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Yr 5 Cardiology > Phlebitis, PAD > Flashcards

Phlebitis, PAD Flashcards

1
Q

What is superficial thrombophlebitis?

A

Superficial vein becomes inflamed & forms a clot within

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2
Q

Which vein is normally affected by thrombophlebitis?

A

Long saphenous

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3
Q

What are the risk factors for thrombophlebitis?

A 
Obesity
Thrombophilia
Smoking
COCP
Pregnancy
IVDU/ IV infusion
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4
Q

What is migratory thrombophlebitis?

A

Recurrent thrombosis in superficial veins at various sites

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5
Q

What conditions is thrombophlebitis associated with?

A

Polyarteritis nodosa

Buerger’s disease

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6
Q

How does superficial thrombophlebitis present?

A

Erythema
Swelling
Tenderness
ALL ALONG VEIN

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7
Q

What are signs of varicose vein thrombophlebitis?

A

Hard, tender knot within vein

Erythema & bleeding at site

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8
Q

How does septic thrombophlebitis present?

A 
Often with long-term cannula/IVDU
Local irritation
Hard lump
Fever, tachy, hypoT
N&V
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9
Q

What investigation should be avoided in superficial thrombophlebitis?

A

Venography- contrast medium may aggravate condition

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10
Q

How is superficial thrombophlebitis managed?W

A

1) Elastic support
2) Exercise
3) Analgesia- TOP NSAID (Naproxen)
4) LMWH: Tinz 1m

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11
Q

What is the mechanism of PAD?

A

Signif obstruction to blood flow
↓oxygenation of limbs
Characteristic claudication pain during exercise
Obstruction worsens → rest pain (critical limb ischemia)
Skin ulceration → gangrenous necrosis → amputation of necrotic limb

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12
Q

How does acute PAD occur?

A

Embolus

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13
Q

How does chronic PAD occur?

A

Atherosclerosis

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14
Q

How does functional PAD occur?

A

Vasospasm (transient)

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15
Q

What are the signs of chronic upper limb PAD?

A

Pulse deficit
Arm pain/pallor/paraesthesia/perishingly cold
Unequal BP in arms

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16
Q

If there is upper limb claudication what condition should be considered?

A

Takayasu’s

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17
Q

Which vessel is most commonly affected in chronic upper limb PAD?

A

Subclavian artery + brachiocephalic trunk

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18
Q

Which vessel is most commonly affected in chronic lower limb PAD?

A

Superficial femoral artery

19
Q

What are the signs of chronic lower limb PAD?

A

Ischaemic pain- intermittent claudication
Throbbing/cramping/tightness
Pain relieved by resting/hanging leg over bed
Commonly U/L

20
Q

How does acute limb ischaemia present?

A 
6 P's!!
Rapid onset
High severity
Dusky leg
Mottling
21
Q

What is Leriche’s syndrome?

A 
Claudication
Pain in buttock/thigh
Absent femoral pulse 
Male impotence
Due to saddle aorta-iliac obstruction
22
Q

How does critical limb ischaemia present?

A

Ischaemic rest pain
Ulcers/gangrene
6 P’s
Pulse deficit

23
Q

How is PAD investigated?

A 
Assess ALL pulses
ABPI 
Doppler probe
Duplex USS- 1st LINE IMAGING
Contrast MR angio
24
Q

What do the different ABPI values represent?

A

> 1.2- calcified stiff arteries = advanced age or PAD
1.0-1.2 = normal (0.9 – 1.0 = Ok)
< 0.9 = likely PAD
< 0.5 = Critical PAD requires urgent referral
< 0.1 = ACUTE ISCHAEMIC LIMB

25
How is ABPI calculated?
highest ankle pressure / highest arm pressure
26
What different sounds can be heard with a doppler probe?
``` Triphasic = normal Biphasic = Abnormal Monophasic = PAD ```
27
In PAD who gets duplex USS?
ALL patients who require revascularisation
28
How quickly does acute limb ischaemia need to be treated?
4-6hours
29
What is the Rutherford classification for acute limb ischaemia?
Dusky leg = Viable → Arteriography White leg/paralysis = Threatened → Surgery Fixed staining/mottled/ tense muscle = Irreversible → TLC/amputation
30
How is acute limb ischaemia treated?
Analgesia + UFH if for surgery Surgical embolectomy fails → angiogram If due to thrombosis → Alteplase
31
How is critical limb ischaemia treated?
Revascularisation via angioplasty/bypass | Amputation
32
How is chronic limb PAD treated?
``` Exercise program Analgesia Treat co-morbidities Clopidogrel if Sx Naftidrofuryl oxalate (VasoD) Surgery: Angioplasty + stent or bypass ```
33
What is given long term post-intervention in acute limb ischaemia?
Warfarin
34
What is the mechanism of a reperfusion injury?
Neut migrate to reperfused tissue = inflammation Limb oedema due to ↑capillary permeability → compartment syndrome Leakage from damaged cells Acidosis, ↑K+ (arrhythmia), myoglobinaemia (ATN → AKI, ↑urine Na+ ↓osmolality)
35
Describe venous ulcers
- Caused by chronic venous insufficiency - Sloughy, painless, superficial oedema, mottled- brown/black - Above ankle - below knee
36
Describe arterial ulcers
- Toes & heels -Punched out, circular, painful, gangrenous -Pain worse when lying, better when legs lowered -No palpable pulses Hx = PAD, claudication
37
Describe neuropathic ulcers
- Due to pressure & lack of sensory innervation - Plantar surface of hallux & metatarsal head - Painless
38
What are varicose veins?
Leakage @ venous valves Retrograde flow Deep veins can tolerate pressure but superficial veins cannot Become dilated & torturous
39
Which vein is usually affected in Varicose veins?
Saphenous
40
What are the Sx of varicose veins?
INITIALLY: Itching, discomfort, heavy feeling, ↓Exercise tolerance, night cramps, burning sensation THEN: dull aching pain & cramps, visible, large veins, chronic venous insufficiency
41
What are signs of chronic venous insufficiency?
``` Ulcers Lipodermatosclerosis (hardened, indurated skin) Pigmentation Telangiectasia Eczema ```
42
How are varicose veins investigated?
Duplex USS- DIAGNOSTIC Examination Trendelenburg test: Assess valvular competency Perthe's test: Assess deep venous patency
43
How are varicose veins managed?
Conservative: Avoid long standing, elevate legs, compression stockings, lose weight Endovascular Tx: Radiofrequency ablation, laser ablation, injection sclerotherapy (foam)
44
What is a complication of varicose veins?
Saphena Varix: Dilatation in saphenous.v at confluence w/ femoral vein→ transmits a cough impulse- can be mistaken for inguinal/femoral hernia, inspect = bluish tinge

Yr 5 Cardiology (8 decks)

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