Vascular and Ischaemic Heart Disease Flashcards
1
Q
Where do the right and left coronary arteries arise from?
A
The base of the aorta
2
Q
Where does most coronary venous blood drain into?
A
The coronary sinus and then into the right atrium
3
Q
What area of the heart becomes deprived of blood supply if the left coronary artery becomes blocked?
A
Left ventricle
4
Q
Give four special adaptations of coronary circulation?
A
- High capillary density
- High basal blood flow
- High oxygen extraction (75% compared to 25%)
- Extra oxygen can only be supplied by increasing coronary blood flow
5
Q
What does decreased PO2 do to the coronary arteries?
A
Causes vasodilatation
6
Q
What is an intrinisc mechanism of coronary blood flow, and matches flow to demand?
A
Metabolic hyperaemia
7
Q
What is a potent vasodilator for coronary blood flow (intrinsic mechanism)?
A
Adenosine from ATP
8
Q
What type of nerves are coronary arterioles supplied by?
A
Sympathetic vasoconstrictor nerves
9
Q
What are sympathetic vasoconstrictor nerves in coronary arterioles over-ridden by?
A
Metabolic hyperaemia as a result of increased heart rate and stroke volume
10
Q
What does sympathetic stimulation of the heart result in?
A
Coronary vasodilatation despite direct vasoconstrictor effect
11
Q
What substances activates beta-2-adrenoceptors, which causes vasodilatation?
A
Adrenaline
12
Q
What receptors does sympathetic stimulation act on in relation to coronary blood flow?
A
Alpha receptors
13
Q
What do increased metabolites such as K, PCO2 and H+ do to coronary blood flow?
A
Increase it
14
Q
What does an increase in adenosine, do to coronary blood flow?
A
Increases it
15
Q
When does peak left coronary flow occur?
A
During diastole
16
Q
What does shortening diastole (e.g. very fast heart rate) do to coronary flow?
A
Decreases it
17
Q
What gives blood supply to the brain?
A
Internal carotids and vertebral arteries
18
Q
What is very sensitive to hypoxia in the brain?
A
Grey matter
19
Q
What two arteries form the basilar?
A
Two vertebral arteries
20
Q
What arteries anastomose to for the circle of Willis?
A
Basilar and carotid arteries
21
Q
Where do the major cerebral arteries arise from?
A
The circle of Willis
22
Q
What is caused by an interruption/cut-off of blood supply to a region of the brain?
A
Stroke
23
Q
What are the two main types of stroke?
A
- Haemorrhagic bleeding
2. Ischaemic stroke
24
Q
What type of stroke is described - blood leaks out of artery wall which is damaged?
A
Haemorrhagic stroke
25
What type of stroke is dewscribed - blood clot forms on atheroma on artery wall or comes from another part of body and gets stuck, blood cannot flow past?
Ischaemic stroke
26
What is autoregulation of cerebral blood flow guard against?
Changes in cerebral blood flow if mean arterial blood pressure changes within a range (60 - 160 mmHg)
27
In relation to autoregulation of cerebral blood flow: what happens to resistance vessels automatically when MABP rises?
Resistance vessels constrict to limit blood flow
28
When does autoregulation fail in relation to MABP falling?
Below 60mmHg
29
What does MABP below 50 mmHg, result in?
Confusion, fainting and brain damage if not quickly corrected
30
What does increased PCO2 do to cerebral vessels?
Causes cerebral vasodilatation
31
What does decreased PCO2 do to cerebral vessels?
Cause vasoconstriction (which is why hyperventilation could lead to fainting)
32
What is the term for blood flow increasing to active parts of the brain?
Regional hyperaemia
33
What is normal intracranial pressure (ICP) within the skull?
8 - 13 mmHg
34
What is the equation for cerebral perfusion pressure (CPP)?
CCP = MAP - ICP
35
What two things could increase ICP?
1. Head injury
| 2. Brain tumour
36
What does increasing ICP, do to CPP and cerebral blood flow?
Decreases it
37
What are tight intercellular junctions called in cerebral capillaries?
The blood brain barrier
38
What are cerebral capillaries highly permeable to?
