Vascular Flashcards
What is the most common cause of a non-traumatic subarachnoid haemorrhage?
Rupture of a berry (saccular) aneurysm.
Which renal pathology is known to increase your risk of developing a berry aneurysm?
PKD
Other than a CT what test can confirm a subarachnoid haemorrhage? What is the timeframe for this test? What are you looking for?
Lumbar puncture.
12 hours after sx onset take LP and deliver within 1 hour.
Looking for xanthochromia (RBC breakdown).
SAH increases the risk of communicating hydrocephalus, what is this?
CSF can drain through ventricles but arachnoid granules struggle to absorb it resulting in upstream dilation of ventricles.
What is a cavernoma? How might they present?
Collection of thin blood vessels within the brain (can also happen in the spinal cord)
Headache, epileptic seizures, neurological deficit, haemorrhages, spinal cord injury.
How do you manage cavernomas?
Definitive mx is surgery: those who are actively growing, actively bleeding, or having recurrent seizures.
Fr those who are not appropriate: medications to mx sx and monitoring of cavernoma.
What are the signs that the middle cerebral artery has infarcted?
- Homonymous hemianopia,
- Hemiplegia,
- Facial droop,
- Wernicke’s dysphasia (unrelated words jumbled together: if infarct is on dominant side)
What is the result of Cushing’s reflex?
Triad of HeTN, bradycardia, and irregular breathing which leads to decreased cerebral flow (intracranial HoTN) and can lead to herniation and death.
What is the process of Cushing’s Reflex?
1) Raised ICP (>MABP) means decreased CPP which = cerebral ischaemia, this triggers sympathetic response causing HeTN (A1 adrenergic receptors) and increased HR (B1 receptors).
2) baroreceptors detect HeTN and trigger parasympathetic response through the vagus to reduce HR (muscarinic receptors).
3) HeTN alongside increased ICP presses the respiratory centre of the brainstem which causes irregular breathing/apnoea.
An anterior spinal artery embolism results in what consequences?
Ischaemia/infarction to the anterior 2/3 of the spinal cord.
This affects the spinothalamic and corticospinal tracts = loss of pain/temperature sense and voluntary motor function.
Dorsal columns (vibration, proprioception, discrimination) are unaffected.
How can you differentiate chronic peripheral vascular disease from critical?
ABPI:
- Chronic: 0.9-0.5
- Critical: <0.5
What is the 1st line investigation for venous insufficiency?
Doppler
What is a Saphenia Varix?
Dilation of saphenous vein @ the saphenofemoral junction.
Bluish tinge, +/- cough reflex, dissapears when lying down.
Pts often have a hx of varicose veins.
What is angiodysplasia? How do patients present? Mx?
Tortuous, dilated small blood vessels in the mucosal and submucosal layers of the GI tract.
Px- fatigue, dizziness, weakness, and SOB due to anaemia, and rectal bleeding.
Mx- interventional colonoscopy.
What are signs of chronic venous insufficiency?
- Lipodermatosclerosis (subcutaneous fibrosis and skin induration)
- Varicose veins
- Pitting oedema
- Ulceration
What is Raynaud’s Phenomenon?
Vasospasm of small arterioles and arteries, leading to reduced blood flow to the skin.
Colour change from white - blue - red.
Why are farmers more at risk of developing Raynaud’s?
Use of vibrating tools.
What is the management for Raynaud’s?
Dihydropyridine CCBs (nifedipine).
Who are compression stockings CI in?
ABPI <0.7 due to risk of ischaemia - advice weight loss instead.
What is the pathophysiology behind Takayasu’s arteritis?
Inflammation of large vessels leads to narrowing and reduced blood flow to the areas of the body supplied by these.
What are the signs/sx of Takayasu’s arteritis? Complications?
- Undetectable radial pulse
- BP difference between sides
- Night sweats
- Myalgia
- Skin nodules
- Visual defects
Cx : Stroke, Aortic aneurysms
What do you see on CT angiography of Takayasu’s arteritis?
Narrowing of affected vessels and possibly a dilated aortic root/aortic aneurysms.
What is the pathophysiology of a venous ulcer?
Oedema of the soft tissue with poor lymphatic /capillary drainage leads to inadequate nutrient and oxygen reaching the skin causing it to die and ulcerate.
What are the features of venous ulcers vs arterial ulcers?
Venous: shallow, sloping edges, these bleed/ooze and are associated with the inverted champagne bottle sign.
Arterial: painful, punched out edges, with well demarcated edges.
What are the signs of a fat embolism? What are the most commonly caused by?
Tachycardia, tachypnoea, hypoxia, petechial rash, retinal haemorrhage.
Caused by fracture of long bones (humerus, femur).
What is superficial thrombophlebitis?
Inflammatory venous condition associated with DVT and varicose veins.
How do you symptomatically manage superficial thrombophlebitis?
NSAIDs
What is the difference between embolic and thrombotic acute limb ischaemia?
E: sx occur over over minutes and are more severe.
T: less severe sx over hours.
What is cholesterol embolization syndrome?
Complication of atherosclerotic disease where cholesterol crystals embolize spontaneously disrupting blood supply in the abdomen and lower extremities.
Pts present with non-specific sx in keeping with an inflammatory response.
How do pts present with cholesterol embolization syndrome?
Fever, malaise, myalgia, dermatological manifestations.
What are the investigation findings for pts with cholesterol embolization syndrome?
AKI, deranged LFTs, raised cardiac enzymes, eosinophilia.
Hyaline casts and eosinophils in urine microscopy.
How do you manage cholesterol embolization syndrome? What is the prognosis like?
Supportive management - there is a high mortality.
What size is a ‘small’ AAA? Mx?
3-4.4cm
Mx with yearly repeated USS.
What size is a ‘medium’ AAA? Mx?
4.5-5.4cm.
Repeat USS every 3 months.
What size is a ‘large’ AAA? Mx?
> 5.5cm.
Surgical intervention recommended.
What medications are important in management of chronic leg ischaemia?
High dose statin (80 mg)
Antiplatelets (clopidogrel)
How do you investigate a SAH?
1st line: non-contrast CT
2nd Line: LP looking for xanthochromia
