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Cardio > peripheral vascular disease > Flashcards

peripheral vascular disease Flashcards

1
Q

lower limb venous flow

A

low pressure system
requires ‘pump’
needs valves to prevent backflow

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2
Q

what happens if the valves stop working in the lower limb venous system

A

blood travels from high pressure (deep veins) to low pressure (superficial veins) > chronic venous insufficiency

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3
Q

chronic venous insufficiency

A

reflux between deep and superficial systems
causes increase in hydrostatic pressure in superficial system > venous hypertension > inflammatory response including leucocyte activation and abnormal healing response > vein wall fibrosis

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4
Q

varicose veins

A

valves connecting deep and superficial systems become incompetent
leads to venous dilation

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5
Q

investigation for varicose veins

A

duplex

and clinical examination

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6
Q

management for varicose veins

A

conservative: graduate compression stockings

endovenous/surgical: foam sclerotherapy, endothermal ablation, open surgery

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7
Q

3 clinical entities of limb ischaemia

A

acute limb ischaemia
acute on chronic limb ischaemia
chronic limb threatening limb ischaemia

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8
Q

acute limb ischaemia is due to

A

embolism
thrombus
trauma
laterogenic

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9
Q

how does embolism cause acute limb ischaemia

A

cardiac- usually context of AF (formed in left atria) or MI (left ventricle)
sometimes paradoxical embolus
non-cardiac- atheroembolism (diseased aorta, AA) or aortic mural thrombus

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10
Q

paradoxical embolus

A

clot from deep venous system passes through patent foramen ovale into arterial system

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11
Q

how does thrombus cause acute limb ischemia

A

hypercoagulable states

chronic atherosclerotic stenosis

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12
Q

investigation for acute and chronic limb ischaemia

A

measure severity by ABI
duplex US and doppler
ECG- MI arrhythmia
CT angiography-

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13
Q

management of limb ischaemia

A 
medical: dependent of extent, IV heparin, IV fluids 
surgical:
mild- moderate: thrombolysis 
if embolus: embolectomy
bypass (acute-on-chronic)
compartment syndrome: fasciotomies
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14
Q

management of chronic limb ischaemia

A 
exercised program
anti-platelet and statin (clopidogrel) 
(Naftidrofuryl oxalate as vasodilator) 
surgical: not generally recommended 
- percutaneous transluminal angioplasty
- bypass
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15
Q

acute on chronic limb ischaemia

A

acute occlusion on background of underlying disease
same initial management as Acute limb ischaemia
urgent arterial imaging required

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16
Q

aneurysm

A

dilation of vessel by more than 50% of the normal

17
Q

true aneurysm

A

the vessel wall is intact

18
Q

flase aneurysm

A

breach in vessel wall

19
Q

presentation of ruptured AAA

A

sudden onset epigastric/central pain
may radiate to back
mimic renal colic
collapse

20
Q

AAA when examined

A 
may look well 
hypo/hypertension
pulsatile, expansive mass 
transmitted pulse 
peripheral pulse
21
Q

screening for AAA

A

normal: <3cm
small 3-4.4cm- requires annual US
medium 4.5-5.4cm- require quarterly US and prevention therapy
large: >5cm - possible elective repair

22
Q

surgical and enodvascular intervention of AAA

A

open aneurysm repair

endovascular stent insertion

23
Q

surgical and enodvascular intervention of AAA

A

open aneurysm repair

endovascular stent insertion

24
Q

Diabetic foot sepsis includes…

A

diabetic neuropathy
peripheral vascular disease
infection

25
Q

clinical findings of diabetic foot sepsis

A

pyrexia, tachycardia, tachypnoeic, confused

swollen digits, swollen forefoot, tenderness, ulcer, erythema, necrosis

26
Q

management of diabetic foot sepsis

A

vascular surgical emergencies

antibiotics

27
Q

DVT

A

deep venous thrombosis

thrombi form in venous valve pockets ad other sites of presumed stasis

28
Q

PE

A

pulmonary emboli

thromboemboli detach and travel through the right side of the heart to block vessel in lungs

29
Q

virchows triad

A 
Hypercoaguable state (blood clotting components) 
endothelial injury (blood vessels)
circulatory stasis (blood flow)
30
Q

presentation of DVT

A

swollen painful limbs
redness and heat
tender along veins
dub acute development

31
Q

d-dimer

A

breakdown product of cross linked fibrin

32
Q

diagnosis of VTE

A

Wells score- doesnt confirm
if wells score shows unlikey to be VTE- do d-dimers
if d-dimers raised- radiological imaging to confirm
DVT- ultrasonography and doppler
PE- computed tomopraphic pulmonary angiography or V/Q isotope lung scanning

33
Q

management of DVT

A

oral anti-coagulation- apixaban or rivaroxaban, vitamin K- warfarin

34
Q

PE management

A

high risk- thrombolysis then oral anti-coagulation

Cardio (16 decks)

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