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Cardiology > Vascular > Flashcards

Vascular Flashcards

1
Q

What are indications for amputation? 3Ds

A

Dead limb - gangrene
Deadly limb - wet gangrene, spreading cellulitis
Dead useless limb - gross deformities

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2
Q

What are the benefits of above knee amputation?

A

Quick to do

Heals reliably

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3
Q

What are the potential complications of amputation? (early)

A

Haemorrhage
Ischaemia
Infection
Wound dehiscence

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4
Q

What are the potential complications of amputation? (late)

A

Pain from unresolved infection

Adherent to bone and an amputation neuroma

Phantom limb

Phantom pain

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5
Q

What is aortic dissection?

A

Tearing of intima media

Blood pools in the media layer

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6
Q

How does someone with Aortic dissection present?

A

Tearing chest pain radiating through the back
Tachycardia
Hypotension
New AR murmur

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7
Q

What is a AR murmur?

A

Aortic regurgitation murmur

Valves cannot close and become leaky

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8
Q

Define aortic dissection

A

Injury to the innermost of the aorta allows for blood to flow between the aortic walls forcing them apart

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9
Q

What are the two ways of classifying Aortic Dissection?

A

Stanford (Type A or B)

Debakey (Type I, II and III)

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10
Q

What bedside investigations would you do in aortic dissesction?

A

ECG to exclude other cardiac pathology

A to E assessment

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11
Q

What bloods for possible aortic dissection?

A 
FBC
U&Es 
LFTs
Coag
Lactate
Trop
Group and save
Cross match 10 units of blood
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12
Q

What imaging do you do for aortic dissection?

A

CT with contrast

See the artery with a line going through it

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13
Q

Define acute limb ischaemia

A

Sudden decrease in limb perfusion that threatens the viability of the limb = VASCULAR EMERGENCY

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14
Q

What are the causes of acute limb ischaemia?

A

Embolic
Thrombotic
Traumatic
Stent-related

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15
Q

What are the 6Ps of acute limb ischaemia?

A

pain, pallor, perishingly cold, pulselessness, paresthesia, paralysis

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16
Q

What are the investigations for acute limb ischaemia?

A

ECG to look for AF
Doppler USS

Routine + serum lactate, dying tissue

CT/MR angiogram with contrast
Digital subtraction angiography

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17
Q

What is thrombus association with?

A

AF because of stasis

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18
Q

How do we manage acute limb ischaemia?

A

Referral to tertiary vascular centre

Embolectomy or Thrombolysis

Bypass or angioplasty in long thrombotic occlusions

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19
Q

What is done in prep for surgery for patients with acute limb ischaemia?

A

IV Heparin
IV fluids
NBM

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20
Q

What are the complications of acute limb ischaemia?

A 
Reperfusion injury
Compartment syndrome
Release of substances from damage muscle cells:
K+ --> hyperkalaemia
H+ --> acidosis
Myoglobin can result in AKI
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21
Q

What is chronic limb ischaemia?

A

Symptomatic reduction of blood supply to the limbs
aka
Peripheral arterial disease

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22
Q

What can be caused by chronic limb ischaemia?

A

Intermittent claudications - cramping pain after walking a fixed distance

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23
Q

What defines critical limb ischaemia?

A

ABPI < 0.5

Persistent rest pain

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24
Q

What is the classification of chronic limb ischamia?

A

Stage I - asymptomatic
Stage II - Intermittent claudication
Stage III - Ischaemic rest pain
Stage IV - gangrene

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25
Q

What is ABPI?

A

Ankle brachial pressure index (ABPI)

The ABPI is the ratio of the ankle systolic blood pressure to the brachial systolic blood pressure

Normal is 1

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26
Q

Why might the ABPI be greater than 1?

A

Pressure in leg higher than brachial caused by calcification

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27
Q

How can we manage chronic limb ischaemia conservatively?

A

Regular exercise
Healthy diet/Weight loss
Smoking Sensation

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28
Q

How can we manage chronic limb ischaemia medically?

