Vascular Disorders

Question 1

What are symptoms of
thoracic aneurysm
Vs.
Abdominal aortic aneurysm

Answer 1

thoracic aneurysm: Deep, diffuse chest pain that may extend to interscapular area,
hoarseness as a result of pressure on the recurrent laryngeal nerve,
dysphasia from pressure on esophagus

Abdominal aortic aneurysm: Abdominal or back pain

Both can be asymptomatic

Question 2

What Should be monitored in postop aortic aneurysm repair?

Answer 2

Graft patency and adequate renal perfusion,
maintenance of adequate blood pressure,
peripheral pulses, skin temperature in color, capillary refill time,
sensation and movement of extremities,
hourly urine output and daily weights are recorded.
No heavy lifting for at least 4 to 6 weeks

Question 3

What is an aortic dissection? Symptoms?

Treatment?

Answer 3

Occurs most commonly in thoracic aorta. Result of a tear in the intimal lining of the arterial wall. Blood tracks between intima and media and creates a false lumen of blood flow.

Symptoms: sudden severe pain in anterior chest. interscapular pain radiating down spine into abdomen or legs.
Pain described as tearing or ripping.

Tx: lower BP and myocardial contractility with meds. Sometimes surgery.

Question 4

Peripheral artery disease (PAD) of lower extremities.

What are symptoms?

Answer 4

Intermittent claudication is classic symptom.

Paresthesia, numbness or tingling in toes or feet.
Gradual loss of both pressure and deep pain sensations.
Shiny taut skin, loss of hair on LE. Diminished or absent pulses.
Elevation pallor, reactive hyperemia when limb is in dependent position (dependent rubor)

Question 5

Intermittent claudication

Answer 5

Ischemic muscle ache or pain that is precipitated by consistent level of exercise, resolves within 10 minutes of rest, and is reproducible.

Question 6

Elevation pallor

Answer 6

Pallor or blanching when leg is elevated

Question 7

Reactive hyperemia

Answer 7

is the transient increase in blood flow that occurs following a brief period of ischemia (e.g., arterial occlusion).

Question 8

Dependent rubor

Answer 8

is a fiery to dusky-red coloration visible when the leg is in a dependent position but not when it’s elevated above the heart. The underlying cause is peripheral arterial disease (PAD), so the extremity is cool to the touch.

Question 9

Critical limb ischemia

Answer 9

CLI is a severe obstruction of the arteries which markedly reduces blood flow to the extremities (hands, feet, and legs) and has progressed to the point of severe pain and even skin ulcers or sores. The pain caused by CLI can wake up an individual at night.

Can cause gangrene due to advanced PAD.

Question 10

Thromboangiitis obliterans

Answer 10

also known as Buerger disease.
Caused by tobacco use, including second hand smoke.

is a recurring progressive inflammation and thrombosis (clotting) of small and medium arteries and veins of the hands and feet.

May cause intermittent claudication.
Ulcers develop.

Treatment is STOP SMOKING.

Question 11

What time of drugs could be used for Raynaud’s phenomenon?

Answer 11

Calcium channel blockers

promote vasodilation, or the opening of blood cells to allow blood to flow more easily.

Question 12

Venous thrombosis is most common disorder of veins. What are 3 important factors in etiology of venous thrombosis?

Answer 12

Virchow’s triad:

1- Venous stasis
2- damage of epithelium
3- hypercoagulability of blood

Question 13

What is Venous thrombosis?

Answer 13

Formation of thrombus in association with inflammation of vein.

Question 14

Symptoms and treatment of superficial thrombophlebitis.

Occurs in about 65% of patients receiving IV therapy and is usually of minor significance

Answer 14

Symptoms: palpable, firm subcutaneous cord-like vein. Area is red tender and warm. Mild fever and leukocytosis.

Treatment: elevating extremity. Warm moist heat.

Question 15

What is chronic venous insufficiency?

Answer 15

Results from valvular destruction, allowing retrograde flow of venous blood.

Question 16

Complications of DVT

Answer 16

Pulmonary embolism

Chronic venous insufficiency

Question 17

Treatment/ interventions for DVT

Answer 17

Usual tx involves bed rest,
Warm compress
Elevation of extremity
Anticoagulation

Question 18

Varicose veins (varicosities) are dilated, tortuous subcutaneous veins most frequently found in saphenous system.

What is difference between primary and secondary varicose veins?

Answer 18

Primary: more common in women and people with family history. Probably caused by congenital weakness of veins.

Secondary: typically result from previous DVT.
Can also occur in esophagus, anorectal area.

Question 19

What are reticular veins?

Telangiectasis veins?

Answer 19

reticular veins: smaller varicose veins that appear flat, less torturous and blue-green in color.

Telangiectasis veins: aka spider veins. Very small, visible. Appear purple blue-black or red.

Question 20

What are symptoms of Chronic venous insufficiency?

Answer 20

Edema in LE,
Skin and subcutaneous tissue is replaced by fibrous tissue resulting in thick, hardened contracted skin.
Skin of lower leg is leathery with brownish “brawny” appearance.
Eczema and edema- “stasis dermatitis”
Pruritus

Venous leg ulcers

Question 21

Causes of chronic venous insufficiency?

Answer 21

Previous DVT
Vein incompetence 
Deep vein obstruction 
AV fistula
Calf muscle failure

Question 22

Characteristics of venous ulcers

Answer 22

Classically above medial malleolus.
Wound margins irregularly shaped.
Tissue is ruddy color.
Drainage may be extensive, especially with edema present.
Pain - worse when leg is in dependent position.

