Huber 2

Question 1

Vascular Diseases have frequent coexistence with _________.

Answer 1

Cardiac disease

Question 2

Describe Peripheral Artery Disease

Answer 2

• Affects up to 15% of patients > 60 years of age
• 50% of CAD also have PAD
• Atherosclerosis most common etiology

Question 3

Outcomes of Periperhal Artery Disease

Answer 3

• Many asymptomatic
• Claudication
  
  • Aching or cramping on exertion
  • Relieved by rest
  • 5 year mortality rate of 30%, amputation rate of 5%
• Acute arterial occlusion
• Thromboangiitis obliterans (Buerger’s disease)
  
  • Inflammation/blockage of small vessels in extremities

Question 4

Managmenet of Peripheral Artery Disease

Answer 4

• Tailored to severity of disease
• Control modifiable risk factors (smoking, weight control, diabetes)
• Exercise regimen
• Avoid vasoconstricting medications
• Pharmacotherapy
  
  • Pentoxifylline ( Increases vasodilation, decreases aggregation and blood viscosity)
• Resection/revascularization/stents

Question 5

Describe Aneurysmal Vascular Disease

Answer 5

• Affects up to 3% of patients > 50 years old
• Common occurrence with CAD
• Atherosclerosis most common etiology
• Marfan Syndrome
• Family history

Question 6

Outcomes of Aneurysmal Vascular Disease

Answer 6

• Most are asymptomatic
• Concern for catastrophic rupture
• Compression against surrounding tissues
• Embolization of atherosclerotic debris or clot

Question 7

Management of Aneurysmal Vascular Disease

Answer 7

• Monitor for change/symptoms
• Surgical correction
• Prosthetic grafts
• Stents

Question 8

Describe Aortic Dissection

Answer 8

Tear in the aortic intima leading to blood dissecting between the intima and media

Question 9

Pre-disposing factors and Management of Aortic Dissection

Answer 9

1. Hypertension, Marfan Syndrome
2. B-blockers, Surgical repair/Endovascular stent

Question 10

Describe Giant Cell Arteritis

Answer 10

Involvement of extracranial branches of carotid artery (temporal arteritis) in patient over 65

Question 11

Signs & Symptoms and Managment of Giant Cell Arteritis

Answer 11

• Headache, temporal artery tenderness, visual loss, jaw claudication, weight loss, fever, markedly elevated erythrocyte sedimentation rate.
• Managed with coticosteroids

Question 12

Describe the location, risk factors, risks, and management of Deep Vein Thrombosis

Answer 12

1. Most commonly affects veins of lower extremities (i.e. femoral, iliac, calf)
2. Risk factors: Venous stasis, hypercoagulability, vein injury (Virchow’s triad)
3. Risk for embolic complications such as pulmonary embolism (proximal > distal)
4. Managed with anticoagulation regimen

Question 13

Describe Pulmonary Embolism and it’s causes

Answer 13

• 250,000 hospitalization annually
• 3 month mortality rate up to 15%
• Usually result of venous thromboemboli
  
  • Deep veins of thigh
• Other causes
  
  • Marrow fat from orthopedic surgery
  • Air from central venous catheters
  • Amniotic fluid from labor
  • Sickled red blood cells
  • Blood borne parasites

Question 14

Predisposing factors, signs & symptoms, and management of Pulmonary Embolism

Answer 14

1. Prominent predisposing factor is Virchow’s triad
2. Dyspnea, pleuritic chest plain, tachypnea
3. Managed with anticoagulant therapy: Inferior vena cava filter if there is recurrent risk of lower limb DVTs

Question 15

Define Hypertension and it’s categories. What is the impact of the new hypertension guidelines?

Answer 15

Persistent elevated systemic and local blood pressure. 46% of adults have HTN.

Question 16

1. Increased BP is a function of _____.
2. Systolic BP _______ throughout life and is a more important cardiac risk factor ______ the age of 50.
3. Diastolic BP tends to ______ around age 50 and is a more important cardiac risk factor ______ the age of 50.

Answer 16

1. Aging
2. Increases; After
3. Stabilize and begin to drop; Before

Question 17

The relationship between any BP above normal and ________ is linear. An increase of 20 mmHg systolic and 10 mmHg diastolic ______ the risk of death from stroke, heart disease, or other vascular disease.

Answer 17

1. The morbidity and mortality of stroke or coronary heart disease
2. Doubles

Question 18

Prevalence of HTN by race and ethnicity

Answer 18

Non-Hispanic blacks > Non-Hispanic whites > Hispanics > Non-Hispanic Asians

Question 19

HTN is called “the silent killer” becuase it is usually _______. HTN can lead to eventual ________.

Answer 19

1. Asymptomatic
2. End organ damage

Question 20

Primary or essential HTN accounts for _____ of cases (etiology poorly understood). Secondary HTN accounts for _____.

Answer 20

• 95%
• 5%

Question 21

Causes of Secondary HTN

Answer 21

Question 22

What are the critical roles of the kidneys?

Answer 22

1. Renin-angiotensin system
2. Release of vascular relaxing substances (nitric oxide, prostaglandins): Action is to counterbalance the vasopressor effects of angiotensin
3. Influence of GFR
4. Natriuretic factors

Question 23

Function of Renin

Answer 23

• Proteolytic enzyme produced by renal juxtaglomerular cells in response to:
  
  • Low BP in afferent arterioles
  • Elevated catecholamines levels
  • Low sodium levels in distal convoluted renal tubules

Question 24

Describe the Renin-Angiotensin System

Answer 24

• Renin cleaves plasma angiotensinogen to angiotensin I, which in turn in converted to angiotensin II by angiotenin-converting enzyme (ACE) in the periphery. Angiotensin II raises blood pressure by:
  
  • Inducing vascular SMC contraction
  • Stimulating aldosterone secretion by the adrenal gland
  • Increasing tubular sodium resorption

Question 25

Describe the function of **Aldosterone**

Answer 25

* Increases blood pressure by its effect on volume * Increases sodium resorption (and thus water) in the distal convoluted and collecting tubules * Increases potassium excretion into the urine

Question 26

Describe the function of **Natriuretic Peptides**

Answer 26

* Myocardial natriuretic peptides are released from atrial and ventricular myocardium in response to volume expansion * Inhibit sodium resorption in the distal renal tubules, thus leading to sodium excretion and diuresis * Induce systemic vasodilation

Question 27

Describe **End-Organ Damage of Heart**

Answer 27

* About 50% of hypertensive patients die of coronary artery disease * Coronary insufficiency * Myocardial infarction * Congestive heart failure

Question 28

Describe **End-Organ Damage of the Brain**

Answer 28

About 30% of hypertensive patients die of stroke

Question 29

Describe **End-Organ Damage of the Vessels**

Answer 29

Hypertension accelerates atherogenesis and degenerative changes affecting vessel walls

Question 30

Describe **End-Organ Damage of the Kidney**

Answer 30

* HTN is the second leading cause of kidney failure * Arteriosclerotic changes lead to impaired glomerular function * Reduced ability to filter blood * Reduced ability to regulate the fluid, hormones, acids, and salts in the body * Damaged kidney may release more renin contributing to a downward spiral

Question 31

Describe **End-Organ Damage of the Eye**

Answer 31

* Arteriosclerotic damage * Retinopathy * Vision impairment/loss * Optic nerve neuropathy * Vision impairment/loss * Choroidopathy - fluid buildup under the retina * Distorted vision/scarring