Vascular Disease Flashcards by Brianna Spahn

Commonly result of atherosclerosis

Significant independent risk factor for cardiovascular / cerebrovascular morbidity/mortality

Initially asymptomatic, but typically progresses to claudication, ischemia, pain with exercise in lower extremities.

Peripheral Arterial Disease

How well did you know this?

Not at all

Perfectly

Critical progression of PAD

Acute limb ischemia: pain at rest, skin ulceration, gangrene, loss of limb

Numbness, tingling

How well did you know this?

Not at all

Perfectly

What may cause an acute progression of PAD

Arterial Thrombosis / embolism

How well did you know this?

Not at all

Perfectly

Commonly the first symptom of PAD

Intermittent claudication
(Foot or lower leg pain with exercise, relieved by rest)

thigh or buttock pain may occur

How well did you know this?

Not at all

Perfectly

How might PAD affect pulses?

Femoral and distal pulses weak or absent

2. Aortic, iliac, femoral bruit may be present

How well did you know this?

Not at all

Perfectly

Skin changes caused by PAD

Hair loss
Shiny atrophic skin
Pallor with dependent rubor

How well did you know this?

Not at all

Perfectly

Pain, pallor, lack of pulse, paresthesias, poikilothermia, paralysis : INDICATE WHAT

Acute arterial occlusion

How well did you know this?

Not at all

Perfectly

Highly sensitive and specific test for PAD

Ankle-brachial Index (ABI)

ABI <0.9 is diagnostic

ABI 1.00 + is normal

How well did you know this?

Not at all

Perfectly

“Gold Standard” study

Angiography

How well did you know this?

Not at all

Perfectly

Test used for locating stenotic sites and for accurate diagnosis of thrombosis or embolism - not used routinely, only to prepare for revascularization

CT or MRI

How well did you know this?

Not at all

Perfectly

Test used to determine systolic pressures in peripheral arteries

Doppler ultrasound flow studies

How well did you know this?

Not at all

Perfectly

PAD treatment

Aggressive risk factor modification
- tobacco use, diabetes, HTN, hyperlipidemia

Aspirin and/or clopidogrel

Beta blockers / ACE inhibitors, Statins

Exercise

How well did you know this?

Not at all

Perfectly

Highest prevalence of atherosclerotic PAD in what age range

60-70 years

How well did you know this?

Not at all

Perfectly

Primary sites of involvement for PAD

Femoral and popliteal (80-90%)
* *elderly and diabetic patients**
Tibial and peroneal arteries (40-50%)
Aortic and iliac (30%)
* lesions often occur at branch points - due to increased turbulence*

How well did you know this?

Not at all

Perfectly

T/F - Most patients with PAD are symptomatic?

False - fewer than 50% are symptomatic

though many have slow or impaired gait

How well did you know this?

Not at all

Perfectly

What test is used to image and detect stenotic lesions, routinely?

Duplex utlrasonography

How well did you know this?

Not at all

Perfectly

Condition that develops from superficial venous insufficiency and valvular incompetence.

Varicose Veins

Occurs in approx 15% of adults, esp women

How well did you know this?

Not at all

Perfectly

Treatment for Varicose Veins

Graduated elastic stockings
Leg elevation / regular exercise
Unna boot (compression boot dressing) for ulcers

How well did you know this?

Not at all

Perfectly

Virchow’s triad for assessing risk of developing thrombophlebitis

Stasis, vascular injury, hypercoaguability

How well did you know this?

Not at all

Perfectly

Often occurs at site of IV or PICC lines

Superficial thrombophlebitis

How well did you know this?

Not at all

Perfectly

Associated with surgical procedures, prolonged bed rest, lower extremity trauma, oral contraceptives

DVT

How well did you know this?

Not at all

Perfectly

Presents with dull pain, erythema, tenderness, and sometimes induration of involved vein, or no symptoms

DVT

How well did you know this?

Not at all

Perfectly

Most common vein involved w DVT

Long saphenous vein

How well did you know this?

