Vascular History and Examination Flashcards
What is atherosclerosis?
Narrowing of a lumen
What is a thrombosis?
A clot
What is an embolism?
When a clot is knocked off and lodges elsewhere
What are the systemic effects of atherosclerosis?
HEAD - stroke, TIA, amaurosis, fugax
HEART - MI, angina
LEGS - intermittent claudication, critical leg ischaemia
What is peripheral vascular disease (PVD)?
Insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either an embolus or thrombus. It is age related, prevalence 4 -7% UK
What is ischaemic intermittent claudication?
Pain which comes on when walking and is relieved by rest
What is critical ischaemia?
Pain which affects pt at rest, affectsfoot when elevated, May be relieved by dependancy - leads to tissue loss and gangrene
What are the 5 risk factors for vascular disease?
Diabetes Smoking Hypertension Hypercholesterolaemia Family History
What is an ulcer and what are they caused by?
A break in the skin / endothelium continuity.
Caused by: arterial, neuropathic (diabetic), venous, traumatic, connective tissue disorders
Common medications taken by a pt with vascular disease?
Anti - platelets (aspirin, clopidogrel) Statins ACE - Inhibitors (-pril) Beta blockers (-olol) Calcium antagonists Diuretics (bendroflumethaside) Vasodilators
What is arcus senilis?
Crescent around pupil = hypercholesterolaemia
What is xanthelasma?
fatty deposits =hypercholesterolaemia
What is angular stomatitis?
Inflamed angles of the mouth Caused by iron deficiency, anaemia, glossitis
What is an embolic digital ischaemia?
Embolism lodged in the digital artery, causes tissue necrosis
What is clubbing and what does it suggest?
Curved nail, oedema of nail bed. Suggests abnormal A-V shunt
What is involved in a vascular examination?
Trophic changes - dry skin, hair loss, nail changes, cold
Colour, temp, capillary refill
Pulses - presence, pace, volume, rhythm
Burgers Test with the foot - pallor on elevation, rubor on dependancy
What is ABPI
Anchial brachial pressure index. Compare BP of foot to arm, BP in foot will be very low compared to arm so ABPI should be less than 1
What diagnoses can be used for PVD?
ABPI
Duplex dopper ultrasound
MRI - non invasive, limited resolution, venous filling
Angiography - dye into artery and take X ray
How can a pt control PVD?
Increase exercise
Decrease smoking, weight, diet,
BP control and take antiplatelets
What surgical treatment is available for PVD?
Angioplasty
Artery bypass
What happens in a lower artery limb bypass?
Take a vein and turn it around (because of valves) and use it to bypass the blocked artery
What is an angioplasty?
Catheter with balloon inserted to stretch artery
What is an aortic aneurysm?
Abnormal dilation of artery (commonly the infra renal artery). Mostly occurs in men > 65 yrs
Weak arterial wall ( normal aorta 2- 3cm) but dilation >5cm. But >5.5cm it will burst and die
What is EVAR?
Endovascular aneurysm repair (stent inside femoral arteries)
What is carotid arterial disease?
Usually internal carotid. Plaque at the bifurcation of the carotid. If a bit is thrown off it will go into the cerebral circulation:
To cerebral cortex = facial weakness
To cortex = stroke
To retinal artery = reduced vision
What is carotid endorterectomy?
When an artery is >70% narrowed, the lining of the artery is cleaned out and the artery is closed with a patch to reduce the risk of a stroke in the future
