Vascular diseases

Question 1

Peripheral arterial disease

Answer 1

Any arterial syndrome caused by arterial occlusion of lower extremities arteries

Question 2

Most common cause of PAD

Answer 2

Atheroscelerosis

Question 3

Categories of PAD (Asymptomatic to ??)

Answer 3

Asymptomatic

Claudication: Inadequate blood flow during exercise, causing fatigue, discomfort, or pain

Critical limb ischaemia: Compromise of blood flow to extremity, causing limb pain at rest. Patients often have ulcers or gangrene

Acute limb ischaemia: A sudden decrease in limb perfusion that threatens limb viability.

Question 4

6 P’s for acute limb ischaemia

Answer 4

pain, paralysis, paraesthesias, pulselessness, pallor, and perishing with cold

Question 5

Diagnostic test for PAD

Answer 5

ABPI

Question 6

ABPI interpretation

Answer 6

<0.5: Severe arterial disease,gangrene and ulcers (Critical)
0.5-0.79: Moderate-severe claudication
0.8-0.9: Mild-mild claudication
1-1.2: Normal
>1.2: Abnormally hard vessel (calcified). Most often false negative as significant PAD but hardened vessels.

Question 7

Risk Factors for PAD

Answer 7

> 65 yrs old
50 with risk factor for atherosclerosis or FHx of PAD
<50 with diabetes and one other PAD risk factor
Known atherosclerosis in another vascular bed

Question 8

SIgns and symptoms of PAD

Answer 8

Leg pain with walking relieved with rest
Erectile dysfunction
Pain in one leg
Diminished pulse

Question 9

When do you suspect critical limb ischaemia

Answer 9

Leg pain at rest
 Gangrene
 Non-healing wound/foot ulcer
 Muscle atrophy
 Dependent rubor
 Pallor when the leg is elevated
 Loss of hair over the dorsum of the foot
 Thickened toenails
 Shiny/scaly skin.

Question 10

Management of acute limb ischaemia

Answer 10

Analgaesia (pain pathway)
Anticoagulation (commonly heparin)

Viable limb:
no significant tissue loss, nerve damage, or significant sensory loss

Limb not viable:
tissue loss, nerve damage, and sensory loss and will require amputation

Question 11

Management for claudication

Answer 11

Keep walking, antiplatelet therapy, review annually

If more severe give supervised exercise and medication such as:
pentoxifylline, cilostazol, or naftidrofuryl

Question 12

Surgical management for PAD

Answer 12

Percutaneous transluminal angioplasty (PTA) with balloon dilation, stents, atherectomy, laser, cutting balloons, or drug-coated balloons

Question 13

Varicose Veins

Answer 13

subcutaneous, permanently dilated veins 3 mm or more in diameter when measured in a standing position

Question 14

Acute rheumatic fever

Answer 14

Autoimmune disease following a group a streptococci infection. It affects multiple systems including the joints, the brain, the skin, and the heart. Only the effects on the heart can lead to permanent illness; chronic changes to the valves of the heart are referred to as rheumatic heart disease

Question 15

Major manifestations of rheumatic fever

Answer 15

Carditis (inflammation of the heart)

Arthritis:

Chorea (abnormal involuntary jerky movements)

Erythema marginatum: pink serpiginous rash with a well-defined edge

Subcutaneous nodules

Question 16

Minor manifestations of rheumatic fever

Answer 16

Fever: >38.0
Arthralgia
Elevated inflammatory: ESR >60,
Prolonged PR interval or a heart block

Question 17

Criterias for diagnosis of rheumatic fever

Answer 17

Evidence of a recent group A streptococcal infection with at least 2 major manifestations or 1 major plus 2 minor manifestations present.

Rheumatic chorea: can be diagnosed without the presence of other features and without evidence of preceding streptococcal infection. It can occur up to 6 months after the initial infection.

Chronic rheumatic heart disease: established mitral valve disease or mixed mitral/aortic valve disease, presenting for the first time

Question 18

Management of acute rheumatic fever

Answer 18

Analgaesia
Penicillin based antibiotic therapy
If arthritis: Salicylate or NSAIDs
If heart failure: Glucocorticoids, diuretics/ACEi
If AF: Digoxin
If chorea: anticonvulsant
If Valve damage: valve replacement