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MSPA- Cardiology > VASCULAR DISEASE > Flashcards

VASCULAR DISEASE Flashcards

1
Q

What are the 6 P’s of acute PAD clinical presentation ?

A
  • Pain, Pallor, Poikilothermia, Pulselesness, Parasthesia and Paralysis.
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2
Q

What is the chronic presentation of PAD ?

A
  • upto 50% are asymptomatic.
  • It usually presents bilaterally with leg fatigue, intermitent claudication and ulcers.
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3
Q

What is the common vessel involvement in PAD ?

A
  • Iliofemoral 44%
  • Carotids 31%
  • Aorta 31%
  • CAD 18%
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4
Q

What are the risk factors for PAD ?

A

→ Older age
→ HTN
→ Tobacco use
→ Diabetes mellitus
→ Hypercholesterolaemia

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5
Q

What are the investigations in PAD ?

A
  • Complete CV examination.
  • Ankle-Brachial Index (ABI)
    to assess severity of disease.
  • Duplex Ultrasound
  • CT-angiogram
  • MR-angiogram
  • Angiography
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6
Q

What is the ABI in PAD ?

A

→ Normal >0.90
→ Mild 0.71-0.90
→ Moderate 0.41-0.70
→ Severe 0.0-0.40

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7
Q

How to perform Burger’s test in PAD ?

A

https://youtu.be/qJ4FR20zDzk
→ Raise 1 or both legs to 450
for 1-2 minutes
→ Observe the colour of the limbs and Note at what angle pallor occurs and the angle is Known as Buerger’s angle.
→ Sit the pt up and hang their legs over
the side of the bed
→ Look for reactive hyperaemia

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8
Q

What is the Burger’s test indication for severe ischemia ?

A
  • colour change in <20 degree angle of leg elevation.
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9
Q

What is the non pharmacological management of PAD ?

A
  • Lifestyle modifications
  • Secondary prevention of CVD and smoking cessation.
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10
Q

What is the pharmacological management of PAD ?

A

PDE inhibitors such as
→ Cilostazol (Pletal)
→ Pentoxiphylline (Pentoxil)

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11
Q

What is the revascularization approaches in PAD ?

A
  • Angioplasty
  • Stenting
  • Bypass grafting
  • Amputation
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12
Q

What is the nidus of DVT ?

A

Virchow’s triad

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13
Q

What is the clinical presentation of DVT ?

A

→Pain
→Tenderness
→Swelling

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14
Q

What are the Px findings in DVT ?

A

→Swelling
→Palpable cord
→Discoloration
→Superficial vein dilation

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15
Q

What are the risk factors for DVT ?

A
  • Major surgery
  • Periods of
    immobilisation
  • # s
  • Cancer
  • Hx of DVT
  • OCP use
  • Pregnancy or postpartum
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16
Q

What is the Well score classification of DVT risk ?

A
  • ≤ 0 Low probability ( 5%)
  • 1-2 moderate probability ( 17%)
  • ≥ 3 high P ( 17-53%)
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17
Q

What is the Well’s criteria to manage low probability DVT cases?

A

First step is to check D-Dimer. If negative DVT excluded. If positive, perform duplex US and if positive begin anticoagulation or DVT excluded.

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18
Q

What is the Well’s criteria to manage Mod/High probability DVT cases?

A

First step is to Perform US (± D-Dimer). If positive begin anticogaulation, if uncertain repeat US and specialist consult. If negative DVT excluded.

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19
Q

What are the contraindications for anti-coagulants in DVT ?

A

Transient contraindication if retrievable IVC in situ and permanent contraindication, if permanent IVC in situ.

20
Q

What are the indications for out patient management of DVT ?

A

If the patient does not have Phlegamisa or extensive illio-femoral DVT and no-contraindications for thrombolysis outpatient anti-thrombotic therapy with LMWH or tondaparinux can be done.

21
Q

What are the indications for in patient management of DVT ?

A

If there are contraindications for thrombolysis in patient admission for catheter directed thrombolysis or IV systemic thromobolysis with UFH or LMWH or Tondaparinux can be done.

22
Q

What is the duration of out-patient DVT managment ?

A

3 months

23
Q

What are the drug choices in DVT?

A

→LMWH as bridge to PO agent
→Vit K antagonist (warfarin)
→Dabigatran
→Rivaroxaban or Apixaban
→UFH (only as inpt)

24
Q

What are the preventive measures in DVT ?

A
  • May require indefinite anticoagulation with Factor Xa inhibitors or Warfarin
  • IVC filter for repeat DVT or high-risk PE.
  • Ambulation
  • Monitor for post-thrombotic syndrome.
  • Prophylaxis for inpatients.
25
Q

What is the pathophysiology of chronic venous insufficiency ?

