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FA17 Cardio 1 > Peripheral Vascular Dz > Flashcards

Peripheral Vascular Dz Flashcards

1
Q

atherosclerosis of lower/upper extremities

A

peripheral arterial disease

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2
Q

risk factors of peripheral arterial disease

A

smoking
diabetes mellitus
hyperlipidemia
hypertension

presence of PAD is high 10 yr CVD risk

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3
Q

intermittent claudication

A

ischemic muscle pain and weakness in lower extremities

exacerbated by walking

blood supply is enough for sedentary activity but with activity, unable to walk

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4
Q

pseudoclaudication

A

lumbar spinal stenosis

not a PAD complication, instead pts experience persistent muscle pain, weakness, and tingling that is exacerbated by STANDING erect

relief while sitting down or flexion at waist when walking

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5
Q

PAD physical exam findings

A

poor peripheral pushes
ulcerations
skin changes
hair loss

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6
Q

leriche syndrome

A

severe atherosclerosis of abdominal aorta and iliac arteries

caludication symptoms in buttock, thigh, and hip

erectile dysfunction/impotence

poor femoral pulses

aortoiliac bypass graft is treatment

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7
Q

complications of PAD

A

claudication
ischemic ulcerations of lower extremities
amputations
increased risk of cardiovascular event

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8
Q

PAD diagnosis

A

clinical suspicion + Ankle Brachial Index

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9
Q

ABI classifications of PAD:

> 1.3

A

non-compressible and calcified vessel

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10
Q

ABI classifications of PAD:

0.91-1.30

A

normal

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11
Q

ABI classifications of PAD:

0.41-0.90

A

mild to moderate PAD

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12
Q

ABI classifications of PAD:

0.-0.4

A

severe PAD

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13
Q

clinical classification of PAD

A

can be mild, moderate, severe, etc.

rutherford symptoms classification (severity of claudication)

fontaine classification (walking distances provoke claudication)

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14
Q

PAD management

A

treatment of atherosclerosis risk factors, lifestyle modification, anti platelet therapy

HTN, DM, HLD, Smoking

LDL <100

aspirin or clopidogrel (morality decrease)

cilostazol, pentoxifylline (symptom benefit)

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15
Q

Revascularization

A

done to treat PAD

  1. percutaneous revas. (stent, small stenosis)
  2. arterial bypass (large area, severe claudication, ALI)
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16
Q

acute limb ischemia

A

sudden occlusion of lower extremity artery secondary to arterial embolism, thrombosis in situ

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17
Q

acute limb ischemia symptoms

A

sudden onset of claudication symptoms: PAD 6 Ps

pain, pallor, pulselessness, polikilothermia, paresthesia, paralysis

crescendo pattern

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18
Q

treatment of acute limb ischemia

A

anticoagulation
smaller occlusion = stent, larger = bypass

may have to treat gangrene

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19
Q

types of gangrene

A

dry gangrene
gas gangrene
wet gangrene

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20
Q

general pathophys of gangrene

A

tissue loses blood supply and undergoes necrosis

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21
Q

dry gangrene

A

develops from ischemic tissue where blood supply is inadequate to keep tissue viable

so tissue undergoing sterile ischemic coagulative necrosis

clear tissue margins

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22
Q

wet gangrene

A

stagnant blood flow promotes rapid growth of bacteria

characterized by thriving bacteria

tissue swells and emit awful smell, can cause sepsis

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23
Q

gas gangrene

A

myonecrosis that can progress to necrotizing fasciitis

at first skin is normal but pain is out of proportionate

eventually will have sepsis symptoms, palpable crackles, dish water discharge

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24
Q

characteristics of necrotizing skin infections

A

spectrum of illnesses, characterized by

fulminant, extensive soft tissue necrosis, systemic toxicity, high mortality

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25
Q

risk factors for necrotizing skin infections

A

DM, alcoholism, age, peripheral vascular disease, renal failure, HIV, IV drug abuse

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26
Q

pathophys of gas gangrene

A

direct invasion of subQ tissue from external trauma

bacteria proliferate, invade subQ tissue and deep fascia

causes ischemia, liquefaction, and systemic toxicity

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27
Q

diagnosis of gas gangrene

A

clinical suspicion + extremity x rays, CTA, MRI, emergent surgical consult, angiograms

