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Clin Med - Cardio Exam #2 > Peripheral Vein Disease > Flashcards

Peripheral Vein Disease Flashcards

1
Q

What structures within the vein assist in pushing blood back towards the heart?

A

Valves

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2
Q

Define VV (varicose veins)

A

Dilated, tortuous superficial veins in lower extremeties

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3
Q

What veins are most commonly affected by VV?

A

Greater saphenous and its branches

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4
Q

what does distention of the vein lead to in VV?

A

weakened/incompetent valves and dilation along the vein

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5
Q

What does dilation in VV lead to?

A

Increased pressure and distention of the vein segment below the valve and progressive failure of the next lower level

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6
Q

r/f for VV?

A

genetics
prolonged standing
pregnancy
congenital or acquired AV fistula

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7
Q

Primary VV orginate in the ______ system?

A

superficial

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8
Q

VV are more common in ____ than ____

A

females than males

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9
Q

Secondary VV originate in the _______ system and _______?

A

deep system and perforating veins

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10
Q

Signs and symptoms of VV

A

can be asymptomatic
doesn’t correlate to number and size
if present develops after long periods of standing - dull ache/heaviness or fatigue of legs
may be palpablee in obese
Venous stasis dermatitis
brownish pigmentation and thinning of the skin above the ankle

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11
Q

W/u

A

Duplex imaging is best

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12
Q

DDX of VV

A 
Chronic venous insufficiency
Leg pain d/t 2nd cause
-arthritis
-radiculopathy
-arterial insufficiency
congenital malformation/atresia of deep vein in adolescent patients
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13
Q

Complications of VV

A

Superfician Venous thrombosis (rare)

Bleeding (secondary to trauma)

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14
Q

Non-surgical TX for VV

A 
avoid prolonged standing
compression stockings (med-heavy) when standing
Leg elevation when possible
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15
Q

Surgical Tx for VV

A

Radio frequency ablation
Greater saphenous vein stripping
Phlebectomy
compression sclerotherapy

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16
Q

When to refer to a vascular surgeon

A

Bleeding from VV
Superficial VV
Pain
cosmetic concerns

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17
Q

define superficial venous thrombosis

A

Clot that develops in superficial vein

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18
Q

Signs and symptoms of svt?

A

indurated warm red tender cord extending along superficial vein

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19
Q

T/f SVT can develop into PE?

A

F

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20
Q

R/f of SVT?

A 
Pregnancy 
varicose veins
 thromboangitis obliterates 
trama 
systemic hypercoagulability
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21
Q

DDx for SVT?

A 
cellulits
erythema nodosum
erythema induratum
lymphangitis
DVT
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22
Q

Supportive TX for SVT

A

Supportive:

elevation, warm compress, NSAID

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23
Q

When is anticoag used in the event of an SVT?

A

only when a thrombus has developed in thigh/arm and is exteding toward the saphenofemoral junction or cephalon-axillary junction (could potentially migrate to the deep system)

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24
Q

Definition of CVI

A

condition that occurs when wall and/or valves aren’t working effectively. Blood can’t return to heart

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25
Q

How are CVI and VV different

A

VV is dilation and malfunctioning
CVI is when the walls and valves aren’t working properly

CVI is a complication of VV but not everyone with VV will develop CVI

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26
Q

CVI is mc in _____ than _____

A

females than males

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27
Q

Causes of CVI

A 
Secondary to DVT
Hx of leg trauma
VV
Pelvic tumor
Vaslcular malformation
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28
Q

with CVI the ______ ______ are either thickened or scarred, or functionaly inadequate. This causes abnormally high hydrostatic forces that are transmitted to the ______ and _____ of the lower leg.

A

Valve leaflets

subcutaneous veins and tissues

29
Q

What secondary changes can occur from chronic edema?

A

fibrosis of subcu tissue and skin
pigmentation of skin
ulceration that are slow to heal
Varicosities if d/t post-thrombotic event

30
Q

R/f for CVI

A 
DVT
VV
Obestiy
Pregnancy
inactivity
smoking 
extended periods of sitting/standint
female
age over 50
31
Q

What is primary sign/symp of CVI

A

Progressing pitting edema of leg!!

32
Q

What are some of the secondary symp/signs for CVI?

A

itching
dull ache in leg worse with prolonged standing/sitting
skin at ankle tight and shiny w/ brown pigment
subcu tissue becomes thick and fibrous
ulceration may occur near medial and lateral malleolus
cellulitis

33
Q

w/u for CVI?

