signs/Sx/mechanisms Flashcards by Sarah Van Acker

with limb pain, (claudication) disease is usually _ to the symptoms

proximal

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does the patient have good days and bad days?

if the pain is not consistent every time than problem may be neurogenic/ orthopedic in nature.

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what is claudication

pain in muscle during activity and subsides with rest, due to inadequate blood supply .

pain subsides within minutes after ending of activity .

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Ischemic rest pain is

severe symptom of reduced blood flow

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where does ischemic rest pain usually present?

forefoot
heel -plantar
toes

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what type of energy creates relief for ischemic rest pain?

potential energy/ hydrostatic pressure

pain occurs when the limb is not dependent.

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end stage of chronic arterial disease

necrosis of tissue

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claudication and ischemic rest pain is chronic arterial disease (T) or (F)

True- usually caused by atherosclerosis

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Acute arterial occlusion signs and symptoms (p’s)

6 (P's)
pain
pallor
pulselessness
paresthesia - numbness tingling 
paralysis
polar

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(3) causes for acute arterial occlusion

thrombus
emboli
trauma

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what makes acute arterial occlusion an emergency situation and not chronic occlusion

no time for development of collateral channels

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Vasospastic disorders

Primary Raynaud’s

Secondary Raynaud’s

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Primary Raynauds is marked by what

intermittent digital ischemia due to cold exposure to emational stress

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what symptoms present with primary Raynauds

pallor
cyanosis
rubor - due to vasodialation may cause warmth due to ischemic cond’

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Primary Raynauds is a _ condition

benign

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Ischemia in Primary Raynauds is due to __

is common in __population, commonly__ and occurs __

digital arterial spasm
young women
hereditary
bilateral

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Secondary Raynauds is also known as __

obstructive Raynauds syndrome

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mechanism of Secondary Raynauds is

vasoconstriction of arterioles present with a FIXED artery obstruction

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With secondary Raynauds ischemia is ___ present

constantly

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Secondary Raynauds may be the beginnings of what other disease

Buerger’s which is Arteritis

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what (3) signs of occlusion will present on physical exam

pallor
cyanosis
rubor

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cyanosis is

concentration of deoxygenated hemoglobin

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rubor suggests

dilated vessels

dilated vessels secondary to reactive hyperemia

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reactive hyperemia is

aka venous hyperemia

increase in organ blood flow occurring following brief period of ischemia

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what is the difference between hyperemia and congestion

hyperemia- active process, red raised temp increased volume enhanced function congestion passive process, cyanosis , hypoxia, low temp, increased volume edema, decreased function, eg; local obstruction or CHF

capillary filling test is ____ and accomplished how?

qualitiative | squeezing toe cut off circulation and seeing how blood returns to the skin

Refill time for qualitative capillary refill time is

3 seconds greater than 3 seconds indicates ischemic conditions

elevation and dependency changes indicative of ischemic conditions appear how (2)

pallor - elevation | ruborous discoloration- dependent position

aneurysms can be desctibed as ____ when palapated

bounding

pulses are graded on a scale of ___ to ___

0 - none | 4+ - bounding

Arterial ulceration locations typically occur (inner or outer) area of LE or on tips of or between ____. Or where there is ____ from walking or footwear.

tibial area --OUTER ankle on tips or between toes preassure

Arterial ulcerations are characterized by a ______ look. | Usually ____ in shape. with ______, ____ wound margins.

punched -out look | well-defined, even wound margins

The wounds are (shallow/deep). | and (does/does not) bleed.

deep | does not bleed.

colors of arterial ulcerations | 4

yellow brown grey black

with arterial ulcers the affected area will have little to no ____, nails appear___ and hair____ with skin taking on shiny thin dry and taut appearance with delayed capillary return.

pulse atrophic hair loss

difference between arterial ulcer and venous ulcer

arterial ulcers- VERY Painful. temporary relief is gravity dependant venous ulcers- redness and edema at site of ulcer and may be painless, and relief is found with elevating limb

palpable thrill is_____may indicate ____, ____, or ______

thrill is vibration that you FEEL (you can FEEL a Thrill) fistula, dialysis, post-stenotic turbulence

palpable pulses are found over what LE vessels | 6

``` aorta femoral popliteal dorsalis pedis (DPA) posterior tibial (PTA) ```

Bruits are _______ found by _____

noise you can hear auscultation BRUEE are loud

Bruits are commonly mentioned with what exam

carotid the dr heard one and wants to know were the stenosis is coming from

auscltation of bruits can be found in the following (5) areas

