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Cardiology > Vascular Diseases > Flashcards

Vascular Diseases Flashcards

1
Q

What conditions are associated with peripheral artery disease?

A

intermittent claudication, ulceration, limb loss/amputation

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2
Q

When are thoracic and abdominal aortic aneurysms most common?

A

60-70 yrs old, increased risk w/ age

2-4x more common in males

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3
Q

what is an aneurysm?

A

excessive localized enlargement of an artery caused by weakening of the artery wall

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4
Q

true aneurysms involve all 3 layers of the arterial wall, what are they?

A

intima
media
adventitia

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5
Q

aneurysms distal to the _____ are usually athersclerotic

A

ligementum arteriosus (descending aorta and abdominal aorta aneurysms)

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6
Q

which aneurysm is typically non-athersclerotic and caused by bicupid, Marfans, or syphillis instead?

A

ascending aorta and aortic arch aneurysms (before ligamentum arteriosus)

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7
Q

what are risk factors for aneurysms?

A

smoking, male, advanced age, HTN, family hx, heavy lifting (especially while holding breath)

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8
Q

pt presents w/ pain (chest or back), and heart failure, what type of aneurysm do you suspect?

A

thoracic aortic aneurysm dissection

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9
Q

pt presents w/ abdominal/back/flank pain, limb ischemia, severe pain and hypotension. what type of aneurysm do you suspect?

A

abdominal aortic aneurysm rupture

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10
Q

what diseases can cause aneurysms?

A

athersclerosis, aortitis, syphiis, bicuspid aortic valve, Marfan’s syndrom, Ehlers-Danlos Syndrome, Loeys-Dietz

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11
Q

which diameter of abdominal aortic aneurysm is at most risk for rupture?

A

8.0+ cm in diameter (50% risk)

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12
Q

With a diameter of 6 cm, pt is at ___% risk for abdominal aortic aneurysm rupture

A

20%

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13
Q

With a diameter of <4 cm, pt is at ___% risk for abdominal aortic aneurysm rupture

A

0%

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14
Q

what is the tx for ascending, descending, and abdominal aortic aneurysms?

A

medical management (BP control, smoking cessation, lipid management, aspirin, exercise)

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15
Q

when is surgery indicated for an ascending aortic aneurysm?

A

if diameter >5.5 cm or >5 cm w/ Marfans

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16
Q

When is open/endovascular surgery indicated for abdominal aortic aneurysms?

A

if >5.5 cm in diameter or if ruptured

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17
Q

what is an aortic dissection?

A

tear in the aortic intima, allowing blood to enter between the media and adventitia. The lumen is narrowed and the media is stripped from the adventitia.

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18
Q

What type would you classify an aortic dissection above the ligamentum arteriosum?

A

Type A

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19
Q

What type would you classify an aortic dissection BELOW the ligamentum arteriosum?

A

Type B

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20
Q

What are the risk factors for aortic dissection?

A

HTN, athersclerosis, age (60-80 yr old men), pre-existing aortic aneurysm, inflammatory diseases (Giant cell arteritis, Rheumatoid arthritis), Collagen disorders (Marfan, Ehlers-Danlos), bicuspid aortic valve, aortic coarctation, cocaine, CABG, aortic valve replacement, cardiac catheter, trauma

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21
Q

Pt presents w/ severe, sharp, “tearing” chest/back pain w/ syncope and pulse deficit.

A

aortic dissection

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22
Q

You hear a new diastolic murmur of aortic regurgitation. BP measurements are asymmetrical. what do you suspect?

A

aortic dissection

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23
Q

What valvular disease is Horner syndrome associated w/?

A

aortic dissection

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24
Q

Pt has vocal cord paralysis and hoarseness. What should be in your differential?

A

aortic dissection

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25
Q

How is aortic dissection diagnosed?

A

presentation, ECG (+/- ischemic changes), imaging (CT, transesophageal echo, or MRI)

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26
Q

What is the tx for Type A ascending aortic dissection?

A

surgical emergency

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27
Q

what is the tx for Type B descending aortic dissection?

A

medical therapy

surgery for pts w/ end-organ ischemia or persistent severe hypotension/pain

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28
Q

What is the long-term management for aortic dissection?

A

medical therapy (beta blocker), avoid weight lifting, serial imaging (MRI/CT), reoperation when indicated

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29
Q

What are the possible causes of acute arterial occlusion?

A

embolus, acute thrombosis, dissection of an artery, direct trauma to an artery (broken leg, shot)

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30
Q

what are the risk factors for acute arterial occlusion?

