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Yr 5 Cardiology > Phlebitis, PAD > Flashcards

Phlebitis, PAD Flashcards

1
Q

What is superficial thrombophlebitis?

A

Superficial vein becomes inflamed & forms a clot within

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2
Q

Which vein is normally affected by thrombophlebitis?

A

Long saphenous

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3
Q

What are the risk factors for thrombophlebitis?

A 
Obesity
Thrombophilia
Smoking
COCP
Pregnancy
IVDU/ IV infusion
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4
Q

What is migratory thrombophlebitis?

A

Recurrent thrombosis in superficial veins at various sites

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5
Q

What conditions is thrombophlebitis associated with?

A

Polyarteritis nodosa

Buerger’s disease

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6
Q

How does superficial thrombophlebitis present?

A

Erythema
Swelling
Tenderness
ALL ALONG VEIN

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7
Q

What are signs of varicose vein thrombophlebitis?

A

Hard, tender knot within vein

Erythema & bleeding at site

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8
Q

How does septic thrombophlebitis present?

A 
Often with long-term cannula/IVDU
Local irritation
Hard lump
Fever, tachy, hypoT
N&V
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9
Q

What investigation should be avoided in superficial thrombophlebitis?

A

Venography- contrast medium may aggravate condition

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10
Q

How is superficial thrombophlebitis managed?W

A

1) Elastic support
2) Exercise
3) Analgesia- TOP NSAID (Naproxen)
4) LMWH: Tinz 1m

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11
Q

What is the mechanism of PAD?

A

Signif obstruction to blood flow
↓oxygenation of limbs
Characteristic claudication pain during exercise
Obstruction worsens → rest pain (critical limb ischemia)
Skin ulceration → gangrenous necrosis → amputation of necrotic limb

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12
Q

How does acute PAD occur?

A

Embolus

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13
Q

How does chronic PAD occur?

A

Atherosclerosis

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14
Q

How does functional PAD occur?

A

Vasospasm (transient)

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15
Q

What are the signs of chronic upper limb PAD?

A

Pulse deficit
Arm pain/pallor/paraesthesia/perishingly cold
Unequal BP in arms

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16
Q

If there is upper limb claudication what condition should be considered?

A

Takayasu’s

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17
Q

Which vessel is most commonly affected in chronic upper limb PAD?

A

Subclavian artery + brachiocephalic trunk

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18
Q

Which vessel is most commonly affected in chronic lower limb PAD?

A

Superficial femoral artery

19
Q

What are the signs of chronic lower limb PAD?

A

Ischaemic pain- intermittent claudication
Throbbing/cramping/tightness
Pain relieved by resting/hanging leg over bed
Commonly U/L

20
Q

How does acute limb ischaemia present?

A 
6 P's!!
Rapid onset
High severity
Dusky leg
Mottling
21
Q

What is Leriche’s syndrome?

A 
Claudication
Pain in buttock/thigh
Absent femoral pulse 
Male impotence
Due to saddle aorta-iliac obstruction
22
Q

How does critical limb ischaemia present?

A

Ischaemic rest pain
Ulcers/gangrene
6 P’s
Pulse deficit

23
Q

How is PAD investigated?

A 
Assess ALL pulses
ABPI 
Doppler probe
Duplex USS- 1st LINE IMAGING
Contrast MR angio
24
Q

What do the different ABPI values represent?

A

> 1.2- calcified stiff arteries = advanced age or PAD
1.0-1.2 = normal (0.9 – 1.0 = Ok)
< 0.9 = likely PAD
< 0.5 = Critical PAD requires urgent referral
< 0.1 = ACUTE ISCHAEMIC LIMB

25
Q

How is ABPI calculated?

A

highest ankle pressure / highest arm pressure

26
Q

What different sounds can be heard with a doppler probe?

A 
Triphasic = normal
Biphasic = Abnormal
Monophasic = PAD
27
Q

In PAD who gets duplex USS?

A

ALL patients who require revascularisation

28
Q

How quickly does acute limb ischaemia need to be treated?

A

4-6hours

29
Q

What is the Rutherford classification for acute limb ischaemia?

A

Dusky leg = Viable → Arteriography
White leg/paralysis = Threatened → Surgery
Fixed staining/mottled/ tense muscle = Irreversible → TLC/amputation

30
Q

How is acute limb ischaemia treated?

A

Analgesia + UFH if for surgery
Surgical embolectomy fails → angiogram
If due to thrombosis → Alteplase

31
Q

How is critical limb ischaemia treated?

A

Revascularisation via angioplasty/bypass

Amputation

32
Q

How is chronic limb PAD treated?

A 
Exercise program 
Analgesia
Treat co-morbidities
Clopidogrel if Sx
Naftidrofuryl oxalate (VasoD)
Surgery: Angioplasty + stent or bypass
33
Q

What is given long term post-intervention in acute limb ischaemia?

A

Warfarin

34
Q

What is the mechanism of a reperfusion injury?

A

Neut migrate to reperfused tissue = inflammation
Limb oedema due to ↑capillary permeability → compartment syndrome
Leakage from damaged cells
Acidosis, ↑K+ (arrhythmia), myoglobinaemia (ATN → AKI, ↑urine Na+ ↓osmolality)

35
Q

Describe venous ulcers

A
  • Caused by chronic venous insufficiency
  • Sloughy, painless, superficial oedema, mottled- brown/black
  • Above ankle - below knee
36
Q

Describe arterial ulcers

A
  • Toes & heels
    -Punched out, circular, painful, gangrenous
    -Pain worse when lying, better when legs lowered
    -No palpable pulses
    Hx = PAD, claudication
37
Q

Describe neuropathic ulcers

A
  • Due to pressure & lack of sensory innervation
  • Plantar surface of hallux & metatarsal head
  • Painless
38
Q

What are varicose veins?

A

Leakage @ venous valves
Retrograde flow
Deep veins can tolerate pressure but superficial veins cannot
Become dilated & torturous

39
Q

Which vein is usually affected in Varicose veins?

A

Saphenous

40
Q

What are the Sx of varicose veins?

A

INITIALLY: Itching, discomfort, heavy feeling, ↓Exercise tolerance, night cramps, burning sensation
THEN: dull aching pain & cramps, visible, large veins, chronic venous insufficiency

41
Q

What are signs of chronic venous insufficiency?

A 
Ulcers
Lipodermatosclerosis (hardened, indurated skin)
Pigmentation
Telangiectasia
Eczema
42
Q

How are varicose veins investigated?

A

Duplex USS- DIAGNOSTIC
Examination
Trendelenburg test: Assess valvular competency
Perthe’s test: Assess deep venous patency

43
Q

How are varicose veins managed?

A

Conservative: Avoid long standing, elevate legs, compression stockings, lose weight
Endovascular Tx: Radiofrequency ablation, laser ablation, injection sclerotherapy (foam)

44
Q

What is a complication of varicose veins?

A

Saphena Varix: Dilatation in saphenous.v at confluence w/ femoral vein→ transmits a cough impulse- can be mistaken for inguinal/femoral hernia, inspect = bluish tinge

Yr 5 Cardiology (8 decks)

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