PVD & VTE Flashcards
pallor w/ raised extremity, hair loss on leg/foot, atrophic skin, delayed cap refill, cyanosis
PAD
walking impairment, claudication, ischemic rest pain, erectile dysfunction, non-healing wounds could indicate?
arterial & venous PVD
Leriche Syndrome (3)
decreased femoral pulses
impotence
butt & thigh claudication
amaurosis fugax is associated with?
Carotid artery disease
asymptomatic carotid artery disease treatment
tx HTN, hyperlipidemia, DM, smoking cessation, aspirin
pain in chest, neck, back
swelling of head, neck, arms
thoracic ascending aneurysm
wheezing, SOB, hemoptysis, hoarseness, dysphagia, chest/back pain
aortic arch or descending aortic aneurysm
indication for surgery of thoracic aortic aneurysm
5-6 cm
4.5-5 cm in Marfan’s
treatment of thoracic aneurysm (5)
B-blockers Ang II receptor blockers statins smoking cessation BP goal < 140/90
intima tears, blood penetrates into the media, splitting it longitudinally- false channel created
aortic dissection
Type A Aortic dissection symptom
chest pain
Type B aortic aneurysm symptom
Back pain
TX for type A thoracic aortic dissection
surgery
tx for type b thoracic aortic dissection
reduce BP- B-blockers, then vasodilators
abd pain, pulsatile abd mass, tenderness, hypotension
ruptured AAA
AA dissection tx
surgery for > 5.5 cm or symptoms of rapid expansion
most common complaint w/ abdominal aortic dissection?
back pain
narrowing at bifurcation, presents w/ chronic lower limb ischemia
Aorto-Iliac Occlusive Disease
typical aorto-iliac occlusive disease pt?
younger, female, smoker, hyperlipidemia, small infrarenal aorta
TX for aorto-iliac occlusive disease
aortic bypass surgery, endovascular angioplasty w/ or w/o stenting
venous thrombosis, varicose veins, chronic venous insufficiency
peripheral venous disease
commonly seen after reperfusion of ischemic limb, typically calf
compression of nerves, veins, and arterial inflow
Compartment syndrome
Tx for arterial disease (4)
walking
cholesterol therapy
aspirin
surgical intervention to remove plaque
tx for venous disease (3)
walking, limb elevation, compression therapy
Virchow’s triad
stasis
vessel wall injury
hypercoaguability
asymptomatic; otherwise swelling, pain, warmth, redness
DVT
DVT tx
prevent clot propagation, prevent PE
UE DVT tx
anticoagulant
thrombolysis
surgical decompression
superficial thrombophlebitis tx
local heat, NSAIDs
should resolve 1-2 wks
veins visible on surface following injury, like venous cath/PICC, IV tx
superficial thrombophlebitis
obstruction of the pulmonary a. or one of its branches by material that originated elsewhere in the body
PE
sustained hypotension, pulselessness, bradycardia
resulting in right ventricular failure and possible death
massive PE
RV dysfxn or myocardial necrosis w/o systemic hypertension
submassive PE
dyspnea, tachypnea, pleuritic pain, calf/thigh pain
PE
EKG prognostic finding w/ PE
S1Q3T3
gold standard for diagnosing PE
Pulmonary angiography
how long should heparin therapy go?
at least 5 days
VTE tx (5)
anticoag meds thrombolytics thrombo/embolectomy IVC filter prophylactic measures
anti coag medicine for long term tx of VTE?
warfarin (coumadin)
initial tx of VTE
IV unfractionated heparin
outpt tx of VTE, stable PE for at least 5 days
LMW heparin
Factor Xa inhibitors? (3)
Fondaparinux (Arixtra)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
acute tx of VTE as “bridge” to warfarin
arixtra
acute tx & secondary prevention of VTE (2)
Xarelto, Eliquis
antidote for heparin
protamine
direct thrombin inhibitor, acute tx and secondary prevention
Dabigatran (Pradaxa)
duration of anticoag therapy for transient risk factor
3 mo
duration of anticoag therapy w/ cancer
3 mo. or for the duration of the cancer
duration of anticoag therapy for unprovoked thrombosis
3 mo., consider indefinite
duration of anticoag therapy for underlying thrombophilia
indefinite
activate plasminogen to form plasmin, resulting in accelerated lysis of thrombi
thrombolytics
thrombolytic tx recommended for?
for unstable (hypoxia risk) pts w/ PE
indication for thrombolectomy
unstable PE
IVC filter
prevents DVT from propagating to lungs
IVC filter indications/contraindications
indicated for: recurrent PE despite adequate anticoag
contraindicated for: coags (acute bleeding)
outpt tx for VTE is indicated for? (4)
no indication of PE
pain controlled
good pt compliance
can pay for it
otpt tx of VTE is contraindicated if
DVT of IVC, common femoral, or UE
recent surgery
noncompliant PT