A

Statin
Anti-platlet
Optimise diabetes

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29
Q

How can we manage chronic limb ischaemia surgically?

A

Bypass using vein conduit or PTFE
OR
Angioplasty with/without stenting

Amputation

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30
Q

What are the main features of an arterial ulcer?

A 
Lower legs and tops of feet or toes
Painful
Symmetrical with well defined border
Cool, pale or bluish surrounding skin
Loss of leg hair
Faint or absent ankle pulses
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31
Q

Define carotid artery stenosis

A

Narrowing of the lumen on the carotid artery, most commonly die to atherosclerosis plaque

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32
Q

What are the main features of carotid artery stenosis?

A 
Previous TIA
Amaurosis fugax - black curtain (hypo perfusion of ophthalmic artery)
Peripheral vascular disease
IHD
Valvular disease/replacements
Carotid bruit, best heard on expiration
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33
Q

What are the bedside investigations for carotid artery stenosis?

A

Urine dip to check for proteinuria

ECG to look for ischemic changes, AF

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34
Q

What bloods for carotid artery stenosis?

A

FBC to look for anaemia
U+Es
Glucose/HbA1c
Lipids

35
Q

What imaging is done in carotid artery stenosis?

A

Carotid duplex US to assess size and extent of stenosis

36
Q

How would we conservatively manage carotid artery stenosis?

A 
Smoking cessation
Regular exercise
Weight loss
SALT referral
OT/PT
37
Q

How would we medically mange carotid artery stenosis?

A

Anti-platelet

Manage RFs e.g. T2DM or HTN

38
Q

How would we surgically manage carotid artery stenosis?

A

Assessment for CEA (Carotid Endearcterectomy)
- surgical procedure to remove plaque

Criteria: acute, non-disabling stroke
symptomatic stentosis

39
Q

What are the components of a vascular examination?

A 
Inspection - ulcers, paleness 
Palpation - cap refill, pulses, temp
Auscultation - carotid 
Sensation 
Buerger's test
40
Q

What pulses should we be checking?

A 
Temporal 
Common carotid
Brachial
Radial
Femoral
Popliteal 
Posterior tibialis
41
Q

What is Buerger’s test?

A

Measure angle at which limb goes pale when raised

Less than 20 degrees is indicative of chronic limb ischaemia

42
Q

What is peripheral arterial disease?

A

Atherosclerotic disease affecting the legs

Powerful marker of CVD risk

43
Q

How prevalent is PAD?

A

30% of the adult population

44
Q

How does PAD present?

A

Claudication
Rest pain becomes localised to toes, bad at night
Tissue loss
Gangrene

45
Q

What differentials should be considered alongside PAD?

A

Spinal canal stenosis
Osteoarthritis
Non-atheroscerlotic e.g. entrapment syndromes

46
Q

What are the risk factors for PAD?

A

Smoking
Dyslipidaemia
Hypertension
Diabetes

47
Q

What exams for PAD?

A

CV
AAA
Pulse palpation

48
Q

What investigations for PAD?

A

Doppler
ABPI
Toe pressure
TCPO2

49
Q

What imaging for PAD?

A

DUS
CTA
MRA
Intra arterial DSA

50
Q

Describe the natural history of PAD?

A

50% asympto
40% intermittent claudication
10% critical leg ischaemia

5 year outcomes

  • 73% stable claudication
  • 16% worsening claudication
  • 7% leg bypass surgery
  • 4% major amputation
51
Q

How do we manage PAD conservatively?

A 
Smoking cessation
Diabetes control
Statin
BP control
Antiplatelet

Improve walking distance

52
Q

How can we improve walking distance in PAD?

A

Supervised exercise
Vasoactive drugs
Revascularisation
Amputation (last resort)

53
Q

What typically causes embolic acute limb ischaemia?

A

AF

54
Q

What typically causes thrombotic acute limb ischaemia?

A

Previous PAD disease

History v important when distinguishing between embolic and thrombotic

55
Q

What percentage of patients will develop diabetic foot ulcer?

A

25% of those with diabetes

56
Q

Why is DFD so important?

