Vascular Diseases Flashcards
What is Superficial Vein Thrombophlebitis?
Thrombus formation in a superficial vein (most commonly the saphenous vein and its tributaries of the lower limbs), with associated inflammation in the tissue surrounding the vein. Thrombus formation may be idiopathic or associated with one or more risk factors i.e Varicose veins and DVT
Signs: pain, tenderness, itching, reddening of the skin, and/or hardening of the surrounding tissue. Pigmentation changes of the overlying skin are often observed.
Plan: -referral for specialist assessment if a serious underlying cause, such as cancer, is suspected.
- Managing pain with NSAID and/or paracetamol.
- Self care: application of a warm moist towel to the affected area, avoiding immobility, and elevating the affected leg when sitting.
- venous duplex scanning to help guide treatment a
- compression stockings (after excluding arterial insufficiency).
- Considering screening for a coagulation disorder
-Antibiotics are only required if there is evidence of infection.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is the formation of a thrombus (blood clot) in a deep vein, usually in the legs, which partially or completely obstructs blood flow.
Signs:
RFs: DVT history, cancer, over 60, obesity, male, HF, inflammatory disorders like IBD, vasculitis, recent surgery
TEMP: Immobility, trauma, hormone treatment, pregnancy, dehydration
Assess: D-dimer, WELLS score, PERC score, proximal leg vein US
Treatment: anticoags - warfarin, apixaban, edoxaban, dabigatran
DD: trauma, ruptured baker’s cyst, cellulitis, thrombophlebitis
Pulmonary Embolism
Pulmonary embolism (PE) is a life-threatening condition in which one or more emboli, usually arising from a blood clot formed in the veins, are lodged in and obstruct the pulmonary arterial system, causing severe respiratory dysfunction.
RF: DVT - MOST COMMON CAUSE, surgery, immobility, HX of DVT/PE, cancer, trauma, MI, AGE, pregnancy over 6 weeks post partum, combined oral contraception, HRT, smoking and obesity
Signs: Dyspnoea, haemoptysis, chest pain, syncope or pre-syncope, tachypnoea, features of DVT.
Assess: WELLS PE score, CTPA, D-dimer
Treatment: anticoag treatment
DD: DVT, acute bronchitis, pericarditis, ACS, stable angina
Peripheral Vascular Disease/ Peripheral Arterial Disease
Peripheral arterial disease is a term used to describe a narrowing or occlusion of the peripheral arteries, affecting the blood supply to the lower limbs.
Acute limb ischaemia is a sudden decrease in limb perfusion that threatens limb viability.
PAD: atherosclerosis which narrows the affected arteries. This limits blood flow to the affected limb.
Acute limb ischaemia: sudden reduction in arterial perfusion of the limb, most commonly due to thrombosis within a diseased artery when an atherosclerotic plaque ruptures.
Signs: intermittent claudication (diminished circulation leads to pain in the lower limb on walking or exercise that is relieved by rest), loss of pulses and pallor, calf, leg and thigh pain, non healing wounds.
Assess: ABPI, doppler, Duplex,
Treatment: Smoking cessation, vascular referral, pain management, exercise plan, angioplasty/bypass surgery
DD: Compartment syndrome, Chronic venous insufficiency, Osteoarthritis
Varicose Veins
Varicose veins are dilated, tortuous, superficial veins that are most commonly found in the legs. They are often visible and palpable, and are an indication of superficial lower extremity venous insufficiency
Cause: incompetent valves -> reflux of blood -> increase pressure in vein and as they are superficial they cannot withstand the pressure and dilate.
Can get worse overtime and develop into bleeding, skin changes, thrombophlebitis, DVT and venous ulcer
RF: AGE, family hx, female, pregnancy, obesity, prolonged standing and sitting, previous DVT hx
Signs: usually cosmetic but can cause pain, aches, discomfort, swelling, heaviness and swelling.
Treatment: bleeding -> first aid and vascular referral
- self care weight loss, avoid standing long, and elevate legs
-surgery such as endothermal ablation, foam sclerotherapy
-compression stockings
DD: cellulitis, lymphoedema, ruptured baker’s cyst
Acute Rheumatic Fever after (Scarlet fever)
Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn’t properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus
- can inflame or make the heart, joints, brain, and skin swell. Rheumatic fever is thought to be an immune response to an earlier infection.
Signs: carditis, arthalgia (joint pain), chorea (muscle spasms), subcutaneous nodules, erythema on skin, high temps, joint swelling, SOB, mitral valve stenosis murmur
RF: children, poverty, overcrowding, risks from infection
Treatment: treat underlying infection ABX
Arthritic: NSAIDS
Carditis: ABX, NSAIDS, fluids, rest
Scarlet Fever
Its an infection disease caused by toxins produced by Streptococcus pyogenes GROUP A GAS type.
incubation period (time taking for infection to develop): 2/3 days
infectious period: 2/3 weeks
transmission: mouth, nose, saliva physical contact
RF: Children, old people, postpartum women, immunocompromised, drug injection users
Complications: local spread to otitis media ear infection, peritonsillar abscess, acute sinutsitis
Signs: sore throat, fever, headache, fatigue, nausea
- PINPOINT SANDPAPER BLANCHING RASH (disappears on press) on trunk of body
-Possible strawberry tongue, cervical lymphadenopathy, circumoral (facial) pallor.
Treatment: admission, oral ABX e.g phenoxymethylpenicillin 10 days, self care to prevent contamination
DD: Kawasaki disease, toxic shock syndrome, rubella,
Venous Thrombosis (DVT, PE, VTE)
Deep vein thrombosis or DVT: A blood clot in your deep veins. - limb pain, swelling, tenderness, skin changes
Pulmonary embolism or PE: A blood clot in your lungs. - SOB, chest pain, haemoptysis
Venous thromboembolism or VTE: The term members of your health care team use to refer to both DVT and PE together.
Refers to a blood clot that forms in a vein which partially or completely obstructs blood flow. Hospital-acquired venous thromboembolism refers to a VTE that occurs within 90 days of hospital admission.#
RF: surgery, trauma, immobility, malignancy, obesity, pregnancy, HRT
Risk assessment and prophylaxis forms: for two types of:
Treatment: Mechanical and pharmacological.
Mechanical = anti-embolism stockings for compression.
Pharmacological = Consider their bleeding RF like strokes, thrombocytopenia, blood disorders. Only use if benefits outweigh risk
DRUGS:
PROPHYLACTIC: Low dose unfractionated heparin (LDUH), low molecular weight heparins (LMWH) LIKE Enoxaparin and dalteparin ( factor LLA thrombin and Xa inhibitor in coag cascade OR fondaparinux (anticoag pentasaccharide which inhibits coag cascale factor Xa)
Therapeutic: apixaban, warfarin, rivaroxaban
at least 3 months treatment
Immediately refer patients for hospital admission if they have a suspected PE and signs of haemodynamic instability (including pallor, tachycardia, hypotension, shock, and collapse).
DD: Chronic HF, acute respiratory distress syndrome (ARDS), MI, cardiac tamponade
