PVD Clin Med Final Flashcards
1
Q
PAD (arterial)
A
underdiagnosed, undertreated, highly preventable
2
Q
PAD
A
powerful, independent predictor of mortality
3
Q
Atherosclerosis
A
Hardening
development of fatty streaks (thickened intima and accumulation of foam cells)
plaque and such
Vulnerable plaque- burst and trigger a blood clot
4
Q
Atherosclerosis
A
frequently occurs at bifurcations: aortic, iliac, femoral
5
Q
Atherosclerosis affects:
A
more than 85 of adults >50 YO
6
Q
Contributors of Atherosclerosis
A
Endothelial dysfunction, Inflammatory factors, Immunologic factors, Plaque ruptures, Age
7
Q
Endothelial dysfunction
A
HTN, DM, Hypercholesterol, Smoking
8
Q
Acute limb ischemia
A
Potential threat to limb viability
9
Q
Chronic limb ischemia
A
meaning pt came in later than 2 weeks after onset of acute event
10
Q
Groups at risk for PAD
A
70 or older 50-69 w hx smoking or DM 40-49 w DM and at least one other risk factor Leg sx: claudication or pain at rest Known atherosclerotic at other site
11
Q
PAD risk factors
A
HTN, DM, Dyslipidemia, Smoking, Age, obesity >30BMI, fam hx
12
Q
Claudication
A
intermittent discomfort in a certain muscle group, worse with exercise and relieved with rest
13
Q
Leriche syndrome
A
Claudication
Absent/diminished femoral pulse
Erectile dysfx
14
Q
Aortoiliac disease
A
buttock and hip claudication
15
Q
Aortoiliac or common femoral artery disease
A
thich claudication
16
Q
Superficial femoral artery stenosis
A
upper 2/3 calf claudication
17
Q
Popliteal artery stenosis
A
lower 1/2 calf claudication
18
Q
Tibial or Peroneal artery stenosis
A
foot claudication
19
Q
Insufficient flow AT REST
A
Threatened limb!
10% pts w PAD
20
Q
Ischemic rest pain
A
pain in forefoot/toes WORSE W ELEVATION
21
Q
Critical limb ischemia
A
rest pain
non healing wound/ulcer
Skin discolor/gangrene
pain when elevated, redness when lowered
22
Q
PAD physical findings
A
blue, pale with elevation, dependent redness, thin, dry, shiny, and hairless
23
Q
PAD physical findings
A
brittle nails, cool temp, delayed cap refill, diminished pulse
24
Q
ABI
A
Ankle-brachial index
Ankle systolic/brachial systolic
ABI 0.90 or less with exertional sx is diagnostic for PAD
25
Arterial Duplex Doppler US
determine velocity of blood flow
can show site and severity of % stenosis
26
Contrast arteriography (angiogram)
GOLD STANDARD for definitive dx for PAD
27
Advanced imaging for PAD
CTA and MRA (takes longer, used to plan revascularization procedures)
28
PAD management
```
ASA or PLAVIX
stop smoking
Lipid lowering (Statin)
Control sugar and BP
weight loss/diet
```
29
Tx for claudication sx
supervised exercise
| Cilostazol - phosphodiesterase inhibitor
30
PAD: revascularization
Endovascular (first line)
used for CRITICAL limb ischemia (pain at rest, ulcer, gangrene)
31
Endovascular procedure options
Angioplasty
Stent
Atherectomy
32
Surgical options
Bypass graft
33
Acute arterial occlusion
leads to limb ischemia
usually d/t thromboembolism
34
Atheroembolism
cholesterol embolism
35
6 P's of Acute Arterial Occlusion
```
Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia-coolness
Paralysis
```
36
Management of Acute arterial occlusion
Emergency surgical consult
```
Anticoag: Heparin
Thrombolytic
Thrombectomy
surgical bypass
Amputation
```
37
Chronic Venous Disease
Telangiectasis 50-60%
Varicose veins 10-30%
Chronic venous infuff 1-5%
38
Chronic venous disease
incidene higher in women
39
Risk factors for Chronic Venous Disease
age, obesity, smoking, hx of LOWER EXT TRAUMA, PRIOR VENOUS THROMBOSIS, PREGNANCY, family hx of venous disease, STANDING OCCUPATION
40
Cause of Chronic Venous Disease
Dysfunction of venous valves d/t venous HTN
failure of the venous pump
41
Sx of chronic venous disease
Aching, heaviness, burning
worse with standing.
RELIEVED w ELEVATION
42
Elevate a venous leg
makes it better!