A

A fib, recent MI, aortic athersclerosis, large vessel aneurysmal disease (popliteal aneurysm), hx angioplasty/stent or bypass graft, arterial trauma

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31
Q

What are the 6 P’s for presentation of acute arterial occlusion?

A 
pulselessness
pallor
pain
paresthesias
paralysis
poikilothermia (cold)
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32
Q

what is the tx for an acute ischemic limb?

A

anticoagulation

surgical/percutaneous intervention

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33
Q

what are Arteriovenous Malformations (AVMs)?

A

fast-flow lesions that involve the connection of arterial and venous vessels

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34
Q

what are the symptoms of Arteriovenous Malformations (AVMs)?

A

bleeding, pain, ulceration, and increase CO

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35
Q

can be secondary to liver disease, Hereditary Hemorrhagic Telangiectasia or Osler-Weber-Rendu syndrome

A

Arteriovenous Malformations (AVMs) in lungs

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36
Q

can cause shunting (causing hypoxia) and can occur in the nose causing epistaxis

A

Arteriovenous Malformations (AVMs)

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37
Q

indication for liver transplant

A

Arteriovenous Malformations (AVMs) in lungs

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38
Q

associated w/ increase risk of hemorrhagic stroke and seizures

A

Arteriovenous Malformations (AVMs) in the brain

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39
Q

port-wine stain

A

Arteriovenous Malformations (AVMs) on skin

40
Q

What is the tx for Arteriovenous Malformations (AVMs)?

A

monitoring, sclerotherapy, embolization, and resection

41
Q

what is peripheral artery disease (PAD)?

A

athersclerosis of noncardiac vessels (usually leg arteries)

42
Q

what are the risk factors for PAD?

A

smoking, age, DM, HTN, hyperlipidemia

43
Q

pt presents w/ nonhealing wound/ulcer, skin discoloration/gangrene, dry, shiny, hairless skin, leg pain when exercising (relieved w/ rest). what do you suspect?

A

PAD

44
Q

asymptomatic or acute ischemic limb

A

PAD

45
Q

how is PAD diagnosed?

A

on screening or abnormal lower extremity pulse exam

46
Q

On exam, you find dry, shiny, hairless legs; brittle, hypertrophic & ridged nails; cool, pale feet/legs; ulcers; gangrene; and diminished/absent pulses. what do you suspect?

A

PAD

47
Q

What is the ankle brachial index (ABI)?

A

ratio of the ankle systolic BP/brachial systolic BP detected w/ Doppler probe

48
Q

Which ABI ratio is highly sensitive and specific for PAD?

A

<0.9

49
Q

What is the management for PAD?

A 
exercise
stenting or revascularization
antiplatelets
smoking cessation
glycemic control
antihypertensive therapy
lipid-lowering therapy
diet
50
Q

What are the non-atherosclerotic PADs?

A

Giant Cell Arteritis
Buerger’s Disease
Raynaud’s

51
Q

What is Giant Cell Arteritis?

A

vessel inflammation in temporal artery

52
Q

what are the risk factors for Giant Cell Arteritis?

A

family hx, age >50, smoking

53
Q

pt presents w/ fever of unknown origin, fatigue, weight loss, headache, scalp tenderness, jaw claudication, amaurosis fugax (transient vision loss) in one eye. what do you suspect?

A

Giant Cell Arteritis

54
Q

on physical exam, you find, tender, thickened temporal arteries. what do you suspect?

A

Giant Cell Arteritis

55
Q

on fundoscopic exam, you find cotton wool spots, a swollen, pale disc and blurred margins. what do you suspect?

A

Giant Cell Arteritis

56
Q

What is a complication of Giant Cell Arteritis?

A

permanent vision loss d/t ischemic optic neuropathy

57
Q

How do you diagnose Giant Cell Arteritis?

A

ESR, CRP, temporal artery biopsy

58
Q

what is the tx for Giant Cell Arteritis?

A

glucocorticoids immediately! for 9-12 months
monitor ESR/CRP before decreasing dose

also low dose aspirin

59
Q

what is Raynaud’s phenomenon?

A

exaggerated vascular response to cold temps or emotional stress resulting in abnormal vasoconstriction of digital arteries and cutaneous arterioles d/t to local defect in normal vascular responses

60
Q

describe color changes of Raynaud’s phenomenon

A

white –> blue –> red

61
Q

what’s the mgmt for Raynaud’s phenomenon?

A

gloves, calcium channel blockers

62
Q

what is Thromboangiitis Obliterans (Buerger’s disease)?

