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Cardiology 2 > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

Signs of Arterial/venous disorders

A

Arterial: cold, white, dead, horrible pain

Venous: red, hot, swollen, pain,

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2
Q

What are some factors contributing to blood flow disturbances?

A
  • atherosclerosis and vasculitis
  • acute vessel obstruction d/t thrombus, embolus, or vasospams (Raynauds)
  • abnormal vessel dilation (arterial aneurysms or varicose veins)
  • Compression of blood vessels by extravascular forces (Tumors or edema)
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3
Q

What are the three types of arteriosclerosis? Describe the process of each one.

A
  1. ) Atherosclerosis: plaque build up made up of fat, cholesterol, or calcium
    - moenckeberg medial calcific sclerosis; calcium deposits in the muscular middle layer
    - arteriosclerosis: vessel wall thickening and luminal narrowing in the small arteries and arterioles
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4
Q

Describe Arteriosclerosis

A

thickening and hardening of arterial walls, loss of elasticity of medium or large vessels.

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5
Q

Atherosclerosis

  • complications
  • causes
A

Complications:

  • ischemic heart dz
  • Stroke
  • Aneurysm
  • PVD

Causes:

  • DM
  • Smoking
  • HTN
  • Obesity
  • Fx of early heart disease
  • Hypercholesterolemia
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6
Q

Clinical Presentation of Atherosclerosis:

  • cardiac
  • peripheral arteries
  • Kidneys
  • Genitals
  • Neurologic
A

-Cardiac: angina

Arteries in Arms/Legs
-intermittent claudication

Kidneys:
-high BP or kidney failure

Genitals: difficulties w/ sex or ED in men.

Neurologics:

  • sudden numbness/weakness in arms/legs
  • difficulty w/ speech
  • drooping face muscles
  • TIA
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7
Q

What is Carotid Artery Dz?

What is an initial presentation of CAD and how does this present?

A

-a vascular dx that can block the carotid arteries to the brain and cause paralyzing strokes.

  • TIA is an initial presentation of CAD.
  • -can present as transient hemispheric or monocular blindness(amaurosis fugax), aphasia, slurred speech, and mental confusion.
  • -usually resolves in 24hrs
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8
Q

How do we medically evaluate the carotids?

A
  • physical exam
  • Duplex ultrasound (see how blood moves through arteries and veins) * NEXT INITIAL BEST STEP. :)
  • MRA
  • CTA
  • Angiography * Gold standard
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9
Q

What % of carotid artery stenosis requires surgical interventions?

A

80%

-some may refrain from recommending surgery in any asymptomatic pt

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10
Q

Rheumatic Fever

  • what is this?
  • what causes this?
  • who gets this?
A

-inflammatory dz follow strep pyogenes infection (i.e. strep pharyngitis)

Cause:

  • antibody -cross-reactivity
  • develops 2-4weeks post Group A strep infection

Who gets this:
-children 6-15 yrs

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11
Q

Describe the appearance of Strep pharyngitis

A

beefy, red tonsils w/ exudate, petichiae on roof of mouth, strawberry tongue.

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12
Q
  • Major manifestations of Rheumatic Fever

- Minor Criteria for Rheumatic Fever

A
  • migratory arthritis
  • Carditis, valvulitis (myocarditis which can manifest as CHF w/ SOB)
  • Eythema marginatum
  • Sydenhams Chorea (rapid movements w/o purpose of the face and arms)

Minor Criteria:

  • fever 100.8-102.0
  • Athralgia
  • elevated ESR or CRP
  • leukocytosis
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13
Q

What is the “Modified Jones Criteria” for dx of Rheumati Fever?

A
  • Two major criteria
  • One major criteria plus two minor criteria
  • exception: chorea or indolent carditis.. if you have either of these you automatically have Rheumatic Fever.
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14
Q

Tx Rheumatic Fever

A
  • Aspirin (be careful in children; Reyes Syndrome)
  • NSAIDS (ibuprofen or steroids)
  • Abx (PCN or Clarithromycin Zpack)
  • Heart failure:
  • -ACEi
  • -Diuretic
  • -Beta blocker
  • corticosteroids
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15
Q

What is an aortic aneurysm/dissection?

  • where is aneurysm most common?
  • what is the most common cause of aneurysm
  • most common cause of dissection
A

Aneurysm= bulges in weak areas of the vessel wall.

dissection= inner lining of the aortic wall tears.

  • aneurysm is commonly found in the abdominal aorta.
  • most common cause of aneurysm is atherosclerosis
  • most common cause of dissection is high blood pressure.
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16
Q

Thoracic Aortic Aneurysm may be secondary to collagen vascular diseases, what are these?

