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Cardiovascular > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

In relation to the blockage where will pain be felt?

A

Distal

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2
Q

A patient comes into the GP with calf pain whilst playing golf, it is usually around the 5th hole but now nearer the 4th it is relieved when she stops. What is the diagnosis?

A

intermittent claudication

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3
Q

Describe intermittent claudication

A

muscle ischaemia on exercise, usually comes on at a steady distance & relieved at rest

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4
Q

Describe the progression of intermittent claudication

A

As symptoms worsen so does the blood supply until continuous pain at rest occurs leading to tissue loss

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5
Q

How can intermittent claudication be assessed?

A

Ankle brachial pressure index

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6
Q

What values indicate claudication from the ABPI?

A

Normal 0.9 -1.2
Claudication 0.4 - 0.85
Severe 0 - 0.4

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7
Q

What is a duplex ultrasound?

A

combination of doppler - looks at flow and ultrasound - sees a 3D image

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8
Q

Name three invasive tests for arterial disease

A
  • Magnetic resonance angiography
  • CT
  • Catheter angiography
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9
Q

How can arterial disease be slowed down?

A 
stop smoking 
lipid lowering 
anti platelet (aspirin & clopidogrel) 
hypertension treatment 
diabetes treatment 
lifestyle
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10
Q

What can be offered for intermittent claudication?

A

Supervised exercise programmes the more you walk the better it will be, however this only treats symptoms

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11
Q

What treatment is available for arterial disease?

A
  • Angioplasty with batons & stents

- Bypass

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12
Q

Name three things required to complete bypass surgery

A
  1. inflow
  2. outflow
  3. graft
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13
Q

Why is it better to use a patients own vein as opposed to a prosthetic one?

A

Microorganisms love prosthetic veins whereas a patients own veins are resistant to infection

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14
Q

How can critical limb ischaemia be described?

A

Toe/foot pain usually at night when flat in bed, then progresses to all the time

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15
Q

What can critical limb ischaemia lead to?

A

Ulcers & gangrene as a result of minor trauma

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16
Q

State five clinical features of critical limb ischaemia

A
  • cold
  • absence of pulses
  • poor tissue nutrition
  • venous guttering
  • ulcers/gangrene
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17
Q

What is venous guttering?

A

When you lift the leg up the vein will empty rapidly

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18
Q

If an artery cannot be treated what is required?

A

Amputation

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19
Q

What does amputation depend on?

A

Damage to leg & blood supply

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20
Q

Name the structure that connects the deep venous system to the superficial system

A

Perforators

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21
Q

What is required in order to get blood out of the legs?

A
  1. Vessel
  2. Valves (one-way system)
  3. Pump (muscles)
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22
Q

Define varicose vein

A

dilated, tortuous superficial elongated vein due to abnormal transmission of deep vein pressure

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23
Q

What are the two types of varicose vein?

A

Primary - occurs out of the blue

Secondary - due to DVT

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24
Q

Name risk factors for Varicose veins

A
  • Age (old)
  • Gender (female)
  • Pregnancy
  • Obesity
  • Family history
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25
Q

State five clinical features of Varicose Veins

A
  • bleeding
  • thrombophlebitis
  • venous hypertension
  • lipodermatosclerosis
  • ulceration
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26
Q

What do you do if a varicose vein starts bleeding?

A

Elevate and apply pressure

27
Q

Define thrombophlebitis

A

inflammation of a vein caused by a clot

28
Q

What does venous hypertension lead to?

A

Haemosiderin deposits

29
Q

State the characteristics of lipodermatosclerosis

A

white cells, inflammation & fibrosis

30
Q

Why must you be careful of ulceration?

A

There may be an underlying cause especially if it has rolled edges

31
Q

What investigation is done for varicose veins?

A

Duplex scan to check if;

  • occlusion or incompetence
  • which vein/valve is affected
32
Q

How can a varicose vein be managed?

A

Educate the patient, bandaging & graduated compression

33
Q

When are compression stockings contraindicated?