A

High rates of amputaiton and mortality

Costs NHS more than 1B£ a year

57
Q

How do you manage diabetic foot sepsis?

A 
Surgical emergency 
Sepsis 6
Foot x-ray
Bloods
Microbiology
Emergency debridement
58
Q

What is the FAST acronym for stroke?

A

Face
Arms
Speech
Time

59
Q

What is the investigation pathway for stroke?

A 
ECG
Duplex
CTScan 
Decision re intervention
Rapid intervention for max gain
60
Q

What defines a AAA?

A

Abnormal dilation >50% its normal size

61
Q

What are risk factors for AAA?

A

Male
HTN
Smoking
Genetics

62
Q

How do AAAs present?

A 
Asympto normally
OR
Pressure
Rupture
Thrombosis
Embolisation

Expansile and pulsatile

63
Q

When do we operate on AAAs?

A

Size > 5.5cm but 5cm threshold for females

Increase > 1 cm in a year\

Repair of aorto-iliac disease

Informed patient preference

64
Q

What are the two ways of surgically repairing an AAA?

A

Open

Endovascular

65
Q

How to you choose between open and endovascular?

A

Low risk - open

High op risk - EVAR

66
Q

What are signs and symptoms of venous disease?

A 
Pain
Discomfort
Heaviness
Varicose veins
Oedema
Skin discolouration (brown)
Lipodermatoscelrosis (champagne bottle legs)
Ulceration
67
Q

What are the RFs for venous disease?

A 
Age
FH
Gender
Pregnancy
Obesity
Reduced mobility at work
Smoking
Decreased fibre intake and constipation
68
Q

What does elevated venous pressure result from?

A

Muscle pump
Valvular reflex in deep and superficial veins
Venous obstruction

69
Q

What are the investigations for venous disease?

A

Duplex US

Venogram

70
Q

What are characteristics of venous ulcers?

A

Superficial

Wet

71
Q

What is the treatment of venous ulcers?

A

Compression

and offer surgery to reduce risk of reoccurrence

72
Q

What investigation is done for varicose veins?

A

DUS

73
Q

What are the indications for treatment for varicose veins?

A

Bleeding

Symptomatic primary or recurrent v. veins

Skin changes

Superficial vein thrombosis (hard, painful veins)

Venous leg ulcer

74
Q

What is the treatment for varicose veins?

A

Compression stockings

Venous ablation - under US guidance, radio frequency probe generates heat (thermal
0

Mechnochemical venous ablation

Foam therapy can be used as a part of mechnochemical or by itself

75
Q

What is gangrene?

A

complication of necrosis characterised by the decay of body tissues
can be:
- infectious (wet)
- ischaemic (dry)

76
Q

What is the most common cause of gangrene?

A

Critically insufficient blood supply associated with diabetes and smoking

77
Q

What are 1st line investigations for gangrene?

A 
FBC (raised WCC)
Metabolic panel (Hyponatraemia common)
LDH (haemolytic anaemia)
Blood cultures if suspected infection
CRP
78
Q

What is the treatment for necrotising fasciitis?

A

Intensive supportive care
Surgical debridement +/- amputation
Local irrigation
ABs

79
Q

What is the treatment for ischaemic gangrene?

A

IV heparine
Surgical revascularisation
Thrombolytic therapy

80
Q

What is arterial thrombosis?

A

Blood clot in artery

81
Q

What are the risks of arterial thrombosis?

A

MI
Stroke
TIA
Critical limb ischaemia

82
Q

What are RFs for atherosclerosis?

A

getting older
smoking
an unhealthy diet
a lack of exercise
being overweight or obese
regularly drinking excessive amounts of alcohol
other health conditions, including high blood pressure, high cholesterol and diabetes
a family history of atherosclerosis
being of south Asian, African or African-Caribbean descent

83
Q

What are the treatments for arterial thrombosis?

A

Throbolytic medication
Embolectomy to surgically remove clot
Angioplasty to widen affected artery
CABG (coronary artery bypass graft to divert blood around blocked artery)

Cardiology (16 decks)

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