A
  • Marfans Syndrome

- Ehlers-Danlos Syndrome

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17
Q

Describe the Crawford Classification of Thoracoabdominal/ Abdominal aortic aneurysms and the location of each.

A

I. Left subclavian to renal arteries
II. Left subclavian to iliac bifurcation
III. Midthoracic to infrarenal
IV. distal thoracic to infrarenal

18
Q

Thoracic Aortic Aneurysm Clinical Presentation/Tx

A

Clinical presentation:

  • most are asymptomatic
  • sub sternal, back or abd pain
  • dyspnea, stridor, brassy cough (trachea pressure)
  • Dysphagia (pressure on esophagus)
  • Hoarseness (pressure on recurrent laryngeal nerve)
  • Neck and arm edema from SVC compression

Tx:
-start beta blockers and call surgeon.

19
Q

Where do 90% of AAA originate?

-when do we surgically intervene on abdominal aortic aneurysms?

A
  • below the renal arteries

- Surgical intervention begins when aneurysm is greater than 5cm

20
Q

Screening for AAA

-clinical presentation

A

Screening:

  • abd ultrasonography is highly sensitive and specific for AAA
  • 1x screening in men 65-75 who have never smokes.
  • 1x screening in men 65-75 who never smoked but who have a 1st degree relative who required repair of an AA or died of ruptured AAA.

Clinical presentation:

  • aysmptomatic
  • -picked up on routine physical exam w/ prominent aortic pulsation
  • symptomatic:
  • -midabdominal or lower back pain with prominent aortic pulsations
21
Q

Arterial Embolism/Thrombosis

  • what is an embolism
  • what is thrombosis
  • what are the types of embolisms
  • common sites of arterial embolization
A

Embolism= sudden interruption of blood flow to an organ or body part d/t embolus adhering to the wall of an artery blocking the flow of blood.

Thrombosis= formation of a blood clot inside a blood vessle, obstructing the flow of blood.

Types of Embolisms:

  • thromboembolism
  • cholesterol
  • fat
  • air
  • septic (bacteria containing pus)
  • tissue
  • foreign body

Sites:

  • Bifurcations: femoral**, aortic, iliac
  • Popliteal
  • upper extremities
  • cerebral
  • Mesenteric
22
Q

What are the 6 P’s of acute limb ischemia?

A
  • pain
  • pallor
  • pulselessness
  • paresthesia (burning, prickly, itching, tingling)
  • paraparesis (paralysis
  • poikilothermia (variation of body temp regionally)
23
Q

Arterial Embolic Dz Management

A
  • pt w/ threatened extremity should not delay revascularization & arteriography
  • Rapid systemic anticoagulation ( heparin bolus/cont. drip)
  • Surgery; embolectomy
  • Thrombolytics in appropriately selected patients.
24
Q

How do you reverse heparin?

A

-stop the heparin drip and administer protamine.

25
Q

Disorders of Venous Circulation : definition of each

  • varicose veins
  • thrombophlebitis
  • veno-occlusive disorders
A

Varicose veins: enlarged tortuous veins usually on let

Thrombophlebitis: vein inflammation, thrombi usually form at venous cusps of deep veins where altered or stataic blood flow causes clot formation, may also be superficial(MC is saphenous vein)

Veno-occlusive disorders…idk she didnt tell me.

26
Q

Thrombophlebitis:

formation of clot depends on the presence of at least one of Virchows Triad…name these!

A
  • venous stasis
  • injury to vessel wall
  • hypercoagulable state (Factor V liden deficiency, maylar rash, lupus anticoagulant)
27
Q

Venous Stasis -Presentation

-Tx

A
  • progressive edema of the leg begins at the ankle and calf
  • dull aching discomfort
  • worse at the end of day and improves with elevation
  • varicositis
  • skin changes:
  • -stasis dermatitis
  • -brownish pigmentation (hemochromatosis)
  • Brawny induration
  • skin is thin, shiny, atrophic and cyanotic

Tx:

  • limit standing
  • intermittent elevation of legs during day
  • daily use of thigh-high compression stockings
  • regular exercise
  • cold compress
  • abx used for septic thrombophlebitis
28
Q

Endothelial injury:

-damage from what?