A

nonathersclerotic, segmental, inflammatory disease that most commonly affects small/medium arteries and veins of the extremities

63
Q

in what population is Thromboangiitis Obliterans (Buerger’s disease) found?

A

young (40-45 yrs), smokers

64
Q

what is the mgmt for Thromboangiitis Obliterans (Buerger’s disease)?

A

quit smoking

65
Q

what is the pathophysiology of chronic venous disease (venous insufficiency)?

A

inadequate muscle pump function or incompetent venous valves

66
Q

pt presents w/ pain, leg heaviness/aching, swelling, dry skin, dilated veins, lipodermatosclerosis, and ulceration. what do you suspect?

A

chronic venous disease (venous insufficiency)

67
Q

what are the risk factors for chronic venous disease (venous insufficiency)?

A 
advancing age
family hx
high BMI
smoking
lower extremity trauma
68
Q

how do you diagnose chronic venous disease (venous insufficiency)?

A

clinical, ultrasound

69
Q

what is the mgmt for chronic venous disease (venous insufficiency)?

A 
leg elevation
exercise
compression 
topical dermatologic agents
wound management 
if severe: ablation/surgery
70
Q

what is phlebitis/thrombophlebitis?

A

benign and self-limiting inflammation of the veins where thrombosis may be present

71
Q

if larger veins are involved in phlebitis/thrombophlebitis, what can it progress to?

A

DVT/PE

72
Q

what are the risk factors for phlebitis/thrombophlebitis?

A

chronic venous disease, venous procedures (venipuncture), immoblization, pregnancy, IV therapy, or drug abuse

73
Q

pt presents w/ tenderness, induration, pain and erythema along a superficial vein. what do you suspect?

A

phlebitis/thrombophlebitis

74
Q

how do you diagnose phlebitis/thrombophlebitis?

A

clinical +/- ultrasound

75
Q

what is the treatment for phlebitis/thrombophlebitis?

A

elevate extremity, warm/cool compresses, NSAIDs
abx if infection
anticoagulants if risk of DVT

76
Q

what are varicose veins?

A

dilated, elongated, tortuous, subcutaneous veins 3+ mm in diameter

77
Q

what can cause varicose veins?

A

blood clot in leg vein, leg injury, pregnancy, weight gain, family hx

78
Q

how do you diagnose varicose veins?

A

clinical, venous duplex ultrasonography

79
Q

what is the tx for varicose veins?

A

wait and watch

or ablation/surgery

80
Q

what is Virchow’s triad (describes conditions leading to thrombosis)?

A

venous stasis
vessel wall injury
hypercoagulability

81
Q

what are the risk factors for venous thromboembolism (VTE)?

A 
hx immobilization
recent surgery 
obesity
prior episode 
lower extremity trauma
malignancy
oral contraceptives, hormone replacement therapy
pregnancy/postpartum
genetics (Factor V Leiden)
82
Q

DVT in what veins is more commonly associated w/ PE?

A

proximal DVT (popliteal, femoral, or iliac veins)

83
Q

41 yr old pt presents w/ swelling, pain, and erythema of his calf. there is a palpable cord and you notice a difference in calf diameters. the calf is warm. what do you suspect?

A

DVT

84
Q

What is a Wells score?

A

Measures probability of DVT (2+ points)

85
Q

How do you diagnose DVT?

A

D-dimer, doppler ultrasonography (check for compression of vein)

86
Q

what is the tx for DVT?

A

anticoagulants: heparin (UFH, LMWH) + warfarin

OR oral anticoagulant (rivaroxaban, apixaban, edoxaban, dabigatran)

87
Q

how long should 1st DVT be treated?

A

3 months

88
Q

How long should recurrent DVT be treated?

A

lifelong

89
Q

what is pulmonary embolism?

A

obstruction of a pulmonary artery by a thrombus

90
Q

50 yr old pt presents w/ dyspnea, pleuritic pain, cough, hemoptysis, shock. pt also has swelling, pain, and erythema of his calf. there is a palpable cord and you notice a difference in calf diameters. the calf is warm. what do you suspect?

A

pulmonary embolism

91
Q

How do you diagnose PE?

A

CT pulmonary angiography or ventilation perfusion scanning

92
Q

what is the tx for PE?

A

anticoagulants: heparin (UFH, LMWH) + warfarin

OR oral anticoagulant (rivaroxaban, apixaban, edoxaban, dabigatran)

93
Q

what is the tx for shock secondary to PE?

A

ICU mgmt and urgent surgery, thrombolytics

94
Q

how long should 1st PE be treated?

A

3 months

95
Q

how long should recurrent PE be treated?

A

lifelong

Cardiology (6 decks)

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