O2 and CO2
39
How does glucose cross the blood brain barrier?
By facilitated diffusion using specific carrier molecules
40
What three hydrophilic substances is the blood brain barrier exceptionally impermeable to?
1. Ions
2. Catecholamines
3. Proteins
41
What are the metabolic needs of the airways met by?
Systemic bronchial circulation
42
What is pulmonary artery BP typically?
20-25/ 6-12 mmHg
43
What is the pulmonary capillary pressure like compared to the systemic cappilary pressure?
Low
44
What special adaptation of the pulmonary circulation protects against pulmonary oedema?
Absorptive forces exceed filtration forces
45
What causes vasoconstriction of pulmonary arterioles?
Hypoxia
46
Why is resting blood flow in skeletal muscle low?
Because of sympathetic vasoconstrictor tone
47
In relation to skeletal muscle blood flow: during exercise what overcomes sympathetic vasoconstrictor activity?
Metabolic hyperaemia
48
In skeletal muscle blood flow, what does circulating adrenaline cause?
Vasodilatation (beta-2-areniceptors)
49
What does contraction of muscle aid in relation to veins?
Venous return
50
What does skeletal muscle pump reduce the chance of?
Postural hypotension and fainting
51
What is the term for blood pooling in lower limb veins if venous valves become impotent?
Varicose veins
52
Why do varicose veins not lead to a reduction of CO?
Because of compensatory increase in blood volume
53
What is the term for the result of imparied vascular perfusion depriving the affected tissue of nutrients (including oxygen). It can be reversible on multiple factors including speed of onset, local demand and duration?
Ischaemia
54
What term refers to ischaemic necrosis of a dtissue or organ secondary to occlusion/reduction of the arterial supply or venous drainage. Recovery depends on a tissue regenerative ability?
Infarction
55
What is the term for a set of well regulated processes that accomplish functions (1. maintaing blood in a fluid, 2. induce rapid, localised haemostatic plug at site of vascular injury)?
Haemostasis
56
What is pathological/ corruption of haemostasis?
Thrombosis
57
What is the term for the formation of a solid or semi-solid mass from the constituents of blood, within the vascular system, during life?
Thrombosis
58
What are the three components of Virchow's triad?
1. Changes in vessel walls (endothelial injury)
2. Changes in blood constituents (hypercoaguability)
3. Changes in blood flow
59
What close small breaches in vessel walls and if activated in a vessel cause thrombus?
Platelets
60
Name the two components of platelets?
1. Alpha granules (adhesion componenets, e.g. fibrinogen, fibronection, PDGF, anti-heparin)
2. Dense granules (aggregation, ADP)
61
What do platelets cause when contacting collagen or fibrin?
Temporary patching
62
What maintains a permeability barrier and elaborates anticoagulant, antithrombotic, fibrinolytic regulators?
The endothelial cell
63
What four anticoagulant, antithrombotic and fibrinolytic regulators are elaborated in the endothelial cells?
1. Prostacyclin
2. Thrombomodulin
3. Heparin-like molecules
4. Plasminogen activator
64
What three prothrombotic molecules does the endothelial cell elaborate?
1. VWF
2. Tissue factor
3. Plasminogen activator inhibitor
65
What does the endothelial cell use to modulate blood flow and vascular reactivity?
1. Vasoconstrictors - endothelin, ACE
| 2. Vasodilators - NO, prostacylcin
66
What three substances are used in regulation of inflammation and immunity in the endothelial cell?
1. IL-1, IL-6, chemokines
| 2. Adhesion molecules - VCAM-1, ICAM-1, E-selectin, P-selectin
67
Give three growth stimulators that regulate cell growth in endothelial cells?
1. PDGF
2. CSF
3. FGF
68
Name two growth inhibitors that regulate cell growth in endothelial cells?
1. Heparin
| 2. TNF-beta
69
What are important contributory factors in thrombosis that disrupt laminar blood flow?
Turbulence and stasis
70
What refers to any alteration in the coagulation pathway which predisposes to thrombosis?
Hypercoagulability
71
What two groups can conditions causing hypercoaguability be split into?
