted, can no longer treat artery
      • Would either have to do bypass surgery or amputation
26
Q

How can you treat IC?

A

Exercise

27
Q

What is AAA?

A

Abdominal aortic aneurysm

28
Q

What are the 2 main forms of treatments for AAA?

A
  • Endovascular
  • Open surgery
29
Q

What are the features of endovascular treatment?

A
  • Lower morbidity and mortality
30
Q

What is an example of endovascular treatment?

A
  • Stent graft is a type of treatment for this
    • Life long surveillance
31
Q

What are features of open surgery?

A
  • Higher initial morbidity and mortality
  • Lower long term morbidity and mortality
  • Won’t need life long surveillance
  • Perioperative mortality slightly higher
32
Q

What is the current NICE recommendation for AAA repair open surgery or EVAR?

A

Open surgery

33
Q

What are the 3 types of rarer vascular diseases?

A
  • Inflammatory
  • Vaso-spastic
  • Compressive
34
Q

What’s an example of an inflammatory rare vascular disease?

A

Buergers disease

35
Q

What’s an example of an vaso-spastic rare vascular disease?

A

Raynauds

36
Q

What’s an example of an compressive rare vascular disease?

A

Coeliac compression

37
Q

What other vascular pathologies are there?

A
  • Lymphatic
  • AV malformations
38
Q

How would you treat lymphatic pathologies?

A

Treat secondary with Radiation, Surgery

39
Q

How would you treat AV malformations?

A

Treat with endo-vascular treatment

40
Q

What are the 3 types of veins?

A
  • Superficial
  • Perforators
  • Deep
41
Q

How would you treat an incompetent superficial vein?

A
  • Can easily treat
  • Destroy vein
42
Q

How would you treat an incompetent deep vein?

A
  • More difficult to treat
  • Incompetent deep veins, if backflow → compression
43
Q

What is the pathophysiology of veins?

A
  • Venous return due to:
    • Valves
    • Muscle pump
  • Incompetence
  • Obstruction
  • Mixed
44
Q

What are problems that could arise veins?

A
  • Primary
  • Secondary
    • DVT– Virchows triad
  • Venous hypertension
  • Congenital – KT syndrome
  • Compression – May Thurner Syndrome
45
Q

What is the CEAP classification for varicose veins?

A
  • C0 – No signs
  • C1 – Telangiectasia/reticular
  • C2 – Truncal
  • C3 – Oedema
  • C4 – Skin Changes (Pigmentation/Eczema/LDS)
  • C5 – Healed ulcer
  • C6 – Active Ulcer
46
Q

What is the SFJ?

A

Superficial femoral junction

47
Q

Where is the SFJ located?

A

4 finger breadths lateral and inferior to pubic tubercle

48
Q

How would you investigate issues with veins?

A
  • Duplex
    • Gold standard
  • MRV
    • Pelvic
  • Venography
    • Pelvic
49
Q

What are the treatments for superficial venous disease?

A
  • Lifestyle
  • Compression
  • Sclerotherapy
  • Endo-venous treatments
  • Surgical stripping
50
Q

What is refluxing in veins?

A
  • If a valve becomes damaged, it can’t close properly, gravity takes over, and blood struggles to flow upward toward your heart
    • Instead flows backward → varicosities
51
Q

What are the treatments for deep venous disease?

A
  • Lifestyle
  • Compression
  • Stents
  • Valves

2a- Cardiology (7 decks)

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