PVD Flashcards
at what rutherford stage does PAD go to rest pain then tissue loss
4 is rest pain, 5 and 6 are mild and severe tissue loss
what sx are associated w/ critical limb ischemia
rest pain and tissue loss/ulceration
medical management of PAD
risk factor modification: diabetic tx, HTN tx, smoking cessation, eat healthy, lipid reduction, exercise, stress reduction
cilostazol can help w/ intermittent claudication
2 categories of surgical intervention for PAD
bypass and endovascular (balloon and stent)
definition of aneurysm
at least 50% widening
protective factors for AAA
female, black, DM dx
causes of mycotic aneurysms
secondary infection- staph, salmonella, strep
inflammatory aneurysm characteristics
dense periarotic fibrosis- lymphos, plasmas, macros, giant cells
congential syndromes w/ aneurysms
marfans: fibrillin 1 defect, defect in elastin microfibrils esp in descending aorta
type IV ehler danlos- type III procollagen defect
clinical presentation of AAA
asymptomatic, distal emboli, abdominal/back pain, rupture (pain, hypotension, pulsatile mass)
common place to find athero plaque
bifurcations- lateral wall of carotid artery, thickest at bulb
Dx for carotid stenosis
use carotid duplex (ultrasound, see velocities in various branches of carotids)
MRA, or angiogram
medical therapy- secondary stroke prevention
aspirin and clopidogrel- double platelet inhibition
surgical tx for secondary stroke prevention
carotid endarterectemy, carotid stenting
diff b/w true and false aneurysm
true: bounded by complete wall components
false: rupture in a layer but contained by outer layers, not evenly widened
fusiform vs saccular aneurysm
fusiform is ovoid swelling, saccular is a bubble like outpouch
AAA is associated w/
always severe atherosclerosis
half have HTN, more males
location of aneuysm w/ syphilis, cystic medial degeneration, athero
in order: ascending aorta, ascending and thoracic aorta, abdominal aorta and muscular arteries
define aortic dissection
dissection of blood b/w planes of media, blood filled channel in aortic wall, frequently ruptures
common predispositions to aortic dissection
groups: men 40-60 w/ HTN, young pts w/ connective tissue problems like Marfans
most common preexisting lesion is cystic medial degeneration (Marfans)
thing in common is weakened media
cystic medial degeneration
separation of elastic and fibromuscular elements by small cystic spaces, filled w/ ECM
type A vs type B dissection
type A- proximal or proximal and distal
type B- distal only
type A and proximal more dangerous
common sites for arterial thrombosis
large and medium muscular arteries- aorta, carotid, coronary
intracardiac
Homan sign
forced dorsiflexion of the foot seen w/ DVT
patho of varicose veins
venous wall weakness increases venous pressure and valve incompetence- leads to the dilated, tortuous superficial veins
define raynauds
arterial and arteriolar vasospasm from cold and emotions, esp in fingers and toes
clinical appearance of raynauds
pallor to blue to red, cold, paresthesia, pain
tx for raynauds
prevention, CCB, a1 blockers, vasodilators
temporal arteritis epi
aka giant cell, elderly ppl, most common vasculitis
patho of giant cell
idopathic- granuloma formation in med-large arteries esp branches of carotid like Temporal
giant cell arteritis associated w/
polymyalgia rheumatica
clinical pres of giant cel arteritis
unilateral throbbing headache, sometimes visual involvement
tx for giant cell
steroids
patho of polyarteritis nodosa
idopathic- type 3 immune response w/ Ag-Ab complex, leads to fibrinoid necrosis, thrombosis, and infarct
clinical pres of PAN
constitutional sickness, stenosis/infarct effect in arteries/ organs
tx of PAN
steroids
patho of kawasaki
idiopathic- systemic necrotizing vasculitis of small-med arteries and lymphadenopathy
clinical pres of kawasaki
fever, rash, mucosal lesions, lymphadenopathy, strawberry tongue, many have coronary artery involvement (some w/ aneurysm)
tx for kawasaki
IV Ig, aspirin (rare use of aspirin w/ kids)
patho of takayasu arteritis, other names
aka aortic arch aka pulseless disease
idiopathic- granuloma inflammation in med-large arteries w/ or w/o stenosis, thrombosis, aneurysm
clinical pres of takayasu
constitutional symptoms from inflammation, no pulse
tx of takayasu
steroids
buergers disease etiology and other names
thromboangitis obliterans, from tobacco use
patho of buerger’s
acute inflammation of small-med arteries of distal limbs, thrombosis and infarct
clinical pres and tx of buergers
intermitten claudication, pain, can go to ulcers and gangrene
cease tobacco use
patho of hemangioma
proliferation of endothelium creating large and/or small vascular channels
often on skin, organs, mucous membrane
patho and histopatho of kaposi sarcoma
HHV8 infection causes unregulated endothelial growth
spindle cells (malignant) and lbood filled vascular spaces
define cardiac myxoma, patho
benign neoplasm of primitive connective tissue in heart, usually in atria (more left)
composed of ECM (myxoid stroma) and a few tumor cells
sx from blood flow obstruction
