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Arterial Flashcards

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1
Q

what is carotid artery disease

A

build up of atherosclerotic plaques in one or both common and internal carotid arteries - resulting in stenosis or occlusion

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2
Q

what is the most common location in the carotid arteries for atherosclerosis to develop

A

bifurcation of the carotid arteries

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3
Q

risk factors for carotid artery disease

A

age > 65 years

smoking, hypertension, hypercholesterolaemia, obesity, diabetes

history of cardiovascular disease

family history

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4
Q

what 2 things do people with carotid artery disease usually present with

A

stroke

TIA

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5
Q

investigations into suspected stroke

A

urgent non-contrast CT head

bloods

ECG

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6
Q

management of suspected stroke

A

all should be started on high flow oxygen and have their blood glucose optimised

ischaemic stroke - IV alteplase and 300mg aspirin

haemorrhagic stroke - correction of coagulopathy and referral to neurosurgery

in those with TIA or non-disabling stroke, carotid endarterectomy (CEA) to remove the atheroma

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7
Q

what is the major sequela of carotid artery disease

A

stroke

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8
Q

what is the definition of an aneurysm

A

abnormal dilatation of a blood vessel by more than 50% of its normal diameter

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9
Q

what is an abdominal aortic aneurysm

A

dilatation of the abdominal aorta greater than 3cm

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10
Q

risk factors for AAA

A

smoking, hypertension, hyperlipidaemia, family history and male gender

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11
Q

clinical features of AAA

A

abdo pain

back or loin pain

distal embolisation producing limb ischaemia

pulsatile abdominal mass

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12
Q

investigations into AAA

A

USS first line

followed by a follow-up CT scan with contrast

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13
Q

management of AAA

A

medical; monitoring and surveillance with duplex USS, smoking cessation, improve blood pressure control, statin and aspirin therapy, weight loss and increased exercise

surgical; considered if AAA > 5.5cm or is symptomatic, main treatments are open or endovascular repair

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14
Q

clinical features of a ruptured AAA

A

abdo pain

back pain

syncope

vomiting

pulsatile and tender abdominal mass

haemodynamically compromised

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15
Q

management of ruptured AAA

A

high flow O2, IV access, urgent bloods - crossmatched for minimum 6 units

transfer to vascular - if unstable then straight to surgery for open repair

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16
Q

what are the layers of an artery wall

A

tunica intima, media, adventitia

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17
Q

what is an aortic dissection

A

tear in the intimal layer of the aortic wall, causing blood to flow in between the intima and media layers splitting them apart

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18
Q

risk factors for aortic dissection

A

hypertension

atherosclerotic disease

male gender

connective tissue disorders (typically marfan’s or ehlers danlos)

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19
Q

clinical features of Aortic dissection

A

tearing chest pain, radiating through to the back

tachycardia, hypotension and new aortic regurgitation murmur

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20
Q

you need 2/3 things to diagnose an MI - what are they

A

2 out of the following 3;

abnormal ECG

cardiac sounding chest pain

positive troponins

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21
Q

investigations and imaging into suspected aortic dissection

A

baseline bloods - FBC, troponin, etc. with a crossmatch of at least 4 units

ABG and ECG to aid diagnosis

CT angiogram as first line imaging

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22
Q

management of aortic dissection

A

high flow oxygen, IV access, fluid resus done cautiously maintaining a target pressure

long term antihypertensive therapy

surgical management is indicated in type A dissections with type B getting medical management