A

Chronic venous insufficiency can develop from the protracted valvular incompetence of superficial veins, deep veins, or perforating veins that connect them. Deep vein dysfunction is usually owing to the previous DVT and Perforating vein valvular failure in combination with superficial vein dysfunction leads to venous hydrostatic pressure increase which manifest as pain, edema, and venous microangiopathy.

26
Q

What are the complications of venous micro-angioathy in CVI ?

A

The venous microangiopathy of chronic venous insufficiency causes skin hyperpigmentation from hemosiderin deposition and lipodermatosclerosis. As the disease progress Gaiter area ulcers and Varicose vein formation.

27
Q

What are the special tests in chronic venous insufficiency ?

A
  • Ambulatory Venous Pressure (AVP)
  • Venous Recovery Time (VRT)
  • Plethysmography
  • Venous Duplex Ultrasound
28
Q

What is the Most important noninvasive diagnostic method in evaluating the venous system?

A

Venous Duplex Ultrasound

29
Q

What is the treatment of chronic venous insufficiency ?

A

Compression therapy using
→Unna boot
→Compression stockings
→Multilayer elastic wraps
→Pneumatic compression devices

30
Q

What are the therapeutic effects of compression therapy ?

A

→Decrease oedema
→Improved cutaneous metabolism
→Counteract transcapillary Starling forces which favour leakage of fluid out of the capillary.

31
Q

What is Varicose vein ?

A

It is a disease that primarily involves the superficial
veins of the lower extremities. It can be primary or secondary and is more common in woman. Highest incidence in western countries and can be symptomatic or asymptomatic.

32
Q

What are the most commonly affected veins in Varicoses ?

A

Great saphenous and small saphenous veins.

33
Q

What is the pathophysiology of varicose vein?

A

sustained venous hypertension that increases the diameter of the superficial veins resulting in further valve incompetence and reflux. The causes are mainly
→ Prolonged standing and Chronic venous insufficiency.
→ Increased intra-abdominal pressure due to tumor, pregnancy, obesity etc.
→ Familial & congenital disorders.
→Secondary vascularisation due to DVT
→AV shunts..

34
Q

What is the clinical presentation of varicose vein ?

A

Pain, leg fatigue and edema following prolonged standing and at the end of the day.

35
Q

What are the clinical signs of varicose vein ?

A
  • Telangiectasias
  • Reticular varicosities
  • Upon standing, dilated,
    tortuous veins beneath the
    skin of the thigh & leg
  • Secondary tissue changes:
    → Swelling
    → Lipodermatosclerosis
    → Hyperpigmentation
36
Q

What are the DDx of varicose vein ?

A

→Primary vs Secondary VVs
→AV malformation
→Atresia of the deep vessels

37
Q

What is the work up in varicose vein ?

A

Duplex U/S

38
Q

What are the treatment approaches in VV?

A
  • Conservative approach
    *Medications such as Horse chestnut seed extract or Butcher’s broom.
  • Compression therapy if there is no induration, pigmentation or Lipodermatosclerosis.
  • Injection sclerotherapy, if compression therapy doesn’t work.
  • Endovenous laser treatment
  • Radiofrequency ablation
  • Saphenous vein ligation & stripping
39
Q

What is thrombophlebitis ?

A

It is Inflammation in a vein and can be 1st sign of hypercoagulable state which increases risk of DVT. But can be easily treated and usually resolves within 7-10 days.

40
Q

what is the symptomatology of phlebitis ?

A

Sudden pain and swelling localized to the site of thrombosis. there is will notable Firm, tender, erythematous and Palpable venous/fibrous cord present.

41
Q

What are the labs in phlebitis ?

A

→ FBC, Coag
→ Biochem (U&E, glucose)
→ Protein C & APC resistance
→ Protein S
→ Antithrombin
→ Antiphospholipid Abs panel
→ Homocysteine

42
Q

Why is Venous Duplex U/S done in phlebitis ?

A

→ Look for DVT
→ Evaluate extent of
superficial thrombosis

43
Q

What is the management of Superficial phlebitis?

A
  • Local heat
  • NSAIDS
  • If VV: treat VV to prevent recurrance.
  • If concern for DVT: add anti-coagulants.
44
Q

What is the management of Septic superficial phlebitis?

A

Heparin to prevent further
clot formation and Antibiotics such as Vancomycin or ceftriaxone.

45
Q

What are the 4 main types of ulcers?

A

→Arterial
→Venous
→Neuropathic
→Mixed

MSPA- Cardiology (8 decks)

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