PVS Flashcards
Pulsus parvus? Condition?
Small/weak
Decrease cardiac output
Pulsus parvus et tardus? Condition?
Weak and delayed pulse
Aortic stenosis
Bounding pulse? Condition?
- Increased pulse pressure
- Rapid, brief peak
↑ stroke volume:
Aortic regurgitation, bradycardia, AV fistulas
Pulsus alternans?
Variation in pulse amplitude occurring with alternate beats due to changing systolic pressure
Left ventricular failure
Pulsus bigeminus?
Two beats occur in rapid succession, followed by a pause (normal beat alternating with a premature contraction)
Premature ventricular contractions
Bisferiens pulse?
Two palpable peaks
Hypertrophic obstructive cardiomyopathy
Pulsus paradoxus?
Conditions?
A drop in systolic pressure > 10 mm Hg on inspiration
COPD exacerbations, acute cardiac tamponade, constrictive pericarditis, obstructive sleep apnea
ALLEN TEST
- when suspecting arterial insufficiency in the arm or hand
- to ensure patency of the ulnar artery before puncturing the radial artery for blood samples
Drains the superficial portions of the lower abdomen and buttocks, the external genitalia
Horizontal group
Drains the corresponding area for the great saphenous vein
Vertical group
risk factors for PAD (7)
Risk Factors: smoking hypertension hyperlipidemia family history renal disease diabetes hyperhomocysteinemia
Ask the patient to sit up with legs dangling down. Compare both feet, noting the time required for:
Return of pinkness to the skin (<10 sec)
Filling of the veins of the feet and ankles (15 sec)
- Look for any unusual rubor (dusky redness) to replace the pallor.
Postural Changes Test
Best initial (or screening) test for PAD
ABI index
Best initial imaging test
Duplex Doppler ultrasound
Acute Limb Ischemia
Ischemia: deficient arterial blood supply due to occlusion
Causes: sudden embolism or thrombosis (most common)
graft/ angioplasty occlusion
Trauma
Pre-existing CAD/PAD (+ previous history of claudication)
Clinical finding: of pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
Chronic Arterial Insufficiency
Pain: Intermittent claudication –> rest pain
Color: Pallor on elevation; dusky red on dependency
Skin changes: Thin, shiny, atrophic skin; hair loss; thickened & ridged nails
Ulceration: If present, involves toes or points of trauma on feet
Pulses: Decreased or absent
Temperature: Cool
ABI < 0.9
> 1.40
non-compressible
1.00-1.40
normal
.91-.99
borderline
abnormal
Aortoiliac Occlusive Disease (AIOD) AKA Leriche Syndrome
HISTORY & PE
Claudication of calf muscles, then thigh, hip and buttocks
Impotence/ erectile dysfunction
Diminished/ absent femoral, popliteal and pedal pulses bilaterally
Imaging
Same as for PAD
HX
• Asymptomatic (most)
• Sx of compression, erosion: chest pain, dyspnea, cough, hoarseness, dysphagia
• Sx of aortic regurgitation
PE
•Unremarkable
•AR murmur
•Marfan features
Unruptured THORACIC AORTIC ANEURYSM
HX
Acute, ripping chest pain radiating to the back
Dyspnea
PE
Hypotension, tachycardia
Acute AR murmur
Shock
Dissecting/ ruptured THORACIC AORTIC ANEURYSM
Abdominal ultrasound is for ?
Screening!
Indications
F: age 65- 75y who have ever smoked
M: age 65–75 y who have smoked at least 100 cigarettes in their lifetime
(+) FHx of AAA
CT or MRI with contrast ?
to determine the location and size of abdominal aortic aneurysms
M: F is 3:1
Young (<40 year old)
Smoking is the strongest risk factor
Thromboangiitis Obliterans
Thromboangiitis Obliterans DX ?
Arteriogram (smooth tapering lesions in distal vessels; corkscrew collaterals)
Usually women <30
Symmetric episodic attacks
No tissue injury
Negative ESR, ANA, C3 & C4
Primary Raynaud’s phenomenon
Age > 40, M>F Systemic symptoms Asymmetric attacks Tissue injury or digital ulcers -uncommon Abnormal nailfold capillaroscopy*
Secondary Raynaud’s phenomenon
Cold stimulation test is used in ?
Raynaud ‘s Phenomenon
Compression of the popliteal artery by the gastrocnemius or popliteus muscle
Young, athletic men and women (M>F), usually <30 yo
A congenital (3%) or acquired condition
Hx: Intermittent, exercise-induced, unilateral claudication
PE: Normal; may have diminished pulse on ankle dorsi/plantarflexion
Popliteal Artery Entrapment Syndrome
50% are bilateral Associated with aneurysm of the aorta SSx pulsatile mass limb ischemia secondary to thrombosis or embolism
Popliteal artery aneurysm
DDx to Popliteal artery aneurysm?
Baker’s cyst
Non-pulsatile mass
Knee pain, stiffness, swelling
Aggravated by prolonged standing, not relieved by rest
Venous Disease risk factors ? (4)
Female gender
Obesity
Pregnancy
Virchow’s triad
Hypercoagulability: malignancy, pregnancy, use of estrogen
Endothelial injury : trauma, surgery
Venous stasis: immobility (long trips, bed rest)
Chronic venous insufficiency s/s:
Hyperpigmentation
Stasis dermatitis
Ulcers (medial malleolus)
SSx: Leg pain Aching, burning provoked by standing, relieved by elevation dilated tortuous bluish-green veins
Varicose Veins
Thrombosis and inflammation, usually of the great saphenous vein
Epidemiology: F > M
Location: LE > US; sites of trauma (IV catheters)
Risk factors: Virchow’s triad
SSx leg pain \+ fever erythema, tenderness, induration (“nodular cord”) along the course of a vein swelling
Superficial Thrombophlebitis
Imaging: Duplex ultrasound
Findings: lack of compressibility of vein; impaired blood flow
Superficial Thrombophlebitis
