Vascular Disease, Disease of the Aorta, and Peripheral Vascular Disease - part 2 Flashcards
Risk factors for Aortic Dissection
- Long-standing arterial HTN
- smoking, dyslipidemia, cocaine
- Hereditary vascular conditions
- Vascular inflammation
- Deceleration trauma
- Iatrogenic factors
Pathophysiology of aortic dissection
Intimal tear leads to penetration of blood within the aortic wall
False lumen forms separating layers of aortic wall
What is the most direct and useful classification criteria for aortic dissection?
Sanford classification
How does the sanford classification classify aortic dissection?
Type A: Always involves the proximal aorta
Type B: NO proximal involvement at all (descending aorta dissection only)
Common presenting symptoms of Type A aortic dissections
Can be none
Pain, numbness, TIA, stroke
Symptoms related to compression of the adjacent tissue such as chest pain, dyspnea, hoarseness, dysphagia, CHF, aortic insufficiency, head and neck swelling
Complications of Type A aortic dissections
- Aortic rupture
- –rupture into pericardium, pleura, or peritoneal cavity
- Cerebral ischemia
- Pericardial tamponade
- Acute aortic regurg leading to pulmonary edema
- –disruption of aortic annulus
- Coronary insufficiency
General/Classic clinical presentation of an aortic dissection
Abrupt onset of severe pain in chest or back
Classically described as ‘ripping,’ ‘tearing,’ or migrating
Focal neurologic deficits if dissection extends into cerebral vessels
Syncope
Aortic dissection physical exam findings
Unequal upper extremitiy BPs Tachycardia Pulse deficits Focal neurological deficits Aortic insufficiency (acute) Evidence of pericardial tamponade
Radiographic findings of aortic dissection
-which are most common?
Normal Widen mediastinum ** Abn cardiac contour Abn aortic contour ** Pleural effusion Absence of wide mediastinum
** = most common
Acute aortic dissection therapy/tx
Establish B-blockade Calcium channel Vasodilate if BP remains elevated after adequate B-block Adequate analgeis Low threshold for intubation if unstable DO NOT GIVE FIBRINOLYTICS
See notes for differences b/t Type A and B
Type B dissections can be considered unstable. What would make them classified as this?
Propagation with compromise of downstream vasculature
Impending rupture
Unrelieved pain
Do we do surgery for aortic dissection?
If type A, emergent surgery is definitive treatment
If type B, reserve surgery for complications. Prefer medical therapy if patient is stable.
Chronic aortic occlusions
- chronic meaning..
- locations
- symptoms
- physical exam
Progressive narrowing of distal aorta
From rentals to iliac arteries but also in the great vessels
SXs: claudication of low back, buttocks, impotence or none
Absent pulses below obstruction, bruit, skin/hair changes, redness on dependency
Acute aortic occlusion
- how does it come about
- what does it cause/symptoms
- physical exam
If distal aorta - MEDICAL EMERGENCY
Pre-existing narrowing of plaque and rupture Acute ischemia of lower extremities Pain with rest Pallor Absent pulses
Aortitis can cause…
aneurysms and dissections
see the notes for more on aoritits
-its part of the vasculitis diseases studied previously
Aortic coarctation
Congenital stenosis within aorta (usually by ligamentum arteriosum)
Strongly associated with bicuspid aortic valve
What is peripheral arterial disease (PAD)?
Disease of the arterial tree beyond the heart
Arterial disease is either “blockage or blowout”
Acute PAD results from ..
Risk factors…
embolic sources
Risk factors
- turbulence at bifurcations
- arteriolar narrowing
- trauma
- hyper-coag states and polycythemia
ACUTE PAD IS A MEDICAL EMERGENCY
Chronic PAD of lower extremities has a high association with …
cerebral vascular and heart disease
What are the primary sites of PAD?
Femoral and popliteal (80-90% of symptomatic patients)
Tibial and perineal (40-50%)
Abdominal and iliac (30%)
Hallmark symptom of lower extremity PAD
Reproducible in terms of …?
Hallmark: Claudication
Reproducible in terms of:
- effort
- location
- examination
Claudication
Effort related cramping, pain, or weakness in a mm group that occurs after a reproducible amount of effort
Symptoms occur one joint level distal to the point of obstruction
Spectrum of lower extremity PAD (i.e. what is the progression like in terms of symptoms)
Asymptomatic Claudication Rest pain Numbness, tingling, lack of sensation Ulceration and gangrene
What are some signs of chronic PAD?
Decreased or absent pulses distal to obstruction
Bruits heard over narrowed artery
Mm atrophy and weakness with exercise
Skin texture (thin and shiny) and color changes (cool, pale, blue) and hair loss
Consequences of DVT can be severe. What are some examples of this?
Pulmonary embolism
Death
Chronic venous stasis - swelling, pain, redness, cyanosis/hypoxia, ulcers (wet looking)
Calf pain especially with weight bearing or pressure on calf
D-dimer
- what is it measuring?
- specific or sensitive for deep vein PVD
D-Dimer (degradation product of fibrin) - sensitive but not specific