Acquired and Genetic
72
What are MI, immobilisation, tissue damage, cancer, prosthetic heart valves, DIC, heparin induced thrombocytopenia and antiphospholipid syndrome?
Acquired high risk hypercoaguable states
73
What are AF, cardiomyopathy, nephrotic syndrome, hyperoestrogenic states, oral contraceptive use, late pregnancy, sickle cell anaemia and smoking?
Lower risk aquired hypercoaguable states
74
Give three examples of genetic hypercoaguable states?
1. Factor V mutations
2. Defects in anticoagulant pathways - antithrombin III deficiency, protein C or S deficiency
3. Defects in fibrinolysis
75
What show lines of Zahn?
Arterial thrombi
76
What two areas do mural thrombi take place?
Ventricles (heart) - MI, arrhythmias
| Aorta (aneurysms) - atheroma
77
What thrombi are laminated due to alternating pale (platelet and fibrin) and dark (RBC/WBC) bands?
Mural thrombi
78
What is the term for a venous thrombi evoking inflammation?
Phlebothrombitis
79
What thrombi is most important in DVT of calf?
Venous thrombi (phlebothromboses)
80
What are large vessel thrombi prone to do?
Embolise
81
What thrombi form reddish/blue casts and are adherent to the wall?
Venosu thrombi
82
Give four fates of thrombi?
1. Propagation proximally (small to large vessel)
2. Embolisation
3. Resolution (fibrinolysis)
4. Organisation (granulation tissue, recanalisation)
83
What is the term for a detached intravascular solid, liquid ot gaseous mass which is carried by the bloodstream to a site distant from the point of origin?
Embolism
84
Name a fluid embolism?
Amniotic fluid embolism
85
What travels via IVC to pulmonary circulation?
Pulmonary thromboembolism
86
What can cause acute sudden death vs. segmental infarction (red infarcts), contrast with white infarcts?
Pulmonary thrombo embolism
87
How would you describe wedge shaped infarcts?
Wedge-shaped and firm
88
What is it important to remember in relation to venous emboli?
They do not cause infarcts in peripheral arterial circulation unless, atrial/ventricular septal defect, paradoxical embolus
89
What kind of embolism follows major soft tissue trauma and major bone fractures?
Fat embolism
90
Give two steps/features of fat emboli?
1. Fatty marrow enters venules most globules arrest in lungs = dyspnoea
2. Some reach peripheral circulation = skin rashes, CNS confusion
91
What embolism can result from barotrauma (occurs in divers) and during delivery/abortion or iatrogenic?
Gas/air embolism
92
How are vessels occluded in gas/air embolism?
Frothy bubbles occlude major vessels e.g. pulmonary artery
93
What embolism causes DIC (Disseminated intravascular coagulation), marked oedema and is post-partum?
Amniotic fluid embolism
94
How do amniotic fluid embolisms work?
Amniotic fluid and debris enters torn veins and embolises to lungs
95
What is a prostaglandin rich fluid?
Amniotic fluid
96
What three disease patterns is arteriosclerosis a generic term for?
1. Atherosclerosis
2. Monckeberg Medial Calcific Sclerosis
3. Arteriosclerosis
97
What arteriosclerosis type occurs in >50 years and involes calcification of medium sized arteries?
Monckeberg Medial Calcific Sclerosis
98
What can an atherosclerosis, ischaemic encephalopathy lead to?
Dementia
99
What is the basic lesion in an atherosclerosis disease?
A plaque
100
What two things occur as plaque size increases in atherosclerosis?
1. Luminal diameter decreases
| 2. Blood flow reduces
101
In atherosclerosis, what is a cause of more easily ingested by macrophages, acts as cehmotactic factors for monocytes, increase monocyte adhesion, induce antibody response, directly damage endothelial and smooth muscle cells and inhibit macrophage motility and trapping?
Lipoprotein oxidation
102
During atherosclerosis, when hypercholesterolaemia persists, smooth muscle proliferation and collagen deposition convert the fatty streak into what?
A mature fibrofatty atheroma
103
Which area of the aorta typically displays severe atheroma?
