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Y1 CARDIOLOGY > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What is intermittent claudication?

A

Pain in the back of the calves after exertion, relieved after a while by rest

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2
Q

What causes intermittent claudication?

A

Insufficient blood reaching the exercising muscle (via collaterals), i.e. muscle is starved of oxygen

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3
Q

What classification/staging is used to grade claudication?

A

Fontaine staging

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4
Q

Name two non-invasive investigations for lower limb ischaemia

A

Ankle brachial pressure index (ABPI)

Duplex ultrasound scan

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5
Q

Name three invasive investigations for lower limb ischaema

A

Magnetic resonance angiography
CT angiography
Catheter angiography

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6
Q

How is ABPI measured?

A

Ankle pressure / Brachial pressure (mm Hg) using systolic pressures

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7
Q

What range for ABPI would indicate claudication?

A

0.4-0.85

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8
Q

Name some non-invasive therapy for limb ischaemia

A 
Stop smoking
Increase exercise (EXERCISE THROUGH PAIN)
Antiplatelet drugs
Statins
Antihypertensives
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9
Q

Is angioplasty + stenting indicated for lower limb ischaemia?

A

Yep

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10
Q

What is endarterectomy?

A

Cutting out the inside of an artery (remove plaque and fibrous tissue)

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11
Q

Describe critical limb ischaemia

A

Pain in toes/foot/leg at rest, worse at night (lying down), relieved by walking about for a bit
Can cause ulcers/gangrene

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12
Q

What is the general pathogenesis behind AAA?

A

Defect in collagen-elastin regulation, causing excessive dilation + increase in aortic wall stress

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13
Q

What are some typical features of AAA? What can it mimic?

A

Abdo pain/ Back pain
Collapse
Pulsatile mass
May be asymptomatic unless ruptured

Renal colic

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14
Q

What does expansile mean? How does it differ from pulsatile?

A

Expansile mass pushes hands in opposite directions; pulsatile mass pushes hands up and down

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15
Q

What 2 non-invasive investigations are done for AAA?

A

Duples US scan

CT scan

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16
Q

What is the investigation of choice for AAA?

A

Ultrasound - tells us whether there is an AAA or not

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17
Q

What can a CT scan tell us about an AAA?

A

Whether it is ruptured or not

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18
Q

At what size would an AAA be considered/referred for elective repair?

A

5.5 cm

19
Q

What is involved in endovascular aneurysm repair (EVAR)?

A

Stent inserted via groin and passed up until the weakened part of the artery aneurysm is reached, where it seals off the aneurysm from inside the artery

20
Q

What are the benefits of EVAR over open surgery?

A

Less mortality

Faster recovery

21
Q

What are the benefits of open surgery over EVAR?

A

Possible in almost everyone

Rare further interventions

22
Q

Which veins in the leg make up the deep venous system?

A

Tibials, popliteals, femorals

23
Q

Which veins in the leg make up the superficial venous system?

A

Saphenous, perforators

24
Q

How do varicose veins arise?

A

Back pressure due to incompetent valves causes blood to pool in superficial veins

25
Q

What are secondary varicose veins?

A

Arise due to DVT

26
Q

What is thrombophlebitis?

A

Inflammation of veins caused by a clot, causing scarring/fibrosis

27
Q

Name a non-interventional management of varicose veins

A

Compression stockings

N.B. contraindicated in those with low ABPI

28
Q

Name interventional management of venous insufficiency

A 
Foam sclerotherapy (chemical thrombophlebitis)
Endovenous ablation
29
Q

What are some risk factors for intermittent claudication or AAA?

A 
Smoking
High BP
DM
High cholesterol
Male
Age (>55)
Alcohol
30
Q

What is the treatment for critical limb ischaemia?

A

Analgesia
Angioplasty/stenting
Surgical reconstruction
Amputation

31
Q

The risk of limb loss is increased by…

A

Smoking

32
Q

What is acute limb ischaemia? What are the two types?

A

Sudden loss of blood supply to limb

Acute or acute on chronic

33
Q

What is the cause of acute limb ischaemia?

A 
Embolism
Atheroembolism
Arterial dissection
Trauma 
Extrinsic compression
34
Q

What are the signs of acute limb ischaemia?

A

6Ps: pain, pallor, perishingly cold, pulseless, paraesthesia, paralysis

35
Q

If a limb is blanching it is reversible. True/False?

A

True. Non-blanching is irreversible.

36
Q

What is the management for acute limb ischaemia if the limb is salvageable or not?

A

SALVAGEABLE: embolectomy, thrombolysis, fasciotomy
NOT: amputation, palliation

37
Q

What post-op complication is associated with acute limb ischaemia? How is it managed?

A

Compartment syndrome due to re-perfusion injury

Fasciotomy

38
Q

What are the three types of aneurysm?

A

Saccular
Fusiform
Myocytic (all 3 layers of artery)

39
Q

What are some likely causes of aneurysms?

A 
Atheroma
Trauma
Endocarditis
Syphilis
CT disorder - Marfans
Inflammatory
40
Q

What veins are involved in varicose veins?

A

Long saphenous

Short saphenous

41
Q

What are some risk factors for varicose veins?

A 
Prolonged standing
Age
Obesity
Contraceptive pill
Pregnancy
Family history
42
Q

What are some signs/symptoms of varicose veins?

A

Pain, cramps, tingling, heavy or restless legs

Signs of chronic venous insufficiency - oedema, ulcers, thrombophlebitis, lipodermatosclerosis (hardening of skin)

43
Q

What is the first line investigation for varicose veins?

A

Duplex US scan

44
Q

What are some complications of varicose veins?

A 
Thrombophlebitis
Skin staining
Local ulceration
Wound infection
Nerve damage

Y1 CARDIOLOGY (16 decks)

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