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AP II > Vascular Disease > Flashcards

Vascular Disease Flashcards

2
Q

What are the physiological functions of blood vessels? (3)

A

Regulation of blood to tissues

Synthesis/secretion of vasoactive/antithrombic substances

Delivery of immune cells

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3
Q

What are the measurement of the aorta in cm?

A

~3cm from the origin

~5-6 cm long

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4
Q

What are the 3 branches off the arch of the aorta from left to right?

A

Brachiocephalic

Left common carotid

Left subclavian

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5
Q

What are the layers of the aorta?

A

Intima (innermost)–endothelial cells

Media–smooth muscle cells, elastic/collagen fibers 2:1

Adventitia–collagen (strength), vaso vasorum (vasculature that perfuses the outer layer)

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6
Q

What factors constitute an AAA? (3)

A

50% increased localized diameter

>4 cm in thoracic aorta

>3 cm in abdominal aorta

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7
Q

Define a true aneurysm.

A

Involves all 3 vessel layers

2 types: fusiform, saccular

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8
Q

Define a pseudoaneurysm.

A

Only involves the inner 2 layers: intima and media.

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9
Q

Pseudoaneurysms are more unstable. True or false?

A

False affects the intima and media and is contained in the adventitia.

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10
Q

Label the types of aneurysms.

A
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11
Q

________ is the origin of 90% of aneurysm cases.

A

Atherosclerosis

Note: Usually occurs in males > 50 y/o.

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12
Q

What are cofactors leading to the cause of aneurysms? (4)

A

Smoking

Hypertension

High cholesterol

Loss of elastin

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13
Q

Men are ___ times more likely to have an aneurysm than women.

A

8

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14
Q

Abdominal aneurysms are often asymptomatic. True or false?

A

True

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15
Q

What are the clinical presentations of an aneurysm in the following areas:

Compression of esophagus/trachea
Recurrent laryngeal nerve
Dilation of aortic ring

A

Compression of esophagus: Wheezing, coughing, dyspnea, difficulty swallowing

RLN stretching: hoarseness

Aortic ring: Pt presents with aortic regurge

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16
Q

What are classic signs of an aortic aneurysm rupture?

A

Hypotension

Low back pain

Pulsative abdominal mass

Note: Only 1/2 pts present with these signs.

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17
Q

What is the gold standard for treating AAA?

What is the treatment for less severe ones?

A

surgical repair with prosthetic graft

endovascular graft

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18
Q

When is surgical repair of a AAA considered? (Think of diameter.)

A

> 4.5 - 5 cm in diameter

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19
Q

What other co-existing conditions with pts with AAA have? (5)

A

Ischemic heart disease

HTN

COPD

Diabetes

Renal dysfunction

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20
Q

What kind of access do we need prior to surgery?

A

Large IV

Art line

Central line

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21
Q

What important factors do we need to consider intra-op?

A

Smooth induction to prevent cardiovascular swings.

Major blood loss may occur.

Hemodynamic changes that can occur during clamping/unclamping.

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22
Q

What hemodynamic changes occur during cross clamping?

A

Increased afterload–> increased BP

Decreased preload

Decreased perfusion distal to the clamp

Note: Depending on where the clamp is placed, renal perfusion can be compromised.

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23
Q

What hemodynamic changes occur during unclamping? (3)

A

Sudden decreased afterload –> decreased BP

**need vasoconstrictor to anticipate the change

Lactate washout

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24
Q

What is an aortic dissection?

A

The splitting of the intima from the adventitia along the length of the vessel.

25
Q

What are the 2 types of aortic dissection?

A

Type A

Type B

26
Q

What is a “Type A” aortic dissection? (3)

A

Involves the proximal, ascending aorta

Represents 2/3 of dissections

High risk of extruding into coronary and arch vessels

27
Q

What is a “Type B” aortic dissection?

A

Distal dissection limited to the thoracic and abdominal aorta

29
Q

What is the pathogenesis of aortic dissection? (4)

A

Chronic HTN

Aging

Connective tissue disorder like Marfan’s

Trauma

30
Q

What type of aortic dissection presents as:

sudden, severe pain with ripping/tearing in anterior chest

A

Type A

31
Q

What type of aortic dissection presents as:

sudden severe pain between scapulae

A

Type B

32
Q

What other catastrophic events can occur from a dissecting aorta? (4)

A

MI

Stroke

Renal failure

Loss of pulse in extremities

Note: All occur as a result of occlusion of the propagating hematoma.

33
Q

What are complications of aortic dissection?

A

Rupture

Occlusion of aortic branch vessels

Distortion of the aortic annulus

34
Q

What does the rupture of aortic dissection result in?

A

cardiac tamponade

hemomediastinum

hemothorax

35
Q

What does occlusion of the aortic vessels result in?

A

carotid stroke

coronary MI

36
Q

How do we treat an aortic dissection intra-operatively?

A

Stop progression of the dissection by:

decreasing BP –> Beta Blockers

decreasing LV contraction –> Sodium Nitroprusside

37
Q

Symptomatic pts with >____% blockage yield the greatest benefit from an endarterectomy.

A

50%

38
Q

Pts who have already suffered a stroke will yield the most benefit to a carotid endarterectomy. True or false?

A

False, yields minimum benefit.

39
Q

What do you consider during a carotid endarterectomy pre-op evaluation?

A

Neurological status

CAD

Renal disease

Chronic HTN

Effect of changes in head position

40
Q

What is the anesthetic technique for carotid endarterectomies?

A

Regional: Cervical Plexus Block allows trial occlusion of carotid to evaluate neuro changes. Pt is awake.

GA: Infer neuro changes from EEG

41
Q

What are the cons to performing a cervical plexus block for a carotid endarterectomy?

A

no cerebral protection

42
Q

What are the benefits to GA for a carotid endarterectomy?

A

decreased CMRO2

ability to regulate PO2, PCO2

43
Q

What are the drugs of choice for induction for a carotid endarterectomy? (2)

A

Thiopental

Propofol

Note: Because they lower CMRO2 and redistribute blood flow to potentially ischemic areas.

Etomidate for hemodynamically unstable pts.

Fentanyl/Alfentanyl

44
Q

What are anesthetic considerations intraoperatively for carotid endarterectomies?

A

Control BP

Carotid cross-clamping/unclamping

PROMPT emergence to assess neuro function

45
Q

What are post-operative concerns for carotid endarterectomies? (5)

A

HTN (carotid sinus activation) / Hyptension (baroreceptor reactivation)

MI/Infarction (MI is leading cause post-op complications)

Neurological complications

Airway obstruction

Nerve injury (hypoglossal, RLN, SLN)

46
Q

In what time frame does a carotid endarterectomy incident occur?

A

8-12 hours post op

47
Q

Peripheral disease may result from: (3)

A

atherosclerosis

thromoembolism (acute)

vasculitis

48
Q

70% of pts > 75 y/o are affectedby peripheral atherosclerosis. True or false?

A

true

49
Q

What are the clinical presentations of peripheral atherosclerosis? (4

A

Claudication (cramping)

Ulceration

Skin necrosis

Decreased arterial pulses

50
Q

How do we pharmacologically treat peripheral atherosclerosis? (4)

A

Anti-platelet therapy

Lipid-lowering therapy

DM meds

HTN meds

51
Q

What are causes of acute arterial occlusions? (4)

A

Thrombi originating from:

heart
stenosed aorta
damaged endothelium
bypass grafts

52
Q

What condition:

vasospasm of digital arteries with cold/stress
extreme vasoconstriction
tricolor phasic response- white/blue/red
Affects women 20-40 y/o

A

Raynaud’s Syndrome

53
Q

What medications alleviate symptoms of Raynauds? (2)

A

Calcium channel blockers

Alpha antagonists

54
Q

Avoid EPI in local anesthetics when treating pts with Raynaud’s. True or false?

A

True

55
Q

Where do DVTs normally occur and what is a considerable risk of a DVT?

A

Calf veins or more proximally

Pulmonary embolism

56
Q

What are the clinical symptoms of a 2º DVT, or, pulmonary embolism? (4)

A

Acute dyspnea

Tachypnea

Chest pain

Non-productive cough

57
Q

What are DVT risk factors? (5)

A

Morbid obesity

Stasis of blood flow

vascular damage

Hypercoagulable states

Advanced age

AP II (32 decks)

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