Bifurcation into iliac arteries
104
Give 4 complications of atherosclerosis?
1. Ulceration of athermatous plaque and thrombosis
2. Haemorrhage into plaque with plaque rupture and embolism of plaque contents
3. Ongoing narrowing = critical stenosis
4. Aneurysm formation
105
What results from inadequate systemic perfusion as a result of cardiac dysfunction?
Cardiogenic shock
106
In the clinical diagnosis of angina, what is the pain like and what is it from?
Visceral pain from myocardial hypoxia - hard to describe
107
What do provocation, relief and timing all lead to the clinical diagnosis of?
Angina
108
Pressing, sqeezing, heaviness, a weight. Radiating to arms, back, neck, jaw, teeth. Exertion, stress, cold wind, after meals. Few minutes, relieved by rest, GTN.
Angina
109
Give three features of peptic ulcer pain?
1. Epigastric
2. Boring and point of finger gesture
3. Relief by antacids/foods
110
What type of chest pain is focal, exacerbated by breathing, sharp and catching?
Pleuritic pain
111
What is the pain like in dissection of aorta?
Tearing, excruciating, severe then eases
112
What is the gold standard investigation for CHD?
Angiography
113
What two methods of revascularisation are there for reducing risk and symptoms of CHD?
1. CABG
| 2. PCI
114
What four drugs are there for CHD?
1. Aspirin
2. Bblockers
3. Statin
4. ACE inibitor
115
What is there a risk of 8-10 years post-op in coronary artery bypass?
Graft disease
116
Give 4 complications of CABG?
1. death
2. stroke
3. MI
4. AF
117
What do these steps describe: vascular access, antiplatelet/coagulation, catheter to ostium of coronary, guidewire down vessel, balloons threaded over wire, stents implanted, balloon catheter and wires removed?
PCI technique
118
What are two indications for angiography?
1. Severe symptoms
| 2. High risk
119
What are 4 indications for aborting revascularisation?
1. Multi-vessel disease
2. Diabetes
3. Left main disease
4. Co-morbidities
120
What revascularisation is done in a STEMI?
Primary PCI
121
What revascularisation is done in acute coronary syndrome?
Angiography with a view to revascularisation
122
What revascularisation is done in chronic stable angina?
Revascularisation for severe symptoms or high risk
123
What 2 vasculitis diseases can be risk factors for DVT/PE?
1. SLE and lupus anticoagulant
| 2. Behcet's disease
124
Give 4 things related to drugs and medications that can be risk factors for DVT/PE?
1. IV drug abuse
2. Oestrogens - ORP and HRT
3. Tamoxifen
4. Chemotherapy
125
What blood test would you do to investigate DVT?
D-dimer
126
What are di-dimers?
Fibrin breakdown products
127
What five other conditions can raise d-dimers?
1. Infection
2. MI
3. Surgery
4. Liver disease
5. Pregnancy
128
What imaging would you use to investigate DVT?
Ultrasound
129
What technique for investigating DVT involves: strain gauge around affected limb, venous emptying by compression, measure refill time (fast = not much, empty = clot)?
Venous plethysomography
130
What should be done when diagnosing DVT if there is high PTP score, but negative d-dimer and USS?
No DVT, consider other differentials
131
What should be done when diagnosing DVT if there is a high PTP score, positive d-dimer but negative USS?
Repeat assessment, repeat USS later
132
What are two treatment methods for DVT?
1. anticoagulation with LMWH and warfarin
| 2. Compression stockings
133
What is phlegmasia dolens and what can it cause?
DVT causing obstruction of arterial inflow - severe DVT, background PAOD
Can cause venous gangerene
134
Give three treatments for Phlegmasia dolens?
1. IVC filter
2. Femoral arterial line
3. tPA intra-arterially
135
What are SOB, collapse, pleuritic chest pain, haemoptysis and sudden death causes of?
Pulmonary thromboembolism
136
What is oligemia on CXR and what can it be a sign of?
Segmental loss of pulmonary vasculature - PE
137
What heart sounds can be heard in PE?
