Flashcards in Foundation-Vascular Deck (70)
What is the most common location of aortic aneurysm
AAA=infrarenal abdominal aorta
What is TAA generally caused by?
Cystic medial necrosis
What is the triad of a ruptured AAA (diagnostic)
2. Back or abdominal pain
3. Pulsatile abdominal mass
What is diagnostic of TAA (ascending thoracic aorta)
Pressure on adjacent structures
1. Hoarseness- laryngeal nerce
2. Resp. sx's- Trachea
3. LE pain- thrombi
What is the gold standard diagnostic for aortic aneurysms?
What is the treatment for an unstable pt with ruptured aneurysm?
immediate surgical intervention
Who do we screen for Aortic Aneurysms?
1. Men aged 65-75 who have ever smoked
2. People aged >60 who have a positive FHx for AAA
Stanford classification for Type A dissection
Involved ascending aorta and aortic arch
Stanford classification for Type B dissection
Involved descending aorta
What population do we see aortic dissections at an earlier age than normal? And what age?
-Marfan's Syndrome- Connective tissue dz
-Mean age = 36
What is the top risk factor for aortic dissection?
What population are aortic dissections the most common in?
middle-aged to older males with a history of hypertension
Do aortic dissections usually happen in the presence or absence of aneurysms?
What complaint is more often reported with Type A dissection?
What complaint is more often reported with Type B dissection?
Back and abdominal pain
What murmur would you expect to hear on examination that would clue you in this might be an aortic dissection?
New high frequency diastolic blowing murmur of AR
Is hypotension shock more common with Type A or Type B dissection?
Is HTN more common with Type A or Type B dissection?
What imaging has the highest sensitivity and specificity for aortic dissection diagnosis?
CT with IV contrast, TEE, MRI =95%
What is the study of choice in a hemodynamically unstable patient?
What is the treatment of choice in Type A dissections?
Resect ascending aorta and replace with graft
What is the treatment of choice in Type B dissections?
Medical management if possible
What condition is characterized as a chronic vasculitis of large and medium-sized vessels?
Giant Cell Arteritis or temporal arteritis
What is the mean age of diagnosis in giant cell arteritis?
What is a hallmark indication of giant cell arteritis?
almost never occurs in ppl <50 y.o.
Describe "cord like sensation" when palpating the temporal artery
-Dilated and thickened, allowing it to roll between fingers
What are the presenting symptoms in giant cell arteritis?
-New onset HA
-Abrupt onset of visual disturbances
-Symptoms of polymyalgia rheumatica
-Unexplained fever or anemia
-Elevated ESR or CRP
What is the most feared complication of giant cell arteritis?
What condition is giant cell arteritis associated with?
Define Polymyalgia rheumatica
-Systemic inflammatory dz
-Pain in shoulder and pelvic girdle
-Elevated SED and CRP with this
What is the imaging of choice for giant cell arteritis?
Ultrasound- get color flow image of arteries
Treatment for giant cell arteritis?
At what age does PAD increasingly progress?
What is the classic presentation of PAD?
-Reproducible cramping pain in legs induced by exercise and relieved by rest
What peripheral artery dz (what artery) does calf muscle pain suggest?
What peripheral artery dz (what artery) does buttocks and thigh pain suggest?
What are the characteristics of severe PAD?
-Pain at rest
Describe Buerger Test
Rubor on dependency
-Dependent= dusky redness
Describe arterial ischemic ulcers
-Deep ulcers over bony prominences (toes)
What is the gold standard diagnostic test for PAD?
How do you measure Ankle-Brachial Index (ABI)?
-ankle systolic BP/brachial systolic BP= ratio
-detected with a doppler probe
What is mild PAD based on ABI results?
What is severe PAD based on ABI results?
List Pharmacologic therapy for PAD
1. Anti-platelet drugs- ASA, Plavix
2. Direct vasodilation- Cilostazol (Pletal)
Surgical intervention for PAD?
2. Endovascular- Angioplasty/stenting
3. Thromboendarterectomy- removal of plaque
What is the mortality rate in a pt with PAD for MI and stroke?
Where do most acute arterial occlusions originate from?
-Arterial thrombus from a-fib
-Left ventricular thrombus after MI
-Debris from prosthetic valves/infected valves
What are the 6 P's of acute arterial occlusion?
6. Poikilothermia- cool to palpation
Treatment of acute arterial occlusion-Emergent!
1. IV Heparin bolus, followed by infusion
2. Thrombolytic therapy
3. Surgery- revascularization
Superficial venous thrombophlebitis= superficial phlebitis
What is the etiology of phlebitis?
-Great Saphenous vein
2. Trauma to vein
-IV therapy, PICC line
Physical exam finding of SF thrombophlebitis
**Palpable, nodular cord
Treatment of SF thrombophlebitis
Elevation, warm compress, NSAIDS
When would you prescribe Abs for SF thrombophlebitis
1. High fever
2. Purulent discharge
What is venous insufficiency due to?
Incompetent valves- can't pump low oxygen blood back to the heart
Sx's of venous insufficiency
2. LE swelling-pitting edema**
3. Eczema phenomenon**
What are risk factors for venous insufficiency
1. Standing/sitting for prolonged period of time**
4. Hx of DVT
Define hemosiderin deposits seen in venous insufficiency
What are characteristic of ulcers in venous insufficiency (venous stasis ulcers)?
-Inside the ankle
What is one of the main treatment goals in venous insufficiency
-->ulcers won't heal until edema is controlled
Dilated, elongated, tortuous, subcutaneous veins describes what?
Varicose Veins Epidemiology
1. Increasing incidence with age
2. Increased in pregnancy due to increased blood volume
Treatment options for varicose veins
1. Associated stasis dermatitis= topical corticosteroids
2. Chemical ablation(sclerotherapy)
3. Surgery- phlebectomy
What is Virchow's triad and what condition is it associated with?
1. Venous stasis
2. Vessel wall injury
3. Coagulation abnormality
Clinical presentation of DVT
1. >1-2 cm circumferential difference in legs**
2. Swelling, pain and discoloration of LE
3. Palpable cord, increased warmth
4. +Homan's sign
Anticoagulation- 3, 6, or 12 mos.
=Low molecular-weight Heparin- Lovenox
Etiology of SVC obstruction (complete or partial)
From neoplastic (tumor) or inflammatory conditions in mediastinum
Clinical presentation of SVC obstruction
1. Acute onset of sx's
2. Swelling of neck, fact and UE's**
What life threatening condition can SVC obstruction lead to?
cerebral and laryngeal edema