Vascular Disease Flashcards
what factors contribute to the disturbance in blood flow?
Pathologic changes in the vessel wall (Atherosclerosis and vasculitis). Acute vessel obstruction due to thrombus, embolus or vasospasm (Raynaud’ phenomenon). Abnormal vessel dilation
(Arterial aneurysms or varicose veins). Compression of blood vessels by extravascular forces (Tumors or edema)
What are the three layers of blood vessels?
Tunica Intima:Innermost layer lines the lumen.
Tunica Media: Middle layer. Smooth muscle & elastic fibers. Responsible for vaso dilation & constriction. Tunica Adventitia: Most superficial. Dense irregular basement membrane. Collagen fibers for strength
What are the three types of arteriosclerosis?
Atherosclerosis: Plaque buildup of fat, cholesterol, or calcium. Moenckeberg medial calcific sclerosis: Calcium deposits in the Tunica Media. Poorer diagnosis. Arteriolosclerosis: Vessel wall thickening and luminal narrowing in the small arteries and arterioles
What are major complications of atherosclerosis?
Ischemic heart disease, Stroke (Carotid Arterial Disease), Aneurysm, Peripheral vascular disease
What happens as a result of carotid artery disease?
block the carotid arteries to the brain and cause paralyzing strokes. Without Atrial Fibrillation, 90% come from the ICA
What is a TIA?
Transient episode of neurologic dysfunction caused by loss of blood flow either focal brain, spinal cord or retinal without infarction. Usually resolves in 24 hours
What are symptoms of TIA?
monocular blindness (amaurosis fugax), aphasia, slurred speech (dysarthria) and mental confusion. periorbital numbness
What is the diagnostic function of duplex ultrasonography?
evaluates central (abdominal) and peripheral arteries and veins by determining the amount of vascular stenosis or occlusion within an artery. assists in ruling out aneurysmal disease and is the main aid to rule out thrombotic events
What is rheumatic fever?
Inflammatory disease following Streptococcus pyogenes infection i.e. Strep pharyngitis. Usually develops two to four weeks after a Group A Strep infection
What are the major manifestations of rheumatic fever?
Migratory arthritis, Carditis and valvulitis, Erythema marginatum, Sydenham’s chorea (rapid movements without purpose of the face and arms occurring late in the disease)
What are the minor criteria for rheumatic fever?
fever, Joint pain without swelling, Elevated ESR or C reactive protein, Leukocytosis, as prolonged PR interval
What is the treatment of rheumatic fever?
Aspirin (careful in children), NSAID’s, Penicillin or Clarithromycin or Zpack
Describe aortic aneurysms/dissections
Aneurysms (bulges) in weak areas of its walls. Most common cause is atherosclerosis. Dissection (separation of the layers of its wall). Inner lining of the aortic wall tears. Artery wall deteriorates. usually associated with high blood pressure
What is a thoracoabdominal anerysm?
Traumatic occur at ligamentum arteriosum. Just beyond the Left subclavian artery. From rapid deceleration accidents (MVA’s & Falls)
What is the clinical presentation of thoracic aortic aneurysm?
Sub sternal, back or abdominal pain. Dyspnea, stridor, or brassy cough (trachea pressure). Dysphagia (Pressure on esophagus). Hoarseness (Pressure on recurrent laryngeal nerve). Neck and arm edema from SVC compression. Start on beta blockers/call surgeon
What are screening recommendations for AAA?
ultrasonography is a highly sensitive and specific screening test for AAA. One-time screening recommended in men ages 65-75 who have ever smoked or who have never smoked but have a first degree relative who had AAA
What is the clinical presentation of AAA?
Midabdominal or lower back pain. aortic pulsations. LE occlusive disease. Aneurysms that produce symptoms are at increased risk for rupture.
What is an embolism?
Sudden interruption of blood flow to an organ or body part due to embolus adhering to the wall of an artery blocking the flow of blood. Classified by substance.
What is a thrombosis?
formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood
What are the 6 P’s of acute limb ischemia?
Pain, Paraparesis (paralysis), Pallor, Pulselessness, Paresthesia, Poikilothermia
What is the treatment for arterial emobolic disease?
revascularization & arteriography. Rapid systemic anticoagulation (heparin). Surgery – Embolectomy
Where do thrombi usually form?
at the venous cusps of deep veins where altered or static blood flow causes clot formation
What is the presentation of venous stasis?
Progressive edema of the leg which beings at ankle and calf. Dull, aching discomfort. Worse at end of day and improves with elevation. Often varicosities are present. Skin changes
What is the treatment for venous stasis?
Limit standing. Intermittent elevation of legs during day. Daily use of Thigh-high compression stockings. Regular exercise
What is Virchow’s Triad?
Venous Stasis, Endothelial injury or vessel wall injury, Hypercoagulability
What is the presentation and treatment of superficial thrombophlebitis?
Local pain, erythema and tenderness. cold compresses, analgesia and elastic supports for mild cases. severe cases bed rest, elevation of extremity, support stockings and analgesia
What is Buerger’s Disease (Thromboangitis Obliterans)?
Recurring progressive inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet. Associated with smokers and periodontal disease
What is the pathophysiology of Buerger’s Disease?
Inflammatory reaction of the vessel wall which eventually leads to vasculitis and ischemic changes in distal parts of limbs
What are treatment options for Buerger’s Disease?
Smoking Cessation!!! CONSIDER Calcium channel blockers to manage vasospasm. Hyperbaric chamber
What is peripheral arterial disease?
occlusive arterial disease primarily of the lower extremities, trunk, arms due to hardened and clogged arteries that reduce blood flow
What is Raynaud’s phenomenon?
small arteries (arterioles), usually in fingers or toes, constrict more tightly in response to cold or stress
What is the presentation of lower extremity PAD?
Erectile dysfunction (iliac disease), Claudication, Gangrene, Leriche’s Syndrome (triad). nocturnal pain across the dorsum of the foot and metatarsal heads. Usually relieved by placing feet in dependent position
What diagnostic tests are used for suspected PAD?
ABI (Ankle Brachial Index), Gadolinium-enhanced MRA, X-rays and CT are used to R/O osteomyelitis
What are symptoms of PAD?
Reduced Temperature, Hair loss, Pallor, Nail hypertrophy, Ulcer, Gangrene
What are treatment options for PAD?
Tobacco cessation critical!!! Anti-platelet agent- aspirin 81mg. Cilostazol (100mg BID) a phosphodiesterase inhibitor. walking program
What is vasculitis?
Group of disorders that destroy blood vessels by inflammation
What diagnostic tests are ordered for vasculitis?
ESR, CRP, Anemia, increased WBC and eosinophilia. Biopsy of involved organ or tissue is definitive
What is treatment for vasculitis?
Corticosteroids (Prednisone), Possibly immune suppression drugs, Possibly antibiotics
What is giant cell arteritis (temporal arteritis)?
Inflammatory disease of blood vessels most commonly involving large and medium arteries of the head predominantly the external carotid artery. Most serious complication is permanent blindness. Treated w/prednisone
What is the presentation of temporal arteritis?
Bruits, Fever, Headache, Sensitivity of the scalp, Jaw claudication, Tongue claudication, Acute visual loss or reduced visual acuity, Diplopia, Acute tinnitus
What will you find on physical exam for temporal arteritis?
Palpation of the head reveals prominent temporal arteries with or without pulsation. Temporal area may be tender. Decreased pulses may be found through out the body. Evidence of ischemia may be noted on fundal exam