Fourth heart sound or accentuated pulmonic component of the second heart sound
138
What can a pleural rub, tachypnea, hypotension, cardiorespiratory arrest, wheeze, tachycardia and signs of pleural effusion all be found in?
PTE
139
What, on the ECG is only seen in 20% of PE cases?
S1, Q3, T3
140
What are four main investigations for PTE?
1. Arterial blood gases
2. CXR
3. V/Q scan
4. CTPA
141
When should a V/Q scan be performed to investigate a PE?
Within 48 hours
142
What investigation for PE is poor for more peripheral lesions and involves breath holding/IV contrast?
CT pulmonary angiogram
143
What can potentially be the four main treatments for PE?
1. Anticoagulants
2. Thrombolytic therapy
3. IVC interupption - IVC filter/surgery
4. Surgical removal
144
What is the treatment for a massive PE with shock or syncope?
Thrombolysis or surgery
145
What is the treatment for a major PE with right-ventricular dysfunction?
Anticoagulants and thrombolysis
146
What is the treatment for a major PE without reight-ventricular dysfunction?
Anticoagulants
147
What is the treatment for a minor PE?
Anticoagulants
148
What anticoagulant is used for initial treatment of PE?
LMWH
149
What induction period with heparin is associated with a lower rate of recurrent PE?
5 days
150
What would be used for PTE treatment in these cases: recurrent PTE despite adequate anticoagulation, PTE when coagulation cannot be used (post-op) and high risk patients (phlegmasia dolens)?
IVC filter
151
Give an indication for surgery (pulmonary embolectomy) in PTE?
Chronic thromboembolism pulmonary hypertension
152
Name two anticoagulation vitamin K antagonists for PTE?
Wrfarin and phenindione
153
Name an antithrombin drug used as anticoagulation therapy in PTE?
Dabigatran
154
Name two anti Xa drugs used as anticoagulation in PTE?
Apixaban and rivaroxaban
155
Where are the four vitamin K dependent clotting factors synthesised?
In the liver
156
What are the four vitamin K dependent clotting factors?
1. II
2. X
3. IX
4. VII
157
What drug acts as an anticoagulant by blocking the ability of vitamin K to carboxylate the vitamin K dependent clotting factors, therefore reducing their coagulant activity?
Warfarin
158
What three things is warfarin used in teh prophylaxis/and or treatment of?
1. Venous thrombosis and its extension
2. Pulmonary embolism
3. Thromboembolic complications associated with AF and cardiac valve replacement
159
What is a mathematical correction that normalises the PT ratio by adjusting for the variablity in the sensitivity of the different thromboplastins?
INR ratio
160
Give four conditions where warfarin therapy is contraindicated?
1. Pregnancy
2. Bleeding diathesis
3. Uncontrolled alcohol/drug abuse
4. Unsupervised dementia/physhosis
161
What does heparin bind directly to, to inactivate it?
Thrombin
162
What factors does heparin inactivate?
Xa
IXa
XIa
163
How is heparin dosing monitored?
By activated partial thromboplastin time (APTT)
164
What is a large molecule, cross links thrombin with antithrombin, thrombin inhibition 4 fold compared to action on factor Xa, unpredictable and needs monitored?
UFH
165
What is a small molecule, no cross links, thrombin inhibition 1 to 1 with action of factor Xa, predictable by weight and needs no monitoring?
LMWH
166
Which has less osteopenia, LMWH or UFH?
LMWH
167
Give four cautions and caveats of LMWH?
1. Dosing in obesity and in renal insufficiency
2. Dosing in pregnancy
3. Protamine reversal
4. Interchangeability of different preperations
168
How long is the duration of therapy for PE in a temporary risk factor?
4-6 weeks
169
How long is the duration of therapy for PTE in an idiopathic PE?
3-6 months
170
How long is the duration of therapy for PTE in a second idiopathic event?
LIFELONG
171
What are inherited thrombophilia (not factor V Leiden or prothrombin mutation), antiphospholipid syndrome, recurrent idiopathic VTE, malignancy and thromboembolic pulmonary hypertension?
Potential indications for indefinite anticoagulant therapy
172
For oral anticoagulation, what remains the only option?
