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Block 3 FCM > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

3 layers to wall of artery

A

adventitia
media
intima

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2
Q

what is atherosclerosis

A

deposition of fat in the walls of the artery underneath the intima

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3
Q

peripheral arterial occlusive disease risk factors

A 
age over 40
greater in men
hyperlipidemia
smoking
HTN
Diabetes
Obesity
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4
Q

Signs and symptoms of peripheral arterial occlusive disease

A 
intermittent claudication
loss of hair
thinning of skin
cyanosis or pallor
cool to touch
arterial ulcer
dependent rubor
DIMINSHED OR ABSENT PULSE SOUNDS
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5
Q

what is intermittent claudication?

A

pain in legs when walking, muscles distal to lesion/plaque is what is symptomatic.

ex: plaque in femoral artery causes cramping in calves

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6
Q

peripheral arterial occlusive disease diagnosis

A

physical exam of peripheral pulse by diagnostic testing:

  1. ankle- brachial index
  2. US
  3. CT angiogram
  4. MR angiogram
  5. Angiography
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7
Q

what is gold standard diagnosis for peripheral arterial occlusive disease

A

angiography

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8
Q

easiest/ fastest/ least invasive diagnostic test for peripheral arterial occlusive disease

A

ANKLE BRACHIAL INDEX

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9
Q

When is an MR angiogram likely to be done in diagnosing a pt with peripheral arterial occlusive disease

A

when they can’t handle CT contrast

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10
Q

peripheral arterial occlusive disease treatment

A

CONSERVATIVE CARE:

  1. WALKING PROGRAM
  2. RISK FACTOR MODIFICATION: quit smoking, control cholesterol, diabetes, etc.
  3. Medications: antiplatelt (aspirin 81 mg), cilostazol (symptom relief- HF its can’t take this)

Endovascular revascularizaton

open arterial bypass
(fem-pop MC)

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11
Q

CRITICAL LIMB ISCHEMIA- 6 symptoms/ things to know

A
  1. Dry gangrene- black toe, mummified
  2. Wet gangrene- oozy, can get septic
  3. patients with rest pain- patient lay flat and have pain in distal part of foot, when they walk it improves- “sleep in recliner”
  4. 5 P’s- pulselessness, paresthesia, paralysis, pain, pallor
  5. patients with rest pain require urgent revascularization as well as tissue debridement
  6. may result in amputation
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12
Q

when to do routine referral for peripheral arterial occlusive disease

A

intermittent claudication with failure to respond to conservative measures (walking program)
diminished pulses

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13
Q

when to do urgent referral for peripheral arterial occlusive disease

A

arterial ulcers

gangrene

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14
Q

when to do emergent referral for peripheral arterial occlusive disease

A

suspicion of acute thrombus/embolus

5 P’s

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15
Q

when does arterial thrombosis occur?

A

when the intact intimater plaque ruptures and you get platelets that stick to fatty layer

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16
Q

what is a collection of platelets called?

A

thrombosis

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17
Q

difference between thrombus and embolus?

A

thrombus is at site where intimacy ruptured

embolus is when piece of thrombus breaks off and travels somewhere else

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18
Q

signs and symptoms of arterial thrombus and embolism

A

pain at site of infracted organ

end organ dysfunction

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19
Q

evaluation for arterial thrombus and embolism

A
  1. EKG
  2. Echo
  3. imaging of other potential sources where thrombus may have originated- angiogram, US
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20
Q

treatment of arterial thrombus and embolism

A
  1. immediate anticoagulation
  2. endovascular intervention (thrombolytics: pharm-TPA, or mechanical)
  3. open thrombectomy
  4. bypass for distal flow restoration
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21
Q

aortic aneurysm etiology

A
  1. uncontrolled HTN= MCC
  2. atherosclerosis
  3. connective tissue disorders
  4. infection- microtic aneurysm
  5. traumatic aneurysm- very uncommon
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22
Q

signs and symptoms of aortic aneurysm

A

most are asymptomatic

abdominal pain–> suspect ruptured AA

Bruit

Palpable abdominal mass (pulsatile)

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23
Q

aortic aneurysm Diagnosis

A
  1. US

2. CTA,MRA, Angiogram

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24
Q

when is the wall of artery considered aneurysmal?