``` aorta femoral popliteal carotid heart ```

Risk factors for arterial disease | controllable factors

diabetes HTN hyperlipidemia smoking

uncontrollable arterial disease risk factors

age male family history

Diabetes affects vessels through mechanism of ____________ and occurs at older or younger age

atherosclerosis | affects people at a younger age

diabetes induced atherosclerosis has higher insidence of what (I2)location on LE

distal popliteal and tibial arteries

medial calcification develops in LE arteries, this is associated with increased risk for ___________ events as the disease process affects what layer of the vessel.

cardiovascular | medial layer of the vessel is affected

diabetes induced atherosclerotic disease is associated with a higher incidence of what end stage symptoms

gangrene and amputations | caused by lack of feeling due to co occurring neuropathy

hypertension affects arterial disease by one of what two processes

cause or enhance atherosclerotic processes

what causes hyperlipidemia

diet high in fat, metabolic tissues based on heredity

how does smoking induce atherosclerotic disease

chemicals irritate artery intimal lining causing vasoCONSTRICTION

what is ASO

atherosclerosis obliterans

atherosclerosis obliterans is

hardening of the artery thickening and loss of elasticity

in ASO where do changes occur in the vessel wall

intima and media

what are most important risk factors for ASO: | 3

smoking hyperlipidemia family history

other risk factors for ASO

HTNm diabetes, sedentary lifestyle and arterial wall shear / stress

most common sites for ASO

``` (Think Bifurcations) carotid bifurcation aorto-iliac system * CFA bifurcation SFA-distal ```

what is Leriche Syndrome

Ao occlusion

Leriche syndrome affects ____population and is characterized by what 4 symptoms

Leriche syndrome affects male population more fatigue in lower extremities (hips thighs calves) with excercize absence of femoral pulses impotence pallor and coldness of LE

Acute occlusion is marked by ______, or ______. and can come in the form of ___, ___, or ____.

thrombus or plaque that has become mobile and traveled to a diameter vessel that it occludes solid , liquid or gas

what is trash foot? and is related to sedentary atherosclerosis or embolism onset usually is duration of ____ days

blue toe syndrome and is related to embolism ischemia develops and improves due to collaterazation 1-2 days out ...

what are main cause of embolism- 3

small plaque break loose due to atherosclerotic lesion arteritis angiographic procedure

what other disease should be suspected if blue toe syndrome is present

AAA

what kind of aneurysm is the most common type of aneurysm

true aneurysm

define true aneurysm | name 2 subtypes of true aneurysm

dilatation of all tree arterial wall layers | saccular and fusiform

define saccular aneurysm

sac-like localized dilation

define fusiform aneurysm

circumferential | diffuse dilation

____ aneurysm is small tear of the ____ wall which allows blood to form between two layers in arterial wall

dissecting | intimal wall tear

where is most common place for dissecting aneurysm

thoracic

pseudoaneurysm the ___ arterial layer is affected, is usually ______ cause. And is presented as ______ structure usually found in ____area

outter arterial wall iatrogenic cause pulsatile structure outside vessel wall groin area

what is most common site for true aneurysm

infrarenal

locations for aneurysm : | 5

``` infrarenal renal popliteal artery commmon femoral thoracic ```

50% of patients with _________ are bilateral and include AAA

popliteal aneurysm

more often if aneurysm is in the CFA and popliteal artery have a higher insidence of ____

another aneurysm elsewhere

what are risk factors for true aneurysm | 4

poor nutrition atherosclerosis infection myrafans syndrome

most frequent complication of AAA is _____ and accumulates ______inside

rupture | thrombus

most frequent complication of peripheral aneurysm is ______ and accumulates _____inside

embolization | thrombus `

non atherosclerotic lesions | 5

``` arteritis coarctation of the aorta dissection vasospastic disorders entrapment syndrome ```

Arteritis affects what vessels | 2

think distal arterioles-- small vessels tibial peroneal

inflammation of the arterial wall can lead to ________

thrombosis

most common type of arteritis

buerger's disease

buerger's disease is also called

thrombo-angitis obliterans

buergers disease affects men _____ who smoke heavily

<40 yrs of age

patients present with _______ of distal arteries

occlusion

Buerger's disease patiens present with | 3

ischemic fingers ischemic ulceration rest pain

Coarctation of the Aorta causes ______ in the artery

strictiure congenital narrowing of the thoracic aorta , can present in the abdominal aorta as well

Clinical findings with coarctation of the aorta | 2

HTN due to decreased kidney profusion | LE ischemia --reduced pulses

Dissection of arteries can affect both Aorta and peripheral arteries (T/F)

True

What are sonographic characteristics of a dissection

intimal flap | two flow patterns within the lumen- bidirectional flow

flow _____ will differ in each lumen in dissections

velocities

complications of dissection include | 4

stenosis occlusion thrombosis rupture

Aortic dissections can extend to _______ and could be due to ______, _____, or be _________.

iliacs. | HTN, severe chest trauma, or be spontaneous

is Ultrasound important diagnositc tool in identifing dissections

yes