Vitamin K antagonists
173
Give three things you would monitor with anti-thrombin drugs?
1. Monitor aPTT
2. Thrombin time for DTIs
3. Ecarin clotting time
174
What is used to reverse dabigatran?
Recombinant factor VIIa, FFP and dialysis
175
How do you reverse FXa inhibitors?
Prothrombin complex concentrate (PCC)
176
What occurs when insufficient blood reaches exercising muscle?
The patient is pain-free at rest, but after exercise develops ischaemic pain in the affected limb, which is relieved by rest.
Intermittent claudication
177
Name a protective factor for intermittent claudication?
Alcohol
178
List two non-invasive investigations for lower limb ischaemia?
1. Measurement of ABPI
| 2. Ultrasound scanning
179
Name 3 invasive investigations for lower limb ischaemia?
1. Magnetic resonance angiography
2. CT angiography
3. Catheter angiography
180
What does ABPI stand for?
Ankle Brachial Pressure Index
181
What is the equation for ABPI?
Ankle pressure / brachial pressure
182
What is a normal ABPI level?
0.9 - 1.2
183
What is a claudication ABPI level?
0.4 - 0.85 (-1)
184
What is a severe ABPI level?
0 - 0.45
185
Give four ways of improving claudication symptoms?
1. Exercise training
2. Drugs
3. Angioplasty/stenting
4. Surgery
186
What intensity of exercise should you be doing with intermittent claudication?
1 hour per day
| 30 minutes 3 times per week for 6 months
187
Name a drug used for intermittent claudication?
Cilostozol
188
Give two types of critical limb ischaemia?
1. Rest pain - toe/foot ischaemia (nerve ending pain)
| 2. Ulcers/gangrene = severe ischaemia + damage
189
What is rest pain, in toes and forefoot, worse at night, helped by sitting and putting the leg in a dependent position and helped by getting up and walking about?
Critical limb ischaemia
190
What are two major risk factors for amputation in critical limb ischaemia?
1. Smoking
| 2. Diabetes
191
What are 3 methods of treatment for critical limb ischaemia?
1. Analgesia
2. Angioplasty/stenting
3. Surgical reconstruction/amputation
192
What patients are more likely to develop intermittent claudication and critical limb ischaemia?
Males > 55 years
193
What does this pathogenesis describe: medial degeneration, regulation of elastin/collagen in aortic wall, aneurysmal dilatation, increase in aortic wall stress and progressive dilatation (law of laplace)?
Abdominal Aortic Aneurysm
194
What size are true arterial aneurysms?
50% increase in normal diameter (1.2 - 2cm)
195
What are the three main risk factors for abdominal aortic aneurysm?
Female, smoker, hypertensive
196
What are these symptoms of: tachycardia, hypotensive, pulsatile, expansile mass +/- tender, transmitted pulse and perihperal pulses?
Symptomatic AAA
197
What two investigations are done for AAA?
1. Ultrasound
| 2. CT scan
198
What investigation only tells us if there is an AAA, not its AP diameter?
Ultrasound scan
199
What investigation for AAA, allows identification of shape, size, iliac movement and allows for management planning? It is also the only method to identify ruptured AAA?
CT scan
200
What type of operations are elective aneurysm repairs?
Prophylactic
201
What type of operation is an emergency aneurysm repair?
Therapeutic
202
What can be done during intervention of an abdominal aortic aneurysm?
Endovascular aneurysm repair (EVAR)
203
In open/laparotomy repair of an abdomoinal aortic aneurysm, what graft is used?
Dacron graft
204
What patients are abdominal aortic aneurysms commonly found in?
Males > 60
205
What three veins are part of the deep system in the leg?
1. Tibials
2. Popliteal
3. Femoral
206
What two veins are part of the superficial system in the leg?
1. Saphenous
| 2. Perforators
207
What is the term for dilated, tortuous superficial veins, due to transmission of deep vein pressure?
Varicose veins
208
What can you get varicose veins following?
A DVT
209
What two conditions increase the deep veins pressure and can cause varicose veins?
1. Deep vein obstruction
| 2. Deep valve incompetence
210
What are 4 signs of varicose veins?