Question 23

Compression stockings for chronic venous insufficiency

Answer 23

Worn daily to prevent recurrence.

Replaced every 4-6 months.

Prescription compression stockings

Question 24

What is Kawasaki disease?

Answer 24

Potentially fatal 3 stage disease. If left untreated can progressively weaken walls of child’s blood vessels.
Primarily seen in children during toddler period.

For children in the US, Kawasaki disease is the leading cause of acquired heart disease, that is, heart disease that is not present at birth but develops later in life. The cause of this disease as of 2009 remained unknown, but doctors suspected that an infectious microorganism may trigger.

Question 25

What are the 3 stages of Kawasaki disease?

Answer 25

Stage 1 - Lasts between 10-14 days;is characterized by high fever; conjunctivitis, strawberry tongue; cracks and fissures in the lips; pervasive erythematous rash, including on the palms, soles, edema of hands and feet.

Stage 2 - Lasts about 10 days; is characterized by fever and resolution of the rash. irritability and anorexia; arthritis and arthralgias; and, most seriously, cardiovascular changes, including CHF, arrhythmias, development of coronary aneurysms.

Stage 3 - Lasts until the elevated sedimentation rate returns to normal. Grooves on the fingernails are often noted.

Question 26

Treatment of Kawasaki disease

Answer 26

Although it eventually clears up on its own, if left untreated it can damage the blood vessels that supply the heart muscle. Kawasaki disease is associated with a one in five risk of coronary aneurysms. This blood vessel damage can lead to a heart attack, especially in very young children.
Results are much better when the intervention is administered within 10 days of the onset of the fever. High-dose IV immune globulin (IVIG) and aspirin.

Question 27

PERIPHERAL VASCULAR DISEASE (PVD) / PERIPHERAL ARTERY DISEASE (PAD)

What is it?

Answer 27

narrowing or occlusion by atherosclerotic plaques of arteries outside of the heart and brain.
Peripheral arterial disease (PAD) is a common complication of atherosclerosis. Obstruction or narrowing of the lumen of the aorta and its major branches causes an interruption of blood flow to the brain and extremities, most commonly the legs and feet.

Question 28

PAD may be acute or chronic. What is the difference?

Answer 28

.An acute peripheral arterial occlusion requires emergent, aggressive treatment to revascularize the extremity and prevent limb loss.
Chronic PAD may vary in severity from mild (with few symptoms) to severe ischemia (with tissue necrosis).

Question 29

What are risk factors for Peripheral artery disease?

Answer 29

Risk factors include smoking, aging, hypertension, hyperlipidemia, diabetes mellitus, and family history of vascular disorders, myocardial infarction, or stroke.
Men suffer from PAD more often and at younger ages than women.

Question 30

Signs and symptoms of PAD:

Answer 30

Intermittent pain with exercise relieved with rest (chronic PAD)
Hardness of the extremity from fibrotic changes
Abnormal sensation (pain at rest, tingling, numbness)
Color changes (pallor, dependent rubor, cyanosis)
Coolness of the affected extremity with delayed capillary refill
Diminished or absent pulses
Hair loss, thick nails
Necrotic ulcers (severe ischemic disease)
Paralysis (severe ischemic disease)

Question 31

Treatment of peripheral artery disease

Answer 31

Bypass surgery to revascularize limbs with acute occlusion or severe chronic disease
Fibrinolytics to dissolve clot (acute arterial occlusion)
Endovascular techniques, such as balloon angioplasty, atherectomy, or stenting
Antilipemic agents such as simvastatin (Zocor) to help lower cholesterol
Antiplatelet medication, such as aspirin or clopidogrel (Plavix)
Anticoagulants such as warfarin (Coumadin) if indicated
Control of risk factors, such as smoking, hypertension, & diabetes
Regular exercise program

Question 32

4 types of shock categorized by etiology

Answer 32

Hypovolemic shock
Cardiogenic shock
Circulatory or distributive shock
Obstructive shock

Question 33

How shock affects cells

Answer 33

Causes acidotic intracellular environment.
Cells swells and membrane gets more permeable.
Mitochondria and and other structures are damaged and then cell dies.

Question 34

Symptoms of compensatory stage of shock.

Answer 34

Normal BP, increased pulse, rests slightly increased.
Skin cold and clammy, hypoactive bowel sounds because blood is being routed to vital organs.
Decreased urine output.
Confusion, lethargy.
Respiratory alkalosis.

Question 35

Symptoms in progressive stage of shock. (After compensatory stage)

Answer 35

BP drops, due to failure of compensating mechanisms.
HR 150. Rapid, shallow resps.
Crackles.
Mottled,petechiae
Very low urine output
Metabolic acidosis.

Question 36

Shock eventually progresses to multiple organ dysfunction.

What are the symptoms?

Answer 36

Erratic or asystole.
Requires intubation
Jaundice 
Anuric
Requires dialysis
Unconscious 
Profound acidosis
Eventually irreversible organ failure and then death.

Question 37

What is cardiogenic shock?

And symptoms?

Answer 37

Life Threatening!
Heart fails to pump adequately, compromises tissue perfusion.
Blood backs up into lungs, causing pulmonary edema.

SX: cold skin,hypotension, oliguria, tachypnea, tachycardia

Question 38

Sx of dvt

Answer 38

Redness, pain, warm extremity, swelling, positive Homans sign

(NOT coolness, decreased pulses or cyanosis)