A
  • sheer stress
  • HTN
  • bacteria
  • chronic inflammation
  • biomaterials of implants/devices
29
Q

Hypercoagulability

-causes

A
  • severe trauma/burn
  • disseminated cancer
  • late pregnancy
  • race
  • advanced age*
  • cigarette smoking*
  • hormonal contraceptives*
  • obesity
30
Q

Beurgers Dz

  • aka
  • what is this?
  • associated with what habit?
  • pathophysiology
A

aka: Thromboangitis Obliterans

what is this:
-recurring progressive inflammation and thrombosis of small and medium arteries and veins of the hands and feet.

-associated with the use of tobacco.

pathophys:
- mechanism still largely unknown
- inflammatory rxn of the vessel wall which leads to vasculitis and ischemic changes in distal parts of limbs

31
Q

Dx of Buergers Dx/Thromboangitis Obliterans

Treatment?

A
  • typically 20-40yrs old
  • current of recent tobacco use
  • presence of distal extremity ischemia
  • exclusion of other autoimmune dz

Tx:

  • smoking cessation
  • Calcium Channel blockers to manage vasospasm “dipine” (nifedipine, nicardipine)
  • hyperbaric chamber
32
Q

What is Peripheral Arterial Dz? WHat are the two types?

A
  • stenotic/occlusive arterial dx primairly of the lower extremities, but also includes the trunk, arms, and legs.
  • plaque formation predominates at aortic bifurcation, tibial trifurcation, femoral artery

Two types:
-Oclusive PAD: d/t structural changes that narrow of block arteries often results from atherosclerosis

-Functional PAD: sudden, temporary narrowing (spasm)

33
Q

Lower Extremity PAD

  • 3 distinct patterns of dz, name these.
  • risk factors
  • clinical presentation
A

Type 1. limited to aorta and common iliacs

Types 2. affects aorta, common and external iliaces

Type 3. multilevel dz, aorta, iliac, femoral, popliteal, and tibial

Risk factors:

  • older male
  • DM
  • HTN

Presentation :

  • ED
  • claudication
  • Gangrene:
  • -dry; non infected black eschar
  • -wet; tissue maceration and purulence
  • -bacteria fail to thrive, likely d/t poor flow
  • Leriches Syndrome
  • Ischemic rest pain
  • temperature
  • hair loss
  • pallor
  • nail hypertrophy
  • ulcer
34
Q

LE PAD Dx

A
  1. ABI; SBP ankle divided by SBP in arm
    normal ABI = 1.0 or greater
    ABI less than 0.8 diagnostic for cluadication
    ABI less than 0.4 critical ischemia
  2. MRA
  3. Xray, CT
  4. Doppler & duplex ultrasound
  5. exercise testing
35
Q

LE PAD Tx

A
  • lifestyle changes
  • taking meds
  • possible special procedure or surgery
  • tobacco cessation
  • anti-platelet (aspiring 81mg)
  • Cilostazol (impairs platelet aggregation)
  • goal is to reduce sx, improve quality of live, prevent heart attack, stroke, and amputation
36
Q

Vasculitis

  • what is this?
  • how are the different types classified
A
  • group of disorders that destroy blood vessels by inflammation
  • classified by vessel size.
37
Q

Vasculitis sx

A
  • fever, weight loss
  • palpable purpura
  • muscle and joints; myalgia, arthralgia, arthritis
  • HA, stroke, tinnitus
  • MI, HTN, gangrene
  • Nose bleeds, bloody cough
  • Abd pain, blood stool
  • Glomerulonephritis
38
Q

Vasculitis Dx & Tx

A
  • ESR
  • CRP
  • Anemia
  • increased WBC and eosinophila
  • bx of involved organ or tissue is definitive
  • angiogram is alternate to bx

Tx: Corticosteroids

  • possible immune suppression drugs
  • abx
39
Q

Giant Cell Arteritis Temporal Arteritis

  • what is this?
  • most serious complication
  • Presentation
A

what is this:
-inflammatory dz of blood vessles most commonly involving large and medium arteries of the head, predominately the external carotid artery,

Most serious complication:

  • permanent blindness
  • Presentation:
    • bruits
  • -fever
  • -HA*
  • -Jaw Claudication*
  • -Tongue Claudication*
  • -acute visual loss or reduced visual acuity
  • -diplopia
  • -acute tinnitus
40
Q

Giant Cell Arteritis/Temporal Arteritis

  • PE findings
  • Labs
  • Dx
  • Tx
A

PE:

  • palpation of head reveals prominent temporal arteris with or w/o pulsations
  • temporal area tenderness
  • decreased pulses throughout body

Labs:

  • ESR greater than 60***
  • CRP & platelets elevated

Dx:
-biospy is gold standard**

Tx:
-high dose prednisone to prevent blindness

Cardiology 2 (9 decks)

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