A

when it gets to 4cm

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25
what is a mural thrombus
thrombus stuck to wall of aneurysm- has much smaller risk of embolization
26
aortic aneurysm treatment
1. watchful waiting 2. smoking cessation 3. endovascular stenting 4. open/laproscopic repair
27
what size do you generally fix anuerysms
5 1/2 cm
28
what is aortic aneurysm?
ballooning out of section of aorta
29
when to do routine referral for aortic aneurysm
palpable abdominal mass | aneurysm measuring less than 5 cm
30
when to do emergent referral for aortic aneurysm
suspicion of rupture
31
what is a retroperitoneal rupture in aortic aneurysm ?
outside peritoneum, patients are more likely to survive | usually some structure will tamponade off bleeding
32
what is a intraperitoneal rupture in aortic aneurysm ?
inside peritoneum, can put entire blood volume in peritoneum. these patients die very quickly.
33
percentage of patients that survive a ruptures AA
25%
34
pseudo aneurysm etiology
``` arterial puncture (heart Cath) arterial bypass anastomosis ```
35
what is a pseudo aneurysm
there is hole in artery somewhere and you have flow outside blood vessel but in general it is tamponade off by surrounding structures. generally we see in groin (pulsatile mass)
36
pseudo aneurysm signs and symptoms
pain swelling ecchymosis
37
pseudo aneurysm diagnosis
US
38
pseudo aneurysm treatment
1. inject thrombin into pseudo aneurysm | 2. manual pressure on groin after cath
39
What is an aortic dissection
tear in intima, you get blood flow in false lumen
40
risk factors for aortic dissection
connective tissue disorders, trauma
41
aortic dissection symptoms
chest pain syncope dyspnea compression of surrounding structures
42
aortic dissection physical exam
hyper/hypotension lower extremity paralysis, 5 P's diminished peripheral pulses in in aortic root, can get diastolic murmur
43
diagnosis of aortic dissection
EKG Chest X ray- widened mediastinum CT scan
44
treatment for aortic dissection
manage hyper/hypotension manage pain admit to ICU surgical correction versus management -in stanford A aortic dissection do surgical management -in stanfordB aortic dissection do medical management
45
in the Aortic dissection class Stanford A, what does that mean?
involves ascending aorta and/or aortic arch, and possibly descending aorta
46
in the Aortic dissection class Stanford B, what does that mean?
involves the descending aorta, without involvement of the aortic are or ascending aorta
47
Polymyalgia Rheumatica (4)
involves proximal joint pain no weakness fever, malaise, weight loss elevated ESR
48
what is giant cell arteritis?
systemic arteries affecting medium to large vessels, inflammation in wall of artery
49
giant cell arteritis symptoms
HA Jaw caludication amaurosis fugal scalp tenderness
50
giant cell arteritis physical exam
diminished pulses temporal artery may be nodular, prominent, or pulseless pale and swollen optic dish on fundoycopic exam decreased proximal joins range of motion secondary to pain
51
giant cell arteritis diagnosis
ESR greater than 50 increased C reactive protein temporal artery biopsy
52
treatment for giant cell arteritis
high dose corticosteroids- saves vision | aspirin therapy
53
treatment for polymyalgia rhematica
low dose corticosteroids | may add methotrexate to help taper off steroids
54
when to refer urgently for polymyalgia rhematica or giant cell arteritis
suspicion of giant cell arteritis suspicion of polymyalgia rheumatica refer only after initiation of corticosteroids
55
when to refer emergently for polymyalgia rhematica or giant cell arteritis
suspicion of giant cell arteritis in presence of vision loss
56
Deep Vein Thrombosis risk factors
prothrombotic states: - factor V leiden - prothrombin mutation - Protein C or S deficiency - antithrombin deficiency other predisposing factors: - cancer - pregnancy - post menopausal hormone replacement - birth control use - cigarrete smoking - surgery - trauma
57
Virchow's triad risk factors for DVT
1. venous stasis\ 2. endothelial damage 3. hypercoagulability
58
Clinical evaluation of Deep Vein Thrombosis
``` swelling- usually unilateral extremity pain extremity tenderness discoloration homan's sign ```
59
what is homan's sign?
passive dorsiflexion of foot eliciting pain in calf
60
diagnosis of DVT
1. D-dimer 2. venous US- MC (look for winking of vein, if there is no winking then think thrombosis) 3. venography- active picture done with c arm and IV contrast--> looking for lack of contrast filling
61
Deep Vein Thrombosis treatment
1. anticoagulation - unfractionated or low molecular weight heparin - oral anticoagulation - novel anticoagulation-n dabigatran, rivaroxaban, apixaban 2. compression therapy 3. catheter directed thrombolysis 4. mechanical thrombolysis 5. open thrombectomy 6. IVC filter
62
when do you not need to refer for Deep Vein Thrombosis
when dVT is managed with oral anticoagulation and compression stockings
63
when do you routine refer for Deep Vein Thrombosis
development of post-phlebitic syndrome | phlebitis: warmth, erythema, palpable cord
64
when do you emergently refer for Deep Vein Thrombosis
suspicion of proximal DVT that may benefit from thrombolysis
65
when would you admit for Deep Vein Thrombosis
suspicion of PE
66
superficial thrombophlebitis etiology
1. venous catheterization (by us inserting IV into patient) 2. pregnancy 3. varicose veins 4. trousseau's thrombophlebitis--> abdominal cance process
67
signs and symptoms of superficial thrombophlebitis`
redness tenderness palpable cord (Phlebitis)
68
treatment of superficial thrombophlebitis
``` NSAIDS- treatment of choice warm compress for pain management gentle massage anti coagulation venous ligation ```
69
when to urgently refer for superficial thrombophlebitis
suspicion of thrombus propagation
70
venous insufficiency or varicose veins etiology
``` venous thrombosis (DVT) valvular incompetence- valves are damaged ```
71
signs and symptoms of venous insufficiency or varicose veins
``` aching or heaviness sweilling varicose veins (for VI) ulcerations cellulitis ```
72
physical exam for venous insufficiency or varicose veins
``` low extremity edema varicose veins lipodermatosclerosis- firm skin venous stasis dermatitis ulceration--> poorly defined, usually around ankle ```
73
diagnosis for venous insufficiency or varicose veins
US
74
treatment for venous insufficiency or varicose veins
``` graduated compression socks--> treatment of choice superficial vein ablation perforator vein ligation vein stripping valvular reconstruction ```
75
routine referral for venous insufficiency or varicose veins
cosmetic varicose vein concerns swelling and leg heaviness not helped by compression stockings venous ulceration
76
emergent referral for venous insufficiency or varicose veins
infected venous ulceration with sepsis

Block 3 FCM (7 decks)

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