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23
Q

what is the gold standard investigation for aortic dissection

A

CT angiogram

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24
Q

what are the main causes of thoracic aneurysms

A

connective tissue disorders; marfan’s and Ehlers-Danlos syndrome

bicuspid aortic valve

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25
risk factors for thoracic aortic aneurysms
high BMI, atherosclerosis, hypertension, smoking, family history, male gender and advancing age
26
clinical features of thoracic aortic aneurysms
usually asymptomatic and found incidentally on imaging pain is primary complaint can also have; hoarse voice (damage to recurrent laryngeal nerve), distended neck veins from SVC compression, cough and dyspnoea, symptoms of heart failure
27
what is the preferred imaging modality for thoracic aortic aneurysms
CT chest with contrast
28
what radiograph features can indicate a thoracic aortic aneurysm
tracheal deviation enlarged aortic knob widened mediastinal silhouette
29
management for thoracic aortic aneurysms
statin and antiplatelet therapy, control blood pressure and smoking cessation as baseline treatment surgical management dependent on location of aneurysm
30
define acute limb ischaemia
sudden decrease in limb perfusion that threatens the viability of the limb
31
the causes of acute limb ischaemia can be classified into 3 main groups; what are they
trauma embolisation - thrombus from a proximal source travels distally to occlude the artery thrombosis in situ - atheroma plaque in the artery ruptures and a thrombus forms on the plaques cap
32
6 P's of limb ischaemia
pain pallor pulselessness paralysis perishingly cold paresthesia
33
investigations into acute limb ischaemia
routine bloods - including serum lactate to assess levels of ischaemia, thrombophilia screen and group and save ECG - find potential cause of embolus e.g. AF, MI, etc doppler ultrasound initially followed by CT angiogram
34
how long does it take to cause irreversible damage in acute limb ischaemia
within 6 hours
35
management of acute limb ischaemia
initial = high flow oxygen, IV access and heparin conservative = prolonged course of heparin surgical = most cases require surgical intervention, there are many types depending on if it was an embolic or thrombotic cause irreversible limb ischaemia requires urgent amputation long term = adjust lifestyle factors and start on anti-platelet such as low dose aspirin
36
what is an important complication of acute limb ischaemia
reperfusion injury = sudden increase in capillary permeability; results in compartment syndrome and release of substances from damaged muscle cells such as myoglobin which can result in significant AKI
37
what is the gold standard investigation in acute limb ischaemia
CT angiogram
38
what are some risk factors for acute limb ischaemia
AF, smoking, prosthetic heart valves, post MI, AAA
39
what typically causes chronic limb ischaemia
atherosclerosis
40
risk factors for chronic limb ischaemia
smoking diabetes family history hypertension hyperlipidaemia obesity and physical inactivity
41
what is one of the earliest symptoms of chronic limb ischaemia
intermittent claudication (usually occurs in legs) after walking a fixed distance which is the relieved by rest within a few minutes
42
investigations into chronic limb ischaemia
ABPI - ankle brachial pressure index routine bloods - lactate, thrombophilia screen, group and save ECG initially a doppler ultrasound followed by a CT angiography
43
management of chronic limb ischaemia
medical; lifestyle management, statin and antiplatelet therapy, optimal diabetes control surgical; angioplasty, bypass grafting or amputation (in those with critical ischaemia)
44
what is acute mesenteric ischaemia
sudden decrease in blood supply to the bowel, resulting in ischaemia and potentially death
45
the common causes of acute mesenteric ischaemia can be categorised into what
thrombus in situ embolism (most common) non-occlusive cause venous occlusion and congestion
46
clinical features of acute mesenteric ischaemia
generalised abdo pain, out of proportion to clinical findings diffuse and constant pain with associated nausea and vomiting in 75% of cases
47
lab tests for suspected acute mesenteric ischaemia
ABG - assess degree of acidosis and serum lactate routine bloods - FBC, U&Es, clotting screen, LFTs, amylase (can exclude pancreatitis) and group and save
48
gold standard imaging for acute mesenteric ischaemia
CT angiography
49
management of acute mesenteric ischaemia
initial; resus fluids, catheter, broad spectrum abx (due to risk of perforation) surgical; removal of the affected portion of the bowel or revascularisation of the bowel
50
what is the underlying cause of chronic mesenteric ischaemia
atherosclerosis
51
how does chronic mesenteric ischaemia usually present
usually asymptomatic due to collateral blood supply only symptomatic in cases where both IMA and SMA are affected - pain post eating (usually 10 mins to 4 hours after - this is due to the increased blood requirement post eating)
52
blood supply of the ascending and transverse colon and caecum
all are from branches of the SMA ascending = right colic artery transverse = middle colic caecum = ileocolic artery
53
gold standard imaging of suspected chronic mesenteric ischaemia
CT angiography
54
management of chronic mesenteric ischaemia
conservative; lifestyle modification, antiplatelet and statin therapy surgical; angioplasty or bypass
55
aneurysms vs pseudoaneurysms
aneurysm = abnormal dilatation of an artery that involves all three layers of the arterial wall (intima, media and adventitia); usually caused by smoking, hypertension, increasing age and family history pseudoaneurysm = collection of blood between the media and adventitia layers; they are often caused by trauma as opposed to smoking, hypertension, etc.
56
investigations into pseudoaneurysms
check distal pulses duplex ultrasound followed by CT if needed routine bloods, blood cultures, and crossmatch due to risk of bleed
57
clinical features of pseudoaneurysms
pulsatile lump that can be tender and painful
58
management of infected pseudoaneurysms
surgical due to higher risk of rupture; surgical ligation
59
where is the most common site for a pseudoaneurysm
femoral artery
60
in what arteries do peripheral artery aneurysms most commonly occur
femoral and popliteal arteries popliteal being most common - 70-80%

Vascular (2 decks)

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