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Cardiology > Venous/arterial Disease > Flashcards

Venous/arterial Disease Flashcards

1
Q

Describe the clinical features of intermittent claudication/peripheral arterial disease?

A

Variable period of exercise –> ischaemic pain in limb

Relieved by rest

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2
Q

How would you clinically assess someone with suspected intermittent claudication?

A
  • history of symptoms and risk factors
  • examine legs/feet for signs of ischaemia
  • feel for femoral, popliteal and foot pulses
  • measure ABPI
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3
Q

How do you measure/calculate ABPI?

A

Measure BPs manually, using doppler probe, in both arms + ankle (using posterior tibial, dorsals pedis and peroneal arteries if possible)

ABPI = highest ankle pressure / highest arm pressure

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4
Q

What is a normal ABPI?

A

0.9 - 2.1

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5
Q

What ABPI value would indicate claudication?

A

0.4 - 0.85

severe = 0 - 0.4

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6
Q

Which investigations should be done if considering revascularisation for lower limb ischaemia?

A

Duplex USS

MR angiography

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7
Q

What are the first steps in management of intermittent claudication?

A

STOP SMOKING
Lifestyle advice
Supervised exercise program –> exercise to maximal pain

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8
Q

What is the next step in management of intermittent claudication if lifestyle measures don’t work?

A

Angioplasty + stent

Surgery –> use of prosthesis/vein to bypass area of occlusion

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9
Q

What are the clinical features of critical limb ischaemia?

A

Pain in toe/foot AT REST due to ischaemia (nerve ending pain)
Worse at night, helped by getting up and walking about

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10
Q

What might you find on examination in critical limb ischaemia?

A 
Cool to touch
Absent pulses
Colour change
Hairless
Thick nails
Shiny skin
Venous guttering
Ulcers
Gangrene
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11
Q

What are the management options for critical limb ischaemia?

A 
Pain control - paracetamol + opioid + antiemetic
Imaging if considering revascularisation
- duplex USS, MR angiography
Angioplasty or bypass surgery
Amputation
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12
Q

What are varicose veins?

A

Dilated, tortuous, superficial veins

–> due to abnormal transmission of deep vein pressure

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13
Q

Which veins are usually affected in varicose veins?

A

Long and short saphenous veins

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14
Q

What are primary varicose veins?

A

Exist with normal deep vein pressures

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15
Q

What are secondary varicose veins?

A

Due to raised deep vein pressures e.g. post DVT

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16
Q

How does a DVT lead to the development of varicose veins?

A

Increases the deep vein pressure due to:

  • deep vein obstruction
  • deep valve incompetence
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17
Q

What are the risk factors for varicose veins?

A

Age
Pregnancy
Obesity

18
Q

What are the symptoms of varicose veins?

A

Variable, often asymptomatic

  • achy, heavy, legs
  • burning, throbbing, muscle cramping
  • swelling
  • itching
  • skin discolouration
19
Q

What are some complications of varicose veins?

A
  • bleeding
  • thrombophlebitis
  • discolouration: haemosiderin deposits due to blood breakdown
  • lipodermatosclerosis
  • ulceration
20
Q

Which investigation should be done for varicose veins?

A

Duplex USS

21
Q

What in the initial, non interventional management of varicose veins?

A

Information

Graduated compression stockings

22
Q

When are graduated compression stockings contraindicated?

A

Low ABPI

23
Q

What are the interventional management options for varicose veins?

A

Endovenous:

  • foam sclerotherapy
  • ablation (mechanical, laser or radio frequency)

Surgical

24
Q

What is the definition of an aneurysm?

A

Part of artery with dilatation > 50% of its original diameter

25
Q

How is screening for AAA done in the UK?

A

Abdominal USS

Offered to men when they turn 65

26
Q

What are the possible different findings on AAA screening and how are they managed?

A 
No aneurysm (< 3cm)
--> no further screening
Small AAA (3-4.4cm)
--> repeat scan every year
Medium AAA (4.5-5.4cm)
--> repeat scan every 3 months
Large AAA (>5.5cm)
--> refer to surgeon within 2 weeks
27
Q

Which type of imaging is used to give more information after USS?

A

CT (arterial phase)

28
Q

What are the clinical features of an unruptured AAA?

A

Usually asymptomatic
Abdominal/back pain
Pulsatile mass on abdominal palpation

29
Q

What are the clinical features of a ruptured AAA?

A

Intermittent or continuous abdominal pain
–> radiates to back, iliac fossa or groin
Collapse
Expansile mass (expands and contracts)
Shock

30
Q

What are the two options for repair of an AAA?

A

Open repair

EVAR - endovascular aneurysm repair (stenting)

31
Q

How is an open repair of AAA carried out?

A

Laparotomy
Clamp aorta and iliacs
Dacron Graft placed

32
Q

What are the features of EVAR?

A

Stent inserted via femoral artery
Avoids major surgery, faster recovery
Failure rates higher than with surgery so more likely to require further interventions

33
Q

What are the 3 parts of Virchow’s triad which predispose to VTE?

A

Hypercoagulable state
Endothelial injury
Circulatory stasis

34
Q

How do you investigate a suspected PE?

A

Pre-test probability –> Well’s score

  • if moderate/high risk –> scan
  • if low risk –> check D-dimers
  • D-dimer high –> scan
  • D-dimer normal –> VTE excluded
35
Q

Which scan is gold standard for PE?

A

CTPA

36
Q

Which scan can be used if CTPA is contraindicated?

A

V/Q scan

37
Q

How do you investigate a suspected DVT (without PE)?

A

Doppler USS leg

38
Q

What is the treatment for a DVT?

A 
Oral anticoagulation 
(DOAC - direct oral anticoagulation e.g. apixaban or rivaroxaban)
39
Q

What is the treatment for PE (depending on risk)?

A

High risk –> thrombolysis (fibrinolysis), then DOAC

Intermediate/low risk –> DOAC

40
Q

How long should a provoked VTE with a reversible factor be treated?

A

3-6 months

41
Q

How long should a provoked VTE with an irreversible factor be treated?

A

Depends on factor

3-6 months or lifelong

42
Q

How long should an unprovoked VTE be treated?

A

Long term

unless risk of bleeding

Cardiology (14 decks)

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