A

US

34
Q

TX for CVI

A

compression stocking-mainstay!
Avoid long periods of sitting/standing
intermittent elevations of leg above level of heart

35
Q

Tx for wounds that develop as result of CVI

A

Ulcers-wound care specialist referral
Unna’s boot
Once healed compression

36
Q

Surgical tx for CVI

A

for pt’s with chronic/recurrent ulcers

RFA (radiofrequency ablation) or laser to area of ulceration to promote healing

37
Q

Define DVT

A

blood clot that develops in deep vein system, and may partially/completely block flow through the vein

38
Q

Where are DVT’s MC found?

A

lower extremity (but can develop elsewhere)

39
Q

Define Virchow’s Triad?

A

Venous stasis
injury to vessel wall
hypercoagulable state

40
Q

Etiology of DVT?

A

Venous stasis D/t
-immobilization
-reduced blood flow to heart (polycythemia)
Reduced flow through legs (abd. mass, pregnancy)
Mechanic injury to vein wall-trauma/surgery
Hyper coagulable state
-genetic mutation
-secondary-surgery malignancy

41
Q

Complications of DVT

A

PE
post thrombotic syndrome (CVI_
Phlegmasia alba dolens
phlegmasia cerulea dolens

42
Q

Defile phlegmasia alba dolens

A

Edema in the leg puts pressure on arteries which decreases blood flow to area-causes a white leg

43
Q

Define phlegmasia cerulea dolens

A

progression of white leg-complete occulsion of not only venous system but also arterial system as well. Prognossi is very poor

44
Q

Symptoms of DVT

A

often asymptomatic
leg swelling
leg pain
unilateral leg tenderness

45
Q

signs of DVT

A

unilateral pitting edema
increased calf circumference
calf tenderness
Homan’s sign

46
Q

DDX for DVT

A 
ruptured bakers cyst
cellulitis
lymphedema
thrombophlebitis
post-thrombotic syndrome
trauma
CVI
bone neoplasm
Heart failure
Nephrotic syndrome
cirrhosis
47
Q

w/u for DVT

A

Well’s criteria
D dimer (non-specific)
US
MR venography (when US is non-specific and there is still a high probability)

48
Q

what is the high risk score for well’s criteria in DVT?

A

3 points- 75%

49
Q

What is moderate risk score for well’s criteria for DVT?

A

1-2 points 17%

50
Q

What is low risk score of well’s criteria for DVT?

A

less than 1 point 3%

51
Q

What factor does US depend on being present to rule in DVT?

A

non-compressible veins

52
Q

TX for DVT?

A

Preventing complications is primary
Mainstay of TX:
-Immediate anticoag w/ UFH, LMWH or fondaparinux followed by conversion to coumadin or thrombolytics

53
Q

How long does a pt need to be bridged for warfarin tx?

A

5-10 days

54
Q

what is coumadin INR target for pts with DVT?

A

2.5 (range of 2.0-3.0)

55
Q

What is more commonly used for tx of DVT and why?

A

LMWH - lovenox, (vs. UFH), this is because it has a greater bioavailability and is more predictable

56
Q

Other than LMWH and UFH what can be used for immediate anticoag?

A

Fondaparinux

57
Q

What is used for long term DVT oral anticoag?

A

Warfarin

58
Q

How many days does it take for warfarin to become therapeutic?

A

minimum of 5 days

59
Q

what must be monitored while taking warfarin?

A

INR

60
Q

What is typical starting dose of WarfarN

A

/5mg

61
Q

How do thrombolytics work to tx pt with DVT?

A

Directly attacks the clot

62
Q

When are thrombolytics indicated in DVT?

A

very select extensive DVT, of recent origin, in pt with low bleeding risk

63
Q

When is an IVC filter indicated?

A

Active bleeding that contraindicates anticoag

recurrect DVT despite intensive anticoag.

64
Q

t/f DVT is tx as an outpatient?

A

T

65
Q

How long should duration of tx be for pt’s with provoked DVT in arm/calf

A

3 months

66
Q

How long should duration of tx be for pt’s with provoked proximal leg DVT?

A

3-6 mos

67
Q

How long should duration of tx be for pt’s with cancer?

A

3-6 most of LMWH w/o warfarin and continue anticoag indefinitely unless pt become cancer free

68
Q

How long should duration of tx be for pt’s with unprovoked DVT?

A

Consider indefinite tx d/t high rate of recurrence

69
Q

In patient with a genetic d/o how long should they be treated for DVT?

A

indefinite tx

Clin Med - Cardio Exam #2 (12 decks)

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