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28
Q

treatment of gas gangrene

A

aggressive IV fluids

broad spectrum ABX

emergent debridement or amputations

hyperbaric oxygen

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29
Q

aortic aneurysm

A

dilation of aorta due to weakening of blood vessel wall

risk rupture of hemorrhage, arterial branch stenosis or occlusion

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30
Q

aortic aneurysm

mortality

A

risk of rupture increases exponentially above 5cm diameter

larger risk the bigger it is

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31
Q

risk factors for aortic aneurysm

A

atherosclerosis

rustic medial necrosis (marfan syndrome and ehlers dances)

vasculitis (takayasu, giant cell)

chronic infection

trauma

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32
Q

clinical features of marfan features

A

arachnodactyly

ectopic lentis

long slender limbs

murmurs

aortic aneurysm and disseaction

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33
Q

clinical presentation of abdominal aortic aneurysms

A

compression of adjacent structures causes symptoms

mural wall thrombus may form that causes lower extremity ischemia

iliac aneurysms can comprise ureter and cause hydronephrosis

pulsatile mass below umbilicus

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34
Q

clinical presentation of AAA

A

if they rupture –> abdominal pain, hypotension

cardiovascular emergency

high mortality

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35
Q

AAA diagnosis

A

duplex ultrasonography to screen then CT angiogram for diagnosis

** In emergencies, CT angiograms are used

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36
Q

management of AAA

< 5.5 cm

A

smoking cessation

tight blood pressure control (Beta blockers)

cholesterol reduction

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37
Q

management of AAA

> 5.5 cm

A

surgery

open gortex graft or EVAR

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38
Q

acute aortic syndromes

A

aortic dissections

incomplete dissection

intramural hematoma

penetrating ulcer

39
Q

aortic dissection

A

dissection of blood into intimal layers results in false lumen parallel to true lumen

40
Q

risk factors of

aortic dissection

A

hypertension

connective tissue disease

trauma

cocaine use

aortic coarctation

vasculitis

41
Q

aortic dissection

mortality

A

if the arch is involved, 50% mortality in first 48hrs , 90% in first month

42
Q

clinical presentation

aortic dissection

A

sudden chest pain and/or back pain

abdominal pain

proximal dissection - coronary A. and MI

cardiac tamponade

43
Q

diagnosis of aortic dissection

A

must have high clinical suspicion

“tearing chest or backspin”

chest Xray, CT angiogram, MRA

44
Q

aortic dissection management

A

ICU management

blood pressure reduction

stanford A- surgical therapy + medical therapy

stanford B- medical therapy alone

45
Q

acute mesenteric ischemia

etiologies

A

arterial embolism

atherosclerosis in situ thrombosis

vasospasm of mesenteric arterial system causing decrease flow

46
Q

consider an embolism as a cause of acute mesenteric ischemia if:

A

sudden onset of pain

risk factor: atrial fibrillation

47
Q

consider a thrombus as a cause of acute mesenteric ischemia

A

history of PAD causes a plaque to rupture and develop a thrombus lodged in mesenteric a.

abdominal pain worsened with eating

slower presentation, causes unintentional weight loss

48
Q

consider non occlusive etiology if acute mesenteric ischemia

A

angina of the gut

49
Q

clinical features of acute mesenteric ischemia

A

severe abdominal pain ( out of proportion to exam)

no peritoneal signs (i.e. guarding or rebound)

may have melena or hematochezia

pts will appear very ill

50
Q

diagnosis of acute mesenteric ischemia

A

lactate elevation

CT Abd/pelvis with contrast = “thumb printing” sign, portal venous gas, pneumatosis intestinalis

51
Q

pathoneumonic findings of acute mesenteric ischemia

A

Thumbprining sign on a plain x ray

portal venous gas

pneumatosis intestinalis

52
Q

compared to acute mesenteric ischemia, acute colonic ischemia has

A

patients are not very ill

risk factors are aortic or iliac artery, MI, cardiac bypass, drug side effects, etc.

53
Q

acute mesenteric ischemia tx

A

surgical resection

54
Q

specific acute mesenteric ischemia tx = arterial emboli or thrombosis

A

IV hydration
pain management
vascular surgery consult

55
Q

chronic mesenteric ischemia treatment

A

angioplasty with stent

surgical bypass

56
Q

pathophysiology of vasculitis

A

inflammation of blood vessels due to infection, connective tissue disorder, or idiopathic

57
Q

idiopathic vasculitis

A

buerger disease

non atherosclerotic diseases of small peripheral arteries, veins, nerves

found in young men who smoke

claudication symptoms and necrotic eschar

58
Q

buerger disease diagnosis

A

young smoking male

no evidence of atherosclerosis or emboli

segmental occlusion to small vessels and cork screw collaterals on CTA

59
Q

buerger disease treatment

A

smoking cessation (halt progression)

iloprost (systemic vasodilator)

vascular surgery

60
Q

Raynaud’s phenomenon

A

vasospastic disease of small arteries

primary (no underlying disease) and secondary (autoimmune, buerger disease, drugs)

61
Q

Raynaud’s phenomenon

primary features (sex, age, freq., other)

A

mc in female, adolescents, daily episodes

No finger edema, perilungual erythema, arthritis, no autoantibodies

62
Q

Raynaud’s phenomenon

secondary features

A

male or female, 20-30s, weekly/monthly episodes

common finger edema and redness, arthritis, and autoantibodies

63
Q

clinical features of Raynaud phenomenon

A

recurrent episodes of color changes to toes, fingers, nose, ears due to vasospasm of digital arteries

white (pallor) –> blue (cyanosis) –> red (reactive hyperemia)