A

Patients with a low ABPI

34
Q

What procedures can be done on a patient with varicose veins?

A

Endogenous - foam or ablation - x-ray guided

Surgery - high tie distal from ablation (50% risk of wound infection)

35
Q

What are the three types of ablation?

A
  • mechanical
  • laser (heat)
  • radiofrequency (waves)
36
Q

Define abdominal aortic aneurysm

A

dilatation of a vessel by more than 50% of its diameter

37
Q

In terms of vessel wall what are the two types of aneurysm

A

true - vessel wall is intact

false - breach in the vessel wall

38
Q

Name three types of aneurysm

A
  1. saccular
  2. fusiform
  3. mycotic - due to infection
39
Q

Describe the pathogenesis of AAA

A

Medial degeneration leads to an imbalance between elastin/collagen. This causes aneurysmal dilatation and increase in vessel wall stress

40
Q

Name four risk factors for AAA

A
  • age
  • gender
  • smoking
  • hypertension
41
Q

What are the symptoms of an AAA?

A

75% asymptomatic

Symptoms ; pain, trashing, rupture

42
Q

Define trashing

A

Parts of the thrombus break off & clot

43
Q

How are asymptomatic patients diagnosed?

A

Imaging

44
Q

How will an AAA rupture present?

A

Sudden onset epigastric pain, the patient may look well but will be hypo/hypertensive, pulsatile, have transmitted & peripheral pulses

45
Q

What types of AA are treatable?

A

Contained retroperitoneal but 50% operative mortality

46
Q

When are AAA dealt with?

A

If symptomatic, >5.5cm, grows >1cm/year

47
Q

How are AAA detected?

A

Duplex ultrasound - allows you to see front - back diameter

48
Q

Name the investigation used to assess the complexity of the aneurysm

A

CT scan using IV contrast, only method in detecting a ruptured AAA

49
Q

What is the management for an AAA?

A 
Open repair (laparotomy, clamp aorta & iliac, graft new aorta) 
Endovascular (EVAR, x-ray guided insertion of a stent with a seal)
50
Q

Define acute leg ischaemia

A

sudden loss of blood supply to a limb

51
Q

What are the causes of acute leg ischaemia?

A
  • embolism
  • atheroembolism
  • arterial dissection
  • trauma
  • extrinsic compression (cancer & limb disease)
52
Q

State the six P’s of acute leg ischaemia

A 
Pain 
Pallor 
Pulseless 
Persistently cold 
Paraethesia 
Paralysis
53
Q

After how many hours of no blood supply can a leg be saved?

A

0-4 hours salvageable
4-12 hours partly reversible
>12 irreversible (not blanching/ turning white from purple when pressed)

54
Q

Describe the test for a patient with acute limb ischamia

A

ABC
FBC U/E, CK, Coag, Troponin
ECG

55
Q

If the limb is salvageable what is done?

A

Embolectomy
Fasciotomies
Thrombolysis (rare)

56
Q

If it is not salvageable what is done

A

Palliation or amputation

57
Q

What does the ageing population mean?

A

Not just one emboli may be present

58
Q

What is the triad for a diabetic foot sepsis?

A
  • neuropathy
  • PVD
  • Infection
59
Q

What does diabetic foot sepsis lead to?

A

Ulceration, necrosis & gangrene strongest risk factor for

60
Q

State the causes for diabetic foot sepsis

A
  • simple puncture wound
  • infection from the nail plate/inter-digital space
  • neuro-ischaemic ulcer
    Build up of puss cannot escape, pressure builds up leading to rapid sepsis & necrosis
61
Q

What are the features of diabetic foot sepsis?

A
  • swollen affected digit/forefoot
  • tenderness
  • ulcer
  • erythema
  • patches of necrosis
62
Q

Describe the management of diabetic foot sepsis

A

Polymicrobial needs broad spectrum antibiotics & rapid surgery of infected tissue - open wound to encourage drainage

63
Q

How can diabetic foot problems be prevented?

A

Education &assessment

Cardiovascular (19 decks)

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