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Cardiovascular Week 4 2016/17 > 5: Peripheral vascular disease > Flashcards

5: Peripheral vascular disease Flashcards

(70 cards)

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1
Q

What is chronic lower limb ischaemia?

A

Lack of blood reaching the tissues of the lower limb (inadequate perfusion)

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2
Q

What causes ischaemia?

A

Arterial obstruction due to atheroma

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3
Q

What are four modifiable risk factors which contribute towards endothelial cell damage?

A

Cigarette smoke
Hypertension
Increased conc. glucose (diabetes)
Increased conc. cholesterol

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4
Q

Plaque formation is due to activated ___, __ cholesterol and the ___ response.

A

platelets , LDL , inflammatory

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5
Q

Which kind of cholesterol is taken up by macrophages during plaque formation?

A

Oxidised LDL

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6
Q

What kind of peripheral vascular disease is obvious to spot in a patient?

A

Intermittent claudication

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7
Q

What are two kinds of vascular disease which are more difficult to spot in patients?

A

Coronary artery disease

Cerebrovascular disease

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8
Q

What is claudication?

A

Muscle ischaemia ON EXERCISE

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9
Q

Why may claudication be described as intermittent?

A

Only occurs on exertion when oxygen demand of muscle increases

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10
Q

Collateral arteries can deliver (more / less) blood than the obstructed artery itself.

A

less

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11
Q

Obstruction can be detected by taking a patient’s __ __ pressure index.

A

Ankle brachial pressure index

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12
Q

How is ABPI calculated?

A

Ankle pressure (mm Hg) / brachial pressure (mm Hg)

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13
Q

Are ABPI measurements systolic or diastolic?

A

Systolic

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14
Q

What else is considered apart from the ABPI when trying to figure out the occlusion of an artery?

A

Tone & pitch of the sound on auscultation

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15
Q

What tool can be used to look at the narrowing of an individual blood vessel?

A

Ultrasound

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16
Q

What lifestyle change slows the progression of lower limb ischaemia?

A

Stopping smoking

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17
Q

How often should patients with intermittent claudication exercise?

A

30 mins 3x per week (into pain)

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18
Q

Apart from exercise, the second most effective way of treating intermittent claudication is prescribing ___ drugs.

A

anti-cholesterol

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19
Q

Which surgical methods can be used to treat blocked arteries?

A

Angioplasty +/- stent

Inflow / outflow bypasses (look these up)

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20
Q

Where would pain be felt in a patient with critical limb ischaemia?

A

Toe/foot

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21
Q

When is critical limb ischaemia pain felt?

A

At rest:

  • lying down
  • sleeping
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22
Q

What may occur in the feet of people with critical limb ischaemia?

A

Ulcers, gangrene

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23
Q

Why do people with critical limb ischaemia develop severe damage (ulcers, gangrene) when they damage their feet (trauma, poor fitting footwear)?

A

Lack of blood supply –> lack of proper healing

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24
Q

What alleviates the pain at rest associated with critical limb ischaemia?

