Vascular and ischaemic disease Flashcards
What are the two types of peripheral vascular disease
Intermittent claudication
Chronic limb-threatening ischaemia
When does intermittent claudication occur
When there is not sufficient blood flow to exercising muscle due to atherosclerosis in arteries
What are the features of intermittent claudication (2)
Cramp-like pain on exercise
Pain relieved by rest
When does chronic limb threatening ischaemia occur
When there is insufficient blood supply to a limb to maintain viability of that limb
What are the symptoms of chronic limb threatening ischaemia (8)
Pain at rest
Ulcers
Gangrene
Limb cold to touch
Absence of peripheral pulses
Colour changes
Poor tissue nutrition
Venous guttering
What investigations are used for peripheral vascular disease (4)
Pulse
Ankle-brachial pressure index
Duplex
Angiography
What types of secondary prevention are used for peripheral vascular disease (6)
Weight loss
Blood pressure control
Diabetes control
Exercise
Smoking cessation
Antiplatelet and statin therapy
What is assessed before arterial reconstruction is used to manage peripheral vascular disease (2)
For inflow surgery: If there is adequate blood flow to the affected segment
For outflow surgery: If arteries open up beyond the blockage
What are the determinants of blood pressure (3)
Cardiac output
Peripheral vascular resistance
Blood volume
What are the determinants of hypertension (3)
Changes in cardiovascular control mechanisms
Genetics
Lifestyle
Environment
What are the two types of hypertension
Primary and secondary
Describe primary hypertension (3)
No single cause
Due to a complex interaction of genetic and environmental factors
Most common form of hypertension in adults
Describe secondary hypertension (3)
Single cause
Removal/reversal of cause leads to normalisation of blood pressure
Most common form of hypertension in children
What are risk factors for primary hypertension (6)
Obesity
Age
Smoking
Genetics
High alcohol intake
High salt intake
What are the two sub-types of hypertension
Benign
Malignant
Describe benign hypertension (2)
Stable, long-term elevation of blood pressure
Asymptomatic
Describe malignant hypertension
Acute and severe elevation of blood pressure
What are the symptoms of hypertension (5)
Headaches
Blurred vision
Nausea /vomiting
Chest pain
Altered mental state
What consequences can arise from hypertension (3)
Cerebral oedema
Haemorrhage
Organ failure
What is white coat hypertension
Hypertension that only exists when blood pressure is measured during medical consultations
How can hypertension be classified
In order of increasing severity
Stage one to three
Stage one 140/90
Stage three 180/110
What tests are offered to patients with hypertension (4)
Urine testing (protein)
Blood testing
12 lead ECG
Examination of fundi
What is analysed in the blood for a patient with hypertension (5)
Glucose
Cholesterol
Electrolytes
Creatinine
Glomerular filtration rate
Why are fundi examined in patients with hypertension
For hypertensive retinopathy
What hypertension-mediated organ damage can occur (4)
Left ventricular Hypertrophy
Raised creatinine
Albuminuria
Retinopathy
What is the target blood pressure for patients under 80 (clinic and daytime)
140/90 mmHg
135/85 mmHg
What is the target blood pressure for patients 80 years and over (clinic and daytime)
150/90 mmHg
145/85 mmHg
What lifestyle interventions are used to manage hypertension (3)
Smoking cessation
Exercise
Dietary modifications
What dietary modifications are made to manage hypertension (3)
Limiting intake of alcohol, caffeine, and salt
What is the first step of medical interventions for hypertension
If under 55 or diabetic: ACE inhibitor
If over 55 or of African/Caribbean ethnicity: DHP-calcium channel blocker
When would ARB be used to treat hypertension
if the patient is unable to tolerate an ACE inhibitor
What is step 2 of medical intervention for hypertension + when would it be used
If maximal dose of step 1 has failed/not been tolerated
A combination of a calcium channel blocker and an ACE inhibitor/ARB should be used
What is step 3 of medical intervention for hypertension and when should it be used
when maximal dose of step two has failed/not been tolerated
Addition of thiazide like diuretics
What is step four of medical intervention for hypertension if blood potassium is lower than 4.5 mol/L
Adding spironolactone
What is step four of medical intervention for hypertension if blood potassium is greater than 4.5 mol/L
Increasing thiazide-like diuretic dose
(Or alpha blockers/beta blockers)
When are statins used in primary prevention of hypertension
if ten-year cardiovascular risk is greater than 20%
What could an uncontrolled drop in blood pressure lead to
Ischaemic stroke due to poor cerebral auto-regulation and perfusion
What is the first line of treatment for malign hypertension
calcium channel blockers such as amlodipine
What is deep venous thrombosis
When a thrombus is formed in deep venous circulation
What is a pulmonary embolism
When a thrombus becomes embolism and lodges in pulmonary circulation
What is venous thromboembolic disease
a term that includes both deep venous thrombosis and pulmonary embolism
What are the two types of deep vein thrombosis
distal DVT (calves)
Proximal DVT (popliteal/femoral veins)
How is the severity of DVT judged
by clinical assessment
Where at DVTs likely to occur (2)
In venous valve pockets
Sites of stasis
Describe the clots formed in DVT
Rich in fibrin
What are the symptoms of DVT (6)
limb pain
Swollen limb
Redness
Heat
Tenderness along vein
Distension of superficial veins
How is DVT treated
anticoagulants (direct, vitamin K antagonists, or low molecular weight heparin injections)
How is the severity of a pulmonary embolism assessed (2)
PESI score
Patient’s characteristics
What are the symptoms of pulmonary embolism (4)
shortness of breath
Pleuritic pain
Collapse
Haemoptysis
Hypoxia
Tachycardia
Low blood pressure
How are pulmonary embolism managed (2)
high risk - thrombolysis then oral anticoagulant
Medium/low risk - oral anticoagulant
What complication can arise from pulmonary embolism + what is this associated with (2)
Chronic thromboembolic pulmonary hypertension
Associated with dyspnoea and hypoxaemia
What risk is associated with chronic thromboembolic pulmonary hypertension (CTEPH)
heart failure
what is D-dimer
A product of cross-linked fibrin breakdown
Why is d-dimer valuable as a first line screening test for VTE (2)
It has a high negative predictive value for VTE
It has a low positive predictive value for VTE
What is the duration of treatment for provoked VTE (2)
with reversible factor: 3-6 months
With irreversible factor: could be lifetime
When can post-thrombotic syndrome occur
after idiopathic DVT
What are the symptoms of post-thrombotic syndrome (3)
pain
Oedema
Hyperpigmentation
Eczema
Varicose collateral veins
Venous ulceration
What is Virchow’s triad
hypercoagulation
Endothelial injury
Abnormal blood flow (Stasis)