Not at all

Perfectly

Percentage of patients that present DVT with no symptoms

50%

Classic findings of DVT

swelling of involved area, heat and redness over the site

Preferred study for DVT

Duplex ultrasonography **neg duplex results in patients with high suspicion warrants further testing**

Most accurate method for definitive diagnosis of DVT, but associated with increased risk and rarely indicated

Venography

How can a D-Dimer be used?

To RULE OUT - a negative D-Dimer suggests ultrasonography may be omitted (D-dimers are elevated in a number of conditions - most hospitalized patients have elevated d-dimers)

Study if PE is suspected?

CT angiography is study of choice (Pulm angiography is "gold standard" but rarely performed) *V/Q scan can be used if CT contraindicated*

Treatment for superficial thrombophlebitis

Conservative! 1. Best rest, local heat, elevation 2. NSAIDs 3. Antibiotics **IF** evidence of infection exists

Preventing DVT in bed ridden patients

Elevation of foot Leg exercises Compression stockings / devices **Anticoagulants (Heparin) in high risk patients**

Characterized by loss of wall tension in veins, resulting in stasis of venous blood. Often associated with history of DVT, leg injury, varicose veins

Chronic Venous Insufficiency

Progressive edema starting at the ankle. Itching, dull pain with standing, ulceration

Chronic Veinous Insufficiency

Where are ulcers most commonly found in chronic veinous insufficiency?

Just above the ankle (stasis ulcer)

Skin changes in chronic veinous insufficiency

Skin is shiny, thin, atrophic Dark pigmentary changes and subcutaneous induration

Treatment of stasis dermatitis in chronic venous insufficiency

1. Wet compresses 2. Hydrocortisone cream 3. Zinc oxide 4. Antifungal cream when indicated

Systemic inflammatory condition of medium and large vessels. Frequently coexists with polmyalgia rheumatica.

Giant cell arteritis

Arteries frequently involved with giant cell arteritis?

Temporal Artery and other extra cranial branches of carotid artery

What can giant cell arteritis lead to if not treated aggressively?

BLINDNESS

Within 7 years, what can occur in 15% of patients?

Large vessel problems (e.g. thoracic aortic aneurysm)

Patients are typically elderly and complain of unilateral temporal headache

giant cell arteritis

Additional signs and symptoms of giant cell arteritis

Scalp tenderness, jaw claudication, throat pain, diplopia, elevated inflammatory markers Polymyalgia rheumatica occurs in 50% of patients: pain and stiffness of shoulder and pelvic girdle

Definitive diagnosis for giant cell arteritis

Temporal artery biopsy

Test indicating a temporal artery biopsy may be necessary

History / symptomology + SED and CRP highly elevated

Hematologic finding often associated with giant cell arteritis

Normochromic normocytic anemia and thrombocytosis

Treatment for giant cell arteritis

High-dose prednisone for 1-2 months and low-dose aspirin. **initiated immediately, not to wait to biopsy results**

Weakness and subsequent dilation of the vessel wall, usually caused by atherosclerotic damage to the intima

Aorta aneurysm

Genetic causes of aortic aneurysm

Marfan's, Ehlers-Danlos syndrome

Classic picture of patient with aortic aneurysm

Eldery male smoker with CAD, emphysema, and renal impairment **men are 8x more likely to have aneurysm**

Mortality rate for rupture of aortic aneurism (dissection)

90%

Substernal, back, or neck pain. Dyspnea, stridor and cough. Dysphagia. hoarseness. Superior vena cava syndrome.

Thoracic aorta aneurysm

Severe pain, "ripping" or "tearing" chest pain radiating to the back

Thoracic aortic dissection

Severe back, abdominal, flank pain. Hypotension and shock

Abdominal Aortic Aneurism Rupture

25% of patients with aortic aneurysms present with these diseases

Renal or lower extremity occlusive disease

Study of choice for abdominal aneurysms

Abdominal ultrasonography

Screening protocol for abdominal aneurysms

Single abdominal ultrasound for men older than 65 yrs who have ever smoked

Diagnosing thoracic aneurysms

May require aortography CT/MRI prefered over ultrasonography

Occurrence of abdominal vs thoracic aortic aneurysms

90% abdominal 10% thoracic