64
Q

Raynaud phenomenon

treatment

A

avoidance of triggers

calcium channel blockers

65
Q

Takayasu arteritis

pathophysiology

A

idiopathic granulomatous vasculitis of aorta, branches, and pulmonary artery

granulomatous inflammation in vessel wall results in stenosis and aneurysm

66
Q

Takayasu arteritis epidemiology

A

young asian women

67
Q

Takayasu arteritis clinical features

A

history of fatigue, weight loss, low grade fevers

cool extremities, caludicaiton or numbness, syncope

68
Q

Takayasu arteritis

physical exam findings

A

hypertension of stenosis of renal artery or coarctation of Aorta

aortic regurgitation murmur heard on left sternal border

69
Q

Takayasu arteritis diagnosis

A

clinical presentation consistent

angiogram evidence of stenosis of Aorta or branches

70
Q

Takayasu arteritis treatment

A

corticosteroids

vascular surgery consultant

71
Q

giant cell arteritis

epidemiology

A

more common in females 50+

males more likely to go blind

72
Q

temporal arteritis

pathophysiology

A

vasculitis of temporal arteries + subclavian, axillary, and aortic a.

causes ocular blindness due to occlusion of retinal artery

73
Q

clinical features of giant cell arteritis

A

jaw claudication, retinal a. occlusion

syndrome of pain of shoulder/hip

tender temoral pulse

cherry red spot

74
Q

diagnosis of giant cell arteritis

A

elevated ESR and CRP

temporal artery biopsy (shows inflammation)

tx: of high dose corticosteroids

75
Q

AV malformations

A

abnormal communications that shunt blood from arteries to veins bypassing the capillaries

can be seen in hereditary hemorrhagic telangiectasia

76
Q

varies veins/venous insufficiency

A

dilated tortuous veins of lower extremities, gradual and painful development

caused by venous insufficiency (poor valvular function causes pooling of blood)

77
Q

venous insufficiency risk factors

A 
smoking 
deep vein thrombosis 
sedentary lifestyle/obesity 
lower extremities trauma 
pregnancy
78
Q

clinical présentations of venous insufficiency

A

skin changes
lower extremity edema
leg pain/heaviness

79
Q

venous insufficiency diagnosis

A

venous duplex ultrasound

80
Q

venous insufficiency treatment

A

elevation

compression stockings

silver dressings

escin

81
Q

phlebitis v. thrombophlebitis

A

thrombophlebitis - inflammation and confirmed thrombus

phlebitis is just inflammation

82
Q

signs and symptoms of phlebitis

A

pain, tenderness, redness, swelling

vein feels like palpable cord

83
Q

risk factors off phlebitis

A

IV sites, esp/ potassium

hypercoaguable conditions

thrombophlebitis migrans

84
Q

thrombophlebitis migrans

A

migrating thrombophlebitis due to thrombosis of superficial veins in multiple ares of body

associated with adenocarcinoma

85
Q

virchows tirad

A

endothelial injury
venous stasis
hypercoagulation

86
Q

DVT to PE

A

thrombus forms in calf and breaks off, travels thru heat to pulmonary artery

blocks blood flow causing hypoxia and decreased preload

87
Q

DVT clinical manifestations

A

unilateral calf/leg swelling
Homans sign (pain w/dorsiflexion)
warmth/tenderness

88
Q

Wells Criteria for DVT

A

add one point for: cancer, paralysis, bedridden, tenderness, leg swollen, calf swollen, pitting edema, collateral superficial vein, previous documented DVT

score of 3+= high probability, 1 or 2= moderate, 0= low

89
Q

low probability of DVT work up

A

D-dimer

if elevated, u/s
if normal, it’s not DVT

90
Q

moderate to high DVT probability

A

venous doppler u/s of lower extremities

91
Q

modified wells criteria

A

diagnoses PE, >4 - likely

3 points: clinical DVY, ddx is less likely

  1. 5: HR >100 bpm, immobilization, previous PE/DVT
    1: hemoptysis, malignancy
92
Q

PERC

8

A

used if pts have low probability of PE , if patients meet all 8 likely not PE

age <50
hr < 100 bpm
O2 sat <95% 
no memoptysis 
no estrogen use 
no history of DVT/PE 
no unilateral swelling 
no surgery or trauma
93
Q

gold standard for PE diagnosis

A

CTPA

be careful, risk of AKI with contrast

if risk is there do a VQ scan

94
Q

other testing for PE

A

EKG (S1-Q3-T3)

ABG, Chest X RAY (westermark sign, ham-tom’s hump)

FA17 Cardio 1 (6 decks)

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