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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
What are invasive treatments for peripheral vascular disease in lower limbs?
- 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
How can you treat IC?
Exercise
27
What is AAA?
Abdominal aortic aneurysm
28
What are the 2 main forms of treatments for AAA?
- Endovascular - Open surgery
29
What are the features of endovascular treatment?
- Lower morbidity and mortality
30
What is an example of endovascular treatment?
- Stent graft is a type of treatment for this - Life long surveillance
31
What are features of open surgery?
- Higher initial morbidity and mortality - Lower long term morbidity and mortality - Won’t need life long surveillance - Perioperative mortality slightly higher
32
What is the current NICE recommendation for AAA repair open surgery or EVAR?
Open surgery
33
What are the 3 types of rarer vascular diseases?
- Inflammatory - Vaso-spastic - Compressive
34
What's an example of an inflammatory rare vascular disease?
Buergers disease
35
What's an example of an vaso-spastic rare vascular disease?
Raynauds
36
What's an example of an compressive rare vascular disease?
Coeliac compression
37
What other vascular pathologies are there?
- Lymphatic - AV malformations
38
How would you treat lymphatic pathologies?
Treat secondary with Radiation, Surgery
39
How would you treat AV malformations?
Treat with endo-vascular treatment
40
What are the 3 types of veins?
- Superficial - Perforators - Deep
41
How would you treat an incompetent superficial vein?
- Can easily treat - Destroy vein
42
How would you treat an incompetent deep vein?
- More difficult to treat - Incompetent deep veins, if backflow → compression
43
What is the pathophysiology of veins?
- Venous return due to: - Valves - Muscle pump - Incompetence - Obstruction - Mixed
44
What are problems that could arise veins?
- Primary - Secondary - DVT– Virchows triad - Venous hypertension - Congenital – KT syndrome - Compression – May Thurner Syndrome
45
What is the CEAP classification for varicose veins?
- C0 – No signs - C1 – Telangiectasia/reticular - C2 – Truncal - C3 – Oedema - C4 – Skin Changes (Pigmentation/Eczema/LDS) - C5 – Healed ulcer - C6 – Active Ulcer
46
What is the SFJ?
Superficial femoral junction
47
Where is the SFJ located?
4 finger breadths lateral and inferior to pubic tubercle
48
How would you investigate issues with veins?
- Duplex - Gold standard - MRV - Pelvic - Venography - Pelvic
49
What are the treatments for superficial venous disease?
- Lifestyle - Compression - Sclerotherapy - Endo-venous treatments - Surgical stripping
50
What is refluxing in veins?
- 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
What are the treatments for deep venous disease?
- Lifestyle - Compression - Stents - Valves

2a- Cardiology (7 decks)

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