A

Getting up and walking about, moving the leg

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25
What should you look out for on examination of the foot of a patient with critical limb ischaemia?
``` Cold Absence of peripheral pulses Colour change Hairless, thick nails, shiny Venous guttering Ulcers, gangrene ```
26
Why would a lower limb be amputated?
If critical limb ischaemia was threatening the patient's life
27
What influences the level at which a patient's limb should be amputated?
Healing abilities of the limb | Function of the limb
28
What is an aneurysm?
Dilation of a vessel by >50% of its normal diameter
29
What is a true aneurysm?
An aneurysm where the vessel wall is intact
30
What is a false aneurysm?
Breach in vessel walls (ballooning)
31
Name three further types of aneurysm.
Saccular (ballooning) Fusiform Mycotic (secondary to infection, involves all 3 layers of arterial wall)
32
Which layer of the blood vessel is affected in AAAs?
Tunic media
33
The occurrence of abdominal aortic aneurysm increases with __.
age
34
You are more likely to have a AAA if you are (male / female).
male
35
75% of AAAs are (symptomatic/asymptomatic).
asymptomatic
36
If a AAA is symptomatic in a patient, what would they experience?
1. Pain - may mimic renal colic 2. "Trashing" - thrombi breaking off from AAA and blocking arteries in legs 3. RUPTURE
37
What is the presentation of an AAA rupture?
Sudden onset epigastic / central pain Radiates through to back Collapse
38
What would a ruptured AAA appear like on examination?
Pulsatile, expansive mass - may/may not be tender Transmitted pulse Peripheral pulses
39
What may contain the rupture of an AAA?
Peritoneum (contained if rupture is RETROPERITONEAL) If rupture is INTRAperitoneal you will probs die
40
What may contain the rupture of an AAA?
Peritoneum (contained if rupture is RETROPERITONEAL) If rupture is INTRAperitoneal you will probs die
41
Generally, the greater the size of the aneurysm, the more likely it is to __ and the more important it is to __.
rupture , intervene
42
What imaging tool can be used to look at the AP diameter of possible asymptomatic aneurysms?
Duplex ultrasound
43
Which imaging method involves giving the patient contrast and looking at the aneurysm's morphology - shape, size, iliac involvement.
CT scan
44
A CT scan allows you to decide whether or not an AAA has ___.
ruptured
45
What name is given to the procedure which opens up a patient's abdomen?
Laparotomy
46
Which polyester can be grafted onto the AA to repair a rupture?
Dacron
47
What procedure uses a stent graft to bypass the ruptured AA?
Endovascular aneurysm repair
48
What predisposes you to an AAA?
Smoking, hypertension
49
Important in treating limb ischaemia is distinguishing ___ from __-on-__ ischaemia.
acute , acute-on-chronic
50
What are some causes of sudden occlusion of an artery?
``` Embolism Atheroembolism Arterial dissection Trauma Compression ```
51
What are some causes of sudden occlusion of an artery?
``` Embolism Atheroembolism Arterial dissection Trauma Compression ```
52
What are the clinical features of acute limb ischaemia?
``` Pain Pallor (pale) Pulseless Cold Paraesthesia (pins and needles) Paralysis ```
53
What is a likely cause of acute limb ischaemia?
Embolism
54
Acute ischaemic pain is often resistant to ___.
analgesia
55
"Woody" feel of the muscle compartment indicates ___ ischaemia and muscle ___.
irreversible , death
56
If mottling of the skin (blue/purple) DOESN'T disappear with pressure, thrombus has spread distally and the ischaemia is ___.
irreversible
57
Ischaemia is irreversible beyond __ hours.
12
58
Malignancy makes you (pro/anti) thrombotic.
pro-thrombotic
59
Troponin levels are used to differentiate between ___ and __.
angina , MI
60
Diabetic foot problems encompass...
1. Diabetic neuropathy 2. Peripheral vascular disease 3. Infection
61
Diabetic foot problems often end in ___.
amputation
62
Diabetic foot problems often end in ___.
amputation
63
How may infection be introduced to a diabetic person's foot, leading to diabetic foot sepsis?
1. Small puncture wound 2. Nail infection 3. Ulcers
64
Infection reaches the __ compartments of the foot.
muscle
65
Build up of what, associated with infection, increases pressure in foot muscle compartments and loss of capillary blood flow?
Pus
66
Build up of what, associated with infection, increases pressure in foot muscle compartments and loss of capillary blood flow?
Pus
67
Diabetic foot sepsis is a vascular surgical __.
emergency
68
What would a patient with diabetic foot sepsis look like at first glance?
``` Pyrexia Tachycardic Tachypnoeic Confused Kussmaul's breathing ```
69
What are some local findings associated with diabetic foot sepsis?
``` Swollen Tender Ulcer with pus extruding Erythema Patchy necrosis Crepitus (gas in the small tissues, produced by organisms) ```
70
What is the normal diameter of the aorta?
1.2 - 2.0cm

Cardiovascular Week 4 2016/17 (7 decks)

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