Vascular Disease Flashcards
In patients with carotid artery stenosis, what treatment should be prescribed initially?
Anti-platelet treatment
What is the most common site of rupture in aortic disruption?
Ligamentum arteriosum
What is the definition of a stroke?
Acute onset of focal neurological symptoms and signs due to disruption of blood supply
What are the two types of stroke?
Haemorrhagic (20%)
Ischaemic (80%)
What causes a hemorrhagic stroke?
Burst vessel
Raised blood pressure
Weakened vessel wall (structure abnormality of inflammation)
What causes an ischaemic stroke?
Blocked vessel
Thrombotic
Embolic
Hypoperfusion
Non modifiable risk factors for stroke?
Age Family history of stroke Gender Race Previous stroke
Modifiable risk factors of stroke?
Hypertension Hyperlipidaemia Smoking Diabetes Atria Fibrillation Congestive heart failure Alchohol excess Obesity Physical inactivity Poor socioeconomic status
Rare causes of stroke (especially in younger people)?
Homocysteinemia Vasculitis Genetic Cardioembolic Cervical artery dissection Embolus through patent foramen oval/AV shunts
What is the differential diagnosis for stroke?
Hypogylcaemia Seizure Migrane Hyperglycaemia/hyponatraemia Brain tumour Functional hamiparesis
What is the only way to differentiate between ischaemic and hemorrhagic stroke?
Brain imaging
CT brain +/- angiography
MRI with DWI +/- angiography
MRI with GRE (looks for old bleed)
Where will an atheroembolism infarct?
At the same side as affected carotid artery?
Where will a cardioembolsim infarct?
More than one arterial territory
Bilateral
What is the medical management for a stroke?
Aspirin + dipyridamole/clopidogrel Statins Anticoagulation in AF Antihypertensives Thrombolysis
What is the surgical management for stroke?
Haematoma evacuation
Relief of raised intracranial pressure
Carotid endarterectomy
What are the clinical features of acute limb ischaemia?
Pain Pallor Pulseless Perishingly cold Paraesthesia Paralysis
What is intermittent claudication?
Insufficient blood reaches exercising muscle
Pain free at rest, but exercise causes ischaemic pain in affected limb
How is the ankle branchial pressure index measured?
Ankle pressure / Brachial pressure
What investigations are carried out in lower limb ischaemia?
ABPI measurement
Duplex ultrasound scanning
Magnetic resonance angiography
CT angiography
Catheter angiography
What is the treatment for lower limb ischaemia?
Slowing progression - Smoking cessation, lipid lowering, antiplatelets, hypertension Rx, diabetes Rx, lifestyle factors
Improvement of symptoms - exercise training, drugs, angioplasty/stunting, surgery (REALISTIC EXPECTATIONS)
What are the symptoms of critical limb ischaemia?
Rest pain
Worse at night
Helped by sitting with leg in dependent position or walking about
What are the risk factors for amputation in critical limb ischaemia?
Smoking
Diabetes
What is the treatment of critical limb ischaemia?
Analgesia
Angioplasty/stenting
Surgical reconstruction/amputation
(REALISTIC EXPECTATIONS)
