Ses 6 Cvs Arrythmia And Circulation (bice) Flashcards
Veins how do they drain notion
Superficial veins within the subcutaneous tissue
perforating veins running from superficial to deep veins.
Deep veins below deep fascia and between muscles.
Varicose veins cause, complications, symptoms, risk factors
Varicose veins – valves ineffective and blood movement is slow or even reversed.
Walls of veins weaken → varicosities develop and valve cusps separate, becoming incompetent.
Veins tend to be tortuous and twisted.
Saphenous veins are common site of pathology.
Complications:
Development of chronic venous insufficiency - reflux or obstruction → venous hypertension
Superficial vein thrombophlebitis (inflammatory processes resulting from a clot in vein). Painful erythematous follows varicose veins increased risk of DVT.
Lipodermatosclerosis (inflammation and thickening of fat layer under the skin)
Haemosiderin staining – brawny oedema
Venous ulceration
Symptoms - Heaviness and aching, muscle cramps and throbbing, ankle swelling, varicose eczema, haemorrhage from damaged veins.
Risk factors - Age, family history, female sex, number of births, occupation-standing allot
Explain the role and functioning of the calf muscle pump
Soleus and gastrocnemius muscles contribute to pushing blood against gravity
back towards the heart.
Valves open → blood pushed through to deep veins → valves close. Superficial to deep to heart.
Venous pressure in the foot reduced during exercise (compared to standing still).
Venous eczema and ulceration cause and presentation
Eczema - chronic, itchy red and swollen
tight and can lead to lipodermatosclerosis –
hard to the touch compared to other fatty
tissues above or below
Ulcer - chronic, painful, often develop around
hard nodular areas like medial malleolus
Treat ulcer and cause!
- Result of venous hypertension
calf muscle pump failure
Need to be using calf muscles properly – plantar flexion of the
ankle joint during walking
Who is at risk? • Deep vein incompetence – retrograde flow – system overwhelmed • Superficial vein incompetence – superficial → deep becomes deep
→ superficial
calf muscle pump “overflows”
Gait
Treatment- Ligation and vein stripping to treat – improves ulceration
Arterial + venous Thrombosis characteristics + Virchow’s triad
Arterial thrombosis
- atheroma
platelet rich – activated platelets – aggregate – plaque formation
Venous thrombosis
- stasis and usually another factor eg trauma, medication, dehydration, pregnancy.
Low flow and little platelet component, fibrin rich.
Triad:
Stasis
Hypercoagubility
Vessel wall damage
DVT what is it, consequences and signs
Clotting of blood in a deep vein – commonly calf
Consequences:
Impaired venous return
Inflammatory response produced following thrombosis
- pain, swelling, redness
Fatal - pulmonary embolism
Signs:
Calf tenderness + warmth
distended and visible superficial veins - oedema
Pyrexia with no other obvious cause
Asymmetry
Differential diagnoses – soft tissue trauma,
cellulitis, lymphoedema
Wells score – pre test probability forms part of diagnosis
-all suspected DVT patients
Why does surgery inc risk of DVT and how to prevent
during surgery - Stasis – no calf muscle pump
after surgery - trauma – cutting means blood in prothrombotic state
Prevent by:
Promote mobility soon after surgery
Prophylaxis (anticoagulants) ↓DVT associated with surgery
Gradient stockings
Collateral circulation
Physiological design to limit incidence of acute ischaemia when you flex a joint eg knee(genicular branches of popliteal artery), shoulder, hip
Or
Adaptive response to stenosis of a major vessel over a period of months or years.
Angiogenesis
Sprouting- FGF(fibroblast GF) produced by mesenchymal cells • Pericytes convert into smooth muscle cells • Slow, takes hours to days
Intussusception - Twinned vessels from primary vessel - multiple GFs - quick, mins to hrs
Acute limb ischaemia
Occlusion occurs acutely – minutes to days – no collateral circulation can develop in this time
Trauma and embolism - atrial fibrillation, popliteal artery aneurysm,
sudden rupture of atherosclerotic plaque
6 Ps
Pain - initially
Pallor*
Perishing with cold*
Pulseless
Paraesthesia*
Paralysis or reduced power*
* may be subtle –compare both limbs
imaging → angioplasty/thrombectomy/intra-arterial thrombolysis or amputation.
Compartment syndrome can be a complication if revascularisation possible.
Chronic peripheral arterial disease notion
Can be considered in similar terms to coronary artery disease
intermittent claudication of the lower limb (or upper limb) • Claudication – cramping pain in the leg induced by exercise
caused by atherosclerosis
exercise induced – like stable angina (oxygen demand/supply ratio disupted) • Pain goes away upon rest “only painful when I am walking”
• Management - exercise, smoking cessation,
antiplatelet drugs, angioplasty, bypass graft
Ankle-brachial pressure index (ABPI)
• ABPI part of early diagnostics for peripheral artery disease
• Divide ankle systolic by brachial systolic
• ABPI <0.8 suggests presence of peripheral artery disease
Pathology of claudication
atheroma → atherosclerosis of
superficial femoral artery • Present with calf claudication • Untreated becomes critical ischaemia - dry gangrene
Where the stenosis is identified will dictate where the claudication
presents and which pulses can be palpated
Critical limb ischaemia
Progression of chronic peripheral vascular disease
rest pain - blood supply so poor pain at rest– like unstable angina
“hanging foot out of bed relieves pain” - gravity to perfuse leg
untreated leads to ulceration and gangrene – viability of limb severely compromised – like AMI • Strong pain relief likely needed at this stage
• Referral to vascular surgical unit immediately
– extent of threat to limb survival dictates action
– imaging → angioplasty/thrombectomy/intra-arterial
thrombolysis or possibly even amputation
Palpation of lower limb pulses - watch videos
Femoral pulse – felt at the mid inguinal point
Popliteal pulse – deep in the popliteal fossa - inferior to vein
Dorsalis pedis pulse – just lateral to extensor hallucis longus tendon
Posterior tibial pulse – just behind the medial malleolus