43
occasional rupture with local bleeding is characteristic of what
chronic venous disease
44
Chronic venous insufficiency
d/t valvular incompetence as a result of DVT w RESIDUAL DAMAGE TO VEIN
lumen reestablishes itself all funky after DVT
Post thrombotic syndrome develops
45
chronic venous insuff
rigid and thick walls
| More advanced signs: sig edema, skin changes, ulcers
46
Hemosiderin staining
pigmented byproduct of hemoglobin
chronic venous insuff
47
Lipodermatosclerosis
inflammation of fat under epidermis, subQ fibrosis and hardening of skin
chronic venous insuff
48
Venous duplex doppler US
used to determind velocity of BF
49
Venography
rarely needed but GOLD STANDARD. invasive and expensive
50
Stasis dermatitis
Aka Stasis eczema
51
Stasis dermatitis
erythema, inflamm, pruritis, scaling, vesicles form
medial ankle usually
Tx: emollients, barrier creams, topical steroids
52
Chronic venous disease tx
exercise, wt loss, elevate legs 30 min 4-3 x per day, compression
53
wound care for chronic venous disease
Unna boot: zinc paste impregnated bandage
occlusive hdrocolloidal or gel
54
Sclerotherapy
option for small surface veins
55
Surgical venous
vein stripping if significant
skin grafting also option for some ulcers
56
Arterial disease
pain with walking, resolves with rest
57
Venous disease
pain standing, resolves with elevation
58
Arterial ulcers
toe joints, malleoli, anterior shin, base of heel
pressure points
base: dry, pale/necrotic
arterial pulse: no
skin: atrophy, shint, taut, loss hair
59
Venous ulcer
malleoli above bony prominence, POSTERIOR calf, may be large, circumferential
base: pink with yellow fibrinous tissue, exudate
Arterial pulse is present
Skin: red, edema, dry, varicosities
60
M:F ratio for AAA
4:1
61
Cause of Aortic Aneurysms
Atherosclerosis most common
Also: conn tissue disorders (Marfans, Ehlers Danlos), Trauma
62
Aneurysm
usually 1.5-2x normal size
63
Dissection
tear in vessel wall creating true and false lumen
64
Type A Dissection
Worse prognosis
| Arch proximal to L subclavian artery
65
Type B dissection
Descending thoracic aorta (just beyond L subclavian)
66
Aortic Dissection sx
severe CP radiates to back, SUDDEN ONSET
syncope
CVA like sx
AMS
Paresthesia
67
Aortic Dissection physical findings
HTN, can be hypo if in shock, neuro deficitits
and
Horner's syndrome: ptosis, miosis, anhidrosis
68
Aortic Dissection test of choice
CT chest and abdomen
69
Aortic Dissection tx
Immediate control of BP with beta blockers (labetolol)
urgent surgical intervention (all type As)
70
Thoracic aneursym
<10 % of aortic aneursyms. more rare. bleeding rarely contained, no time for emergent repair
71
Sx of Thoracic AA
(most are asympto)
substernal back or neck pain, dyspnea, stridor, cough, edema in neck and arms, distended neck veins, hoarseness
72
TAA test of chocie
CT scan
73
AAA most common site
Infrarenal abdominal aorta
74
AAA clinical findings
5 cm or greater in 80% patients
most are asymptomatic until they rupture
75
AAA sx
back or abdominal pain with tenderness may proceed rupture
76
AA rupture
assoc w/high mortality
50% bleed out prior to making it to hospital
IF they do make it to hospital, only 50% make it out of surgery
77
AA rupture sx
EXCRUCIATING abdominal pain radiating into back, pulsatile abdominal pulse, tenderness, hypotension
78
AAA diagnostic
Abdominal US is screening diagnostic study of choice*
79
One time screening Abdominal US recommended for:
65-75 current or past smokers
65-75 who have never smoked but have 1st deg relative who required AAA repair or died from ruptured
80
When should CT scan be done for screening
when aneurysm nears diameter threshold for tx: 5.5 cm
81
AAA management
Risk factor modify, routine f/u
| Refer to vascular specialist when 4 cm or greater
82
When to repair AAA
> 5.5 cm in diamter or rapid expansion! >0.5 cm in 6 months
83
Carotid artery stenosis
can result in cerebral infarction
84
Carotid artery stenosis
TIA transient ischemic attacks
Focal neural sx:
Amaurosis Fugax: transient one eyed blindness
85
Amaurosis Fugax (robert had this)
transient monocular blindness
Ophthalmic artery
86
other sx of Carotid Artery Stenosis
contralateral weakness/numbness of extremity or face
dysarthria
aphasia
87
Phys ex findings of carotid artery stenosis
Carotid bruit
Absent pupillary light response
Fundoscopic exam: arterial occlusion or ischmemic damage to retina
88
Carotid duplex US (perform this first!!)
detects blood flow
89
Cerebral angiography
GOLD standard for Carotid artery stenosis
evaluates entire carotid system but invasive and expensive
90
Degree of stenosis - carotid artery stenosis
Severe is 70% or greater of lumen diameter
Moderate is 50-69% of lumen
91
Carotid artery stenosis screening
not recommended UNLESS
Bruit noted, other vascular sx, or 2 or more risk factors for atherosclerotic disease
92
Asympto Carotid atherosclerosis
Marker of increased risk for MI & vascular death
considered a risk equivalent for coronary heart disease
93
Tx for Carotid Artery stenosis
if Asympto: controversial
if Sx: Revascularization (carotid endarterectomy, carotid artery stenting (short term)
