Vasc Flashcards
Presentation with warm, tender, unilateral, swollen red calf, what questions are important to ask?
- recent immobility: any recent surgery, long haul flights
- Coughed up any blood, any SOB?
- PMH: pregnancy, surgery, cancers, previous DVT, thrombophilia.
- DH: pill
- FH: clotting disorders, cardiovascular
How should the legs be measured if a DVT is suspected?
- 10cm below tibial tuberosity
- Greater than 3cm circumference difference
What is Wells’ score used for, and what does it consist of?
- Clinical signs of symptoms of DVT
- PE is no.1 diagnosis, or equally likely
- Heart rate >100
- Immobilisation for 3 days or surgery in previous 4 weeks.
- Previous PE/DVT
- Haemoptysis
- Malignancy
- Malignancy/treatment within 6 months.
What symptoms might present with a PE?
- Short of breath, acute
- Pleuritic chest pain (worse on breathing in, sharp)
- Haemoptysis
- Dizzy & syncope
What signs may exist in a PE?
- Pyrexia
- Cyanosis (low O2 & CO2)
- Tachypneoa/cardia
- Raised JVP
- Hypotension
- Pleural effusion (present on CXR - pulmonary arteries may also be dilated)
What type of aneurysm in the most common in the abdominal aorta?
Fusiform
What can cause an AAA?
Atheroma Trauma Inflammatory Infection Males over 50 Degenerating elastic lamella & smooth muscle
Where can pain be felt in a AAA?
Ache in tummy ‘feel like heart is in tummy’
Expansile abdo mass
How big does an AAA have to be to warrant repair?
Greater than 5.5cm
Expanding by 1 cm/yr
Symptomatic
Where can pain be felt in a ruptured AAA?
Continous/intermittent abdo pain, radiates to groin, back and iliac fossa.
Collapse & shock
Management of a ruptured AAA?
Vascular surgeon and anaesthetist called.
ECG
Bloods: amylase, Hb, crossmatch
Catheterise
IV access, 2 large bore cannula
Treat shock, but BP MUST remain under 100 mmHg systolic
Clamp and graft
What is it called when a vein becomes long, tortuous, dilated and superficial?
Varicose vein
Why do varicose veins occur?
Failure of a valve in a superficial vein
What can cause varicose veins?
- congenital
- obstruction/destruction
- DVT
- Constipation
- Prolonged standing
- Obesity
- Pregnancy
- FH
- Pill
What symptoms would you expect to see with varicose veins?
Pain Cramps Tingling Heavy Restlessness
What signs could also be present with varicose veins?
Oedema
Eczema
Ulcers
Haemorrhage
Where may you see varicose veins?
Anterior thigh & medial calf: long saphenous
Back of calf: short saphenous
What investigations may you carry out with varicosity?
Trendelenburgs
Doppler for incompetent valves
How might varicose veins be managed?
Avoid prolonged standing, elevate legs, wear compression stockings, lose weight.
Endovasc: Radiofrequency ablation to close vein, lasers, surgery
When would a varicose vein warrant a referral?
Bleeding Pain Ulcers Thrombophlebitis QOL
Define intermittent claudication.
Cramping pain and weakness in legs on walking that disappears with rest.
Where is the blockage if intermittent claudication is felt:
a) in the buttock
b) in the calf
a) iliac artery
b) Femoral artery
What is Buerger’s syndrome?
Occurs in young heavy smokers
Inflammatory condition - blood becomes pro-thrombotic leading to occlusions
6 signs on acute ischaemia?
Pale Pulseless Painful Paralysed Paraesthetic Perishingly cold
