Vasculature Flashcards
What are the three main types of ischaemia?
Acute limb ischaemia
Intermittent claudication/ Chronic limb ischaemia
Critical limb ischaemia. rest pain and tissue loss/ ulceration
What is an acute limb ischaemia and what causes it?
Sudden blockage of an artery causing rapid tissue death.
5 T’s - Tears, transection, thrombus, trauma, travelling embolism
What is a main feature of acute limb ischaemia?
PAIN,PAIN, PAIN, PAIN., PAIN, PAIN
What are the 6 P’s of acute limb ischaemia?
Pallor, parasthesia, paralysis, pain, pulselessness and perishingly cold.
How is limb ischaemoa treated?
Analgesia, aspirin, anti-coagulation, thrombolysis
What are the thrombolytic drugs?
Alteplase.
Reteplase.
Tenecteplase.
Streptokinase.
Tpa
What are the treatments for acute limb ischaemia?
Bypass surgery
Amputation
Embolectomy (BAE)
What is a complication of acute limb ischaemia?
Reperfusion injury
How can diabetes affect ABPI?
Calcification and stiffening of arteries
What are some symptoms of chronic limb ischaemia?
Intermittent claudication (location/ distance varies)
Rest relief (critical is rest pain whereas chronic is rest relief)
Loss of hair and toenails
Arterial ulcers
How can you diagnose a chronic limb ischaemia?
Bloods
ABPI
Duplex scan
Angiography
How can you surgically treat chronic limb ischaemia?
Vscular by-pass e.g. using a reverse saphenous graft to connect common femoral to popliteal by-passing superficial femoral.
What happens in critical limb ischaemia?
Rest pain
What is the SFJ and SPJ?
The saphenous femoral junction and saphenous popliteal junction which drains blood from superficial to deep.
What are varicose veins?
Dilated tortuous superficial veins which permit reverse flow. Causes are valvular failure which can be primary/ idiopathic or deep venous osbtruction
Common in both males and females. 50% over 50
Many treated conservatively
Complication like uulcers could mean hosiery or surgery.
What is the scoring system for DVT?
wells score
What is a diagnostic test for a DVT?
The most useful investigation to be performed is a doppler ultrasound of the venous system of the left leg to see if there is evidence of thrombosis. As this is her presenting complaint it is reasonable to do this investigation first which may turn up alternative diagnoses other than DVT such as Baker’s cysts.
A patient had a doppler ultrasound performed which shows thrombus in the left common femoral vein. Which one of the following is the most appropriate course of action?
LMHW heparin and warfarin
When could fetal warfarin syndrome occur?
First trimester
[saddle nose, defects in growth and limbs]
How can the effects of warfarin be reversed?
Giving vitamin K
How can you prevent too much anticoagulation?
Adminsitersing prothrombin
What is primary hypertension?
Has no known cause
Multiple risk factors
FH
What is secondary hypertension?
When the cause is known e.g. hyperaldosteronism
T or F. There is a five fold risk of BP rise with diastolic and a 3 fold rise with systolic.
False. There is a five fold risk with systolic and a three fold risk with diastolic rise
What does ABPM and HBPM stand for?
Ambulatory and home blood pressure monitoring
What are the main stages of hypertension?
Stage 1 140/90 (50)
Stage 2 160/100 (40)
Stage 3 180/110 (30)
What are the complications of hypertension?
End organ damage e.g. retinopathy, haemorrhage/ stroke, renal failure
What is the target of blood pressure for people <80?
BP < 140/90mmHg for people under 80years
What is the target blood pressure for people >80.
150/90
What conservative or life style management could help to reduce HTN?
Moderation in alcohol consumptionModeration in consumption of coffee and other caffeine-rich products.Reducing salt consumption, or using a salt substitute.Stopping smokingRegular exercise and physical activity Weight reduction and maintenanceDietary adviceRegular sleeping patternsRelaxation therapies
What are the signs of venous insufficiency?
Haemosiderin deposits
Ulcers
Reverse bottle sign
Lipodermatosis sclerosis
Darkened skin
What should you do if PE is not detected on CTPA?
Investigating suspected PE: if the CTPA is negative then consider a proximal leg vein ultrasound scan if DVT is suspected
