Vascular Disorders Flashcards
Leading cause of PAD
Artherosclerosis
Risk factors for PAD
Same as CV disease
Smoking
Obesity
Diabetes
Sedentary
Hypercholesterol
HTN
Age over 60
S/Sx of PAD
Intermittent claudication that progresses to constant pain even at rest and especially at night.
Pain in butt, thighs, calf
Skin on LE is tight, edematous, hairless, thin, shiny.
Pulses weak
Cap refill slow
Dependent rubor
Blanching when elevated
What is critical limb ischemia?
Tx?
Chronic ischemic leg pain >2 weeks
OR
Non healing leg ulcers
OR
Gangrene
(All from PAD and not DM)
This needs immediate tx to restore perfusion.
Usually artery bypass surgery, angioplasty or stents
What is acute arterial ischemia?
Sudden blockage of blood flow to a body part
Caused by embolism, thrombi or trauma
An emergency
S/Sx of acute arterial ischemia?
6 Ps
Pain
Pallor
Pulselessness
Paresthesia
Paralysis (late sign)
Poikilothermia (limb being the same temp as environment)
Tx of acute arterial ischemia?
Surgical thrombectomy
Percutaneous catheter directed thrombus removal
Surgical bypass
What is Raynaud’s phenomenon?
Risk factors?
Vasospastic episodic of small vessels of fingers/toes
First vasospasm and decreased perfusion turns finger or toes white, blue. Feels numb and cold.
Then hyperemic blood flow inundates area and it turns red, throbs and swells
Happens in young women
Vibrating machinery
Extreme cold
Smokers/caffeine
Emotional upset
High association with SLE, thyroid
What is thromboangitis obliterans (Buerger’s disease)?
Risk factors?
S/Sx?
Tiny clots form in fingers/toes
This is a recurrent, inflammatory disorder NOT associated with CV disease.
Risk factors: Smoking
Young men <40 yo
Fingers and toes go cold, white, blue and can become necrotic.
Numbness/ tingling
Aortic aneurysm RF?
Age
Male
HTN
CAD/PAD
Family hx
Smoking
High cholesterol
Obesity
Symptoms of thoracic aortic aneurysm?
Symptoms of aortic arch or ascending aorta aneurysm?
Symptoms of abdominal aortic aneurysm? (AAA)
Deep chest pain and inter scapular pain
Angina
TIAs (from decreased blood flow)
coughing
SOB
Hoarseness
Dysphagia
Abdominal/Back pain
What may be a sign of aneurysm rupture in retroperitoneal space?
Grey Turner sign
(flank bruising)
Tx of aneurysms?
If small>wait and watch with lifestyle changes
If large>open aneurysm repair (OAR)
Endovascular aneurysm repair (EVAR)
–this is a graft–
What is aortic dissection?
Types?
Artery splitting and forming false lumen that runs parallel
Types: Type A=ascending aorta and arch (emergency)
Type B=descending aorta (more conservative tx)
Biggest risk factor for aortic dissection?
Other RF?
Hypertension
Other: Age
Artherosclerosis
Smoking
Cocaine/meth
Pregnancy
Valve disease
Marfans (also AAA risk)
VAASC PM
S/Sx of aortic dissection?
Pain!
Sharp
Tearing
Ripping
Stabbing
(Wherever the dissection is)
Tx of aortic dissection?
Lower HR and BP by Beta blockers, morphine
Type A: emergency surgery with 50% mortality rate
Type B: Thoracic endovascular aortic repair (TEVAR) (graft)
What are the main differences in an artery occlusion and vein occlusion?
Artery: everything distal from occlusion will not be getting blood flow. Will be dry and desiccated (dried up like jerky)
Cool, pale, purple/blue/cyanotic
Vein: everything distal will be engorged. Blood goes in but can’t come out. Red, swollen, swampy, hot
What is biggest differences in superficial vein thrombosis and deep?
Superficial: No edema, can have itchiness, usually saphenous vein (runs down inside of leg and back of calf)
Deep: Edema (usually iliac and femoral)
What is VTE?
(Venous thromboembolism)
Broad term to cover anything from DVT to PE
It is the preferred term to cover most venous clot problems
What is Virchow triad?
3 key factors in development of VTE:
- Venous stasis (blood is staying in veins too long from inactive muscles or venous valves aren’t working)
- Damage to endothelial lining (starts clotting cascade)
- Hypercoagulabilty (medications like steroids and birth control, high altitudes, dehydration)
Which anticoags are given IV/PO/SQ?
IV or SQ: Heparin (needs careful monitoring)
PO: Warfarin (long term, takes 2-3 days to start working)
SQ: Lovenox (safest with no daily INRs)
Tx for VTE?
Ideally: Prevention but
Thrombolytics (catheter inserted to clot then bombarded with thrombolytic med, can do this for 3 days max)
Surgery: Vena cava interruption devices (clot catchers)
Venous thrombectomy
What is chronic venous insufficiency?
S/Sx?
Chronically high venous pressure leads to inflammation and changes in skin. It becomes dry, hardened, contracted and dark.
S/Sx: Brownish, bronzy, edematous leathery, dry, itchy legs
Can lead to venous ulcer (also called venous stasis ulcer)
What is the classic location of venous ulcers?
What will they look like?
Just above the medial malleolus
(inside the leg above the ankle)
Shallow, undefined, irregular edges
Tx of venous ulcers focuses on what?
Compression of foot and leg to increase venous return
What will arterial ulcers look like?
–this goes with PAD–
They will be circular, punched out appearance, dry, clearly defined edges. Ulcer will have a sharp drop off at edge, not gradual
Leg/foot will be cold
Earliest sign of occult blood loss?
Tachycardia
What med drops absorption of clopidogrel by 50%?
Omeprazole
