70% of AAA patients are ______, then present with sudden death.
asymptomatic
What is the greatest risk factor for PAD?
diabetes (4-fold)
What are the 4 major risk factors for AAA?
–Age –Gender –Smoking –Family history
Thrombophilia caused by any alteration in coagulation balance that:
• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition
How do aortic dissection pts typically present?
severe, tearing pain --> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved
AAA denoted by diameter of _____ or ____.
> 3.0 cm; 50% increase in size relative to proximal normal segment
What are the 4 major risk factors for AAA?
–Age
–Gender
–Smoking
–Family history
At what aneurism size does the 5 year rupture rate exceed 1 in 4?
5 cm diameter
What are the signs of PAD?
• Decreased or absent pulses
• Bruits (abdominal, femoral)
• Muscle atrophy
• In severe PAD (critical leg ischemia)
– Pallor of feet with elevation
– Dependent rubor
What are the risk factors for aortic dissection?
1. HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
Thrombophilia caused by any alteration in coagulation balance that:
• increases thrombin production • enhances platelet activation/aggregation • mediates endothelial activation/damage • and/or mediates fibrinolytic inhibition
How will you treat PAD with antithrombotic medication?
1. aspirin/clopidogrel
What is aortic dissection?
when the vessel loses its integrity and essentially unravels
How are aortic dissections treated with meds?
1. control heart rate (beta blockers) 2. control BP (nitro, ACEI, Ca++ channel blockers) 3. control pain (narcs)
What are the mechanisms of thrombophilia?
1. increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition
What are the signs of PAD?
1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor
How do aortic dissection pts typically