Vascular Conditions Flashcards
Carotid Artery Disease
- Atheroclerosis of the carotid arteries
- Can cause a stroke
Do we still get blood supply to our brain if out carotid artery is blocked?
Yes, from the verterbral arteries in the circle of willis!
Risk Factors for Carotid Artery Disease
- Diabetes (4x more likely to develop carotid disease)
- Smoking
- Physical Inactivity
- High Lipids
- Obesity
- HTN
- Age
If an individual has diabetes, what should we auscultate?
BOTH coronary and carotid for coronary cladification
If positive, hear bruits - whooshing sound
Clinical Manifestations of Carotid Artery Disease
-
Early Stages
– Typically, no signs or symptoms until complications develop -
Bruits
– Not all patients with carotid artery disease displaybruits
– Common site (within 2 cm of internal carotid) -
Transient Ischemic Attack
– May be the first sign of carotid artery disease
— May have all the signs and symptoms of a stroke, but will go away in 24 hours
— Weakness, changes in vision, unilateral facial droop, anddifficulty with speaking or walking - Stroke
Diagnostic Assessment - Carotid Artery Disease
- Most common test is a Carotid Doppler evaluation which shows carotid blood flow
– Indicated when bruits are heard
– Duplex ultrasonography is emerging as a very accurate tool
– Directly visualizes plaque, stenosis, and narrowing of arteries
Complications - Carotid Artery Disease
- Increased risk for coronary artherosclerosis and MI
- Placques can rupture (Increased risk of TIA and CVA)
What signs do you look for if you suspect someone is having a stroke?
Act FAST.
Face - Does it look uneven?
Arm - One arm hanging down?
Speech - Slurred?
Time - Call 911 NOW!
Deep Vein Thrombosis - Def
Development of a clot in a deep vein of the LE’s or pelvis
Pulmonary Embolism - Def
Blood clot that moved from a DVT to the pulmonary arteriole tree.
Rates of DVT increase sharply after ____
age 45
Risk Factors of DVT and PE
- Anything that can cause Hypercoagulation, Venous stasis, Endothelial Injury
- Inheriting blood-clotting disorder
- Prolonged bed-rest (ex. Long hospital stay, paralysis)
- Prolonged sitting positions, such as when driving or flying. (Hours)
- Injury/surgery to veins in pelvis/LE’s
- Pregnancy (increases pressure in the veins of pelvis and LE’s (pregnancy in combination with any other risk factors especially increases the risk)
- Risk can continue for up to 6 weeks postpartum)
- Oral contraceptives or hormone replacement therapy (increases clotting factors in blood)
- Overweight or Obesity (increases pressure in veins of pelvis and LE’s)
PE - Clinical Manifestations
- SUDDEN onset of dyspnea
- Pleuritic chest pain
- Cough; pleural rub sound
- JVD; increased S2 sound at pulmonic valve
- Tachycardia, Tachypnea (shallow)
- Hemoptysis may occur
Unilateral, sudden onset of dyspnea and chest pain
DVT - Clinical Manifestations
- Swelling
- Redness and Warm in Leg
- Pain with AROM
- “Cramping”
DVT vs Cellulitis
Can’r necessarily know without a doppler BUT…
Cellulitis: Injury or trauma, redness and warmth
DVT: Occlusion of blood to an area of the deep veins typically seen in the legs
Homan’s Sign
- Calf is squeezed while foot is DF with force; Positive test if they have increased pain
- Not accurate; Use a doppler!
- Looking for DVT
PE - Diagnostic
- Confirmed by pulmonary angiogram, CT, MRI, or surgery
- Doppler ultrasonography
- Can be as effective as 91% accurate when used together
Complications - Blood Clot (DVT) travels to lung (PE)
- If Cross Sectional Area (CSA) is decreased by more than 50%, pressure to maintain pulmonary blood flow increases, resulting in pulmonary hypertension = possible R ventricular failure
- Death
Peripheral Artery Disease
- Also known as Artherosclerotic Occlusive Disease (AOD)
- Common Circulatory Problem
- Ischemia of extremities results in intermittent claudification
Why are 50% of individuals with PAD asymptomatic?
- Diabetic/Sensory Loss
- Not working past the workload; Physically Inactive (oxygen demand is not met resulting in symptoms)
PAD - Clinical Manifestations
- Presents as painful cramping affecting primarily the lower extremities
- Can progress from intermittent with activity into pain at rest
- LE:
– Numbness/Weakness
– Decreased Temp
– Sores will not heal
– Change in color
– Hair loss/slower hair growth
– Slower growth of toenails
– Weak pulse
Diagnostic - PAD
ABI (primary):
- Positive (mild/moderate): 0.41-.90,Severe: <.40
- Exercise ABI: used for patients who experience claudication, yet have a normal ABI value
Complications - PAD
Critical Limb Ischemia
- Full occlusion of several arteries in the extremities
- 5 P’s (Pain (extreme), Pallor, Paralysis, Parathesia and Pulselessness)
- Tissue Necrosis -> Limb loss
Pulmonary Hypertension - Def
- Affecting the arteries of lungs
- R side of the heart
- Can be a progressive, fatal condition
- Can result in heart failure
Pulmonary HTN risk increases with
age
Pulmonary HTN - Pathogenesis
- Arteries leading to lungs become hard and narrow
- ↑PVR (pulmonary vascular resistance)
- ↑workload for RV
- Resulting in RV hypertrophy can lead to R heart dysfunctionand failure (Higher pressures on the R side of the heart can lead to tissue breakdown.
Pulmonary HTN - RF
- Having ONE or more of the following:
- Obesity
- Family history
- Illegal drugs (cocaine)
- Appetite suppressant medications (Fen-Phen); now off market
Pulmonary HTN - Clinical Manifestations
- Chest pain
- Dyspnea during normal routine
Pulmonary HTN - Diagnostic
- Defined by mPAP and↑PVR
- mPAP > 25 mmHg
Pulmonary HTN - Complications
Right Sided Enlargement and Heart Failure (Cor Pulmonae)
– RV becomes enlarged, does more work
– Compensates by thickening walls & enlarging chambers
Blood Clots
– arteries of the lungs
Bleeding
– Into the lungs; cough up blood