1. Dilated and tortuous superficial veins
2. More prominent with standing
3. Arising in groin or behind the knee
4. Complications of varicose veins
211
What are three clinical features of chronic venous insufficiency?
1. Haemosidering deposits
2. Lipodermatosclerosis
3. Ulceration
212
What are bleeding and bruising, superficial thrombophlebitis and chronic venous insufficiency all complciations of?
Varicose veins
213
What is thrombophlebitis?
Inflammation of a vein caused by a blood clot
214
What is the term for irreversivle skin damage as a result of sustained ambulatory venous hypertension?
Chronic venous insufficiency
215
What is a break in the skin, between malleoli and tibial tuberosity, presumed to be due to venous disease?
Chronic venous ulcer
216
What are haemosiderin deposits caused?
Red cell leakage, red cell breakdown and haemosiderin (iron)
217
What can superficial reflux (LSV and/or SSV), deep reflux, deep venous occlusion, mixed superficial and deep disease, perforating vein reflux and abnormal calf pumps cause?
Venous hypertension
218
What are the two main issues ultrasound focuses on in relation to varicose veins?
1. State of the deep veins (occlusions or impotence)
| 2. Saphenofemoral or saphenopopliteal incompetence
219
What is graduated compression as a management for varicose veins contraindicated in?
Low ABPI
220
Name three types of interventional, endovenous management methods for varicose veins?
1. Foam sclerotherapy
2. Endovenous ablation
3. Surgical - high tie, stripping or foam, multiple stab avulsions or foam
221
Give four complications of intervention of varicose veins?
1. Thrombophlebitis
2. Skin staining
3. Local ulceration
222
What is acute onset of focal neurological symptoms and signs due to disruption of blood supply?
Stroke
223
In a haemorrhagice stroke: what two factors can weaken blood vessel walls?
1. Structural abnormalities like aneurysm, arteriovenous malformation (AVM)
2. Inflammation of vessel wall (vasculitis)
224
What are three modifiable risk factors for stroke?
1. Hypertension
2. Hyperlipidaemia
3. Smoking
225
What is homocysteinemia a rare cause of?
Stroke
226
What can protein S, C and antithromboin III deficiency cause (rarely)?
Stroke
227
What 4 genetic causes of stroke are there?
1. Factor V Leiden mutation
2. Common prothrombin mutation
3. MELAS + CADASIL
4. Fabry's disease
228
What can hypoglycaemia, siezure and migraines mimic?
Stroke
229
What is the only way of differentiating between ischaemic and haemorrhagic stroke?
Brain imaging
230
What are three brain imaging techniques used for stroke?
1. CT Brain +/- angiography
2. MRI with DWI +/- angiography
3. MRI with GRE - looks for old haemosiderin deposits
231
What does LVH on an ECG suggest?
Uncontrolled hypertension which is common cause of AF
232
What embolism infarcts in same side as affected carotid artery?
Atheroembolism
233
What embolism infarcts in more than one arterial territory, bilateral?
Cardioembolism
234
If there is a haemorrhagic stroke in a young patient, what two underlying conditions will you investigate for?
1. Aneurysm
| 2. AVM
235
If there is a haemorrhagic multiple bleed, what two conditions would you look for?
Vasculitis
Moya Moya disease
(using cerebral amyloid angiopathy
236
What two drugs do you give for initial management of TIA/stroke?
Aspirin 75mg + dipyridamole MR 200mg twice daily/clopidogrel 75mg daily
237
What along with antiplatelets, what three drugs would you give for TIA/stroke managmenet?
1. Statins
2. Anticoagulate if AF
3. Antihypertensives
238
What are three surgical managements for TIA/stroke?
1. Haematoma evacuation
2. Relief of raised intracranial pressure
3. Carotid endarterectomy
239
What surgical management would you do for obstructive hydrocephalus and large total MCA infarctions?
Relief of intracranial pressure
240
What surgical management would you do for a patient with >70% stenosis in same sided internal carotid artery?
Carotid endarterectomy
241
In emergency management of TIA what is done?
Thrombolysis
