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CVPR exam 2 > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

70% of AAA patients are ______, then present with sudden death.

A

asymptomatic

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1
Q

What is the greatest risk factor for PAD?

A

diabetes (4-fold)

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2
Q

What are the 4 major risk factors for AAA?

A

–Age –Gender –Smoking –Family history

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2
Q

Thrombophilia caused by any alteration in coagulation balance that:

A

• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition

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2
Q

How do aortic dissection pts typically present?

A

severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved

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3
Q

AAA denoted by diameter of _____ or ____.

A

> 3.0 cm; 50% increase in size relative to proximal normal segment

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4
Q

What are the 4 major risk factors for AAA?

A

–Age

–Gender

–Smoking

–Family history

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4
Q

At what aneurism size does the 5 year rupture rate exceed 1 in 4?

A

5 cm diameter

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5
Q

What are the signs of PAD?

A
  • Decreased or absent pulses
  • Bruits (abdominal, femoral)
  • Muscle atrophy
  • In severe PAD (critical leg ischemia)

– Pallor of feet with elevation

– Dependent rubor

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6
Q

What are the risk factors for aortic dissection?

A
  1. HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
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7
Q

Thrombophilia caused by any alteration in coagulation balance that:

A

• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition

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8
Q

How will you treat PAD with antithrombotic medication?

A
  1. aspirin/clopidogrel
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9
Q

What is aortic dissection?

A

when the vessel loses its integrity and essentially unravels

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10
Q

How are aortic dissections treated with meds?

A
  1. control heart rate (beta blockers) 2. control BP (nitro, ACEI, Ca++ channel blockers) 3. control pain (narcs)
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11
Q

What are the mechanisms of thrombophilia?

A
  1. increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition
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12
Q

What are the signs of PAD?

A

1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor

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13
Q

How do aortic dissection pts typically present?

A

severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved

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15
Q

_____% of AAA patients are asymptomatic, then present with sudden death.

A

70

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16
Q

Name 2 manifestations of venous thromboembolic disease.

A
  1. PE 2. DVT
18
Q

PAD has a _____ increased risk of CV death.

A

6-fold

19
Q

What are the signs of PAD?

A

1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor

20
Q

30% of pts present with _____, then die.

A

abdominal discomfort or severe pain radiating to the back

21
Q

DX? • 68 yr old male in for routine exam • H/O revascularization for angina in 2009 • In 2011 developed symptoms of left calf cramping on walking 1 block, relieved by rest • Risk factors: 50 pack years smoking, LDL 135, and diabetes • Physical exam: – Right carotid: artery bruit – Left leg: absent femoral and pedal pulses – Right leg: normal femoral and pedal pulses

A

L leg claudication, probably at the level of the iliac artery

22
Q

What are the risk factors for thrombophilia?

A
  1. severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
23
Q

How are AAAs repaired?

A

endovascular infrarenal aortic repair

24
Q

What are the risk factors for aortic dissection?

A
  1. HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
26
Q

What are Ischemic rest pain/ischemic ulcers?

A

Pain in the distal foot or heel, worsened by leg elevation and improved by dependency; painful ulcers

27
Q

Name 2 manifestations of venous thromboembolic disease.

A
  1. PE 2. DVT
28
Q

What are the risk factors for thrombophilia?

A
  1. severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
29
Q

What are the mechanisms of aortic dissection?

A
  1. disruption of the intima (tear) 2. rupture of the vasa vasorum
30
Q

What arteries are most at risk of atherothrombosis?

A
  1. aorta 2. iliacs 3. femoral/superficial femoral 4. popliteal 5. tibial
30
Q

How do aortic dissection pts typically present?

A

severe, tearing pain –> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the artery

31
Q

What is the mortality rate of aortic dissection at 2 weeks? 3 mos?

A

2 weeks = 75% dead 3 mos = 90% dead

33
Q

Dx? • Decreased or absent pulses • Bruits (abdominal, femoral) • Muscle atrophy • In severe PAD (critical leg ischemia) – Pallor of feet with elevation – Dependent rubor

A

PAD

34
Q

What are the mechanisms of thrombophilia?

A
  1. increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition
35
Q

DX? • 25 year old female medical student • Flies coach to Europe • 24 hours after arrival has tender, swollen right calf, pain on standing • Duplex ultrasound reveals thrombosis of popliteal, superficial femoral and iliac veins in right leg • Started on LMWH heparin in hospital, then 6 months warfarin • 2 years post event notices chronically swollen right calf that limits her activities

A

post-thrombotic syndrome (had destroyed all the valves in the affected area)

36
Q

DX? • 25 year old female medical student • Flies coach to Europe • 24 hours after arrival has tender, swollen right calf, pain on standing • Duplex ultrasound reveals thrombosis of popliteal, superficial femoral and iliac veins in right leg • Started on LMWH heparin in hospital, then 6 months warfarin • 2 years post event notices chronically swollen right calf that limits her activities

A

post-thrombotic syndrome (had destroyed all the valves in the affected area)

38
Q

30% of AAA pts present with _____, then die.

A

abdominal discomfort or severe pain radiating to the back

39
Q

What are the signs of PAD?

A

1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor

40
Q

How will you treat PAD with antithrombotic medication?

A

aspirin/clopidogrel

41
Q

____% of AAA pts present with abdominal discomfort or severe pain radiating to the back, then die

A

30

42
Q

At what ankle-branchial index value is PAD?

A

Ratio

43
Q

What are the 4 overall mechanisms of aneurism formation?

A
  1. weakened aortic wall (decreased collagen/elastin) 2. inflammation (B and T lymphs, macs, cytokines, autoantigens) 3. proteolytic enzymes (increased MMP, tPA, decreased TIMPs) 4. biomechanical stress (elastin dist, turbulent blood flow, HTN, mural thrombus)
44
Q

What are the 4 overall mechanisms of aneurism formation?

A
  1. weakened aortic wall (decreased collagen/elastin) 2. inflammation (B and T lymphs, macs, cytokines, autoantigens) 3. proteolytic enzymes (increased MMP, tPA, decreased TIMPs) 4. biomechanical stress (elastin dist, turbulent blood flow, mural thrombus)
45
Q

What is the ankle-brachial index?

A

Ankle SBP/Arm SBP = ABI Ratio

46
Q

What is the ankle-brachial index?

A

Ankle SBP/Arm SBP = ABI Ratio

47
Q

At what aneurism size does the 5 year rupture rate exceed 1 in 4?

A

5 cm diameter

CVPR exam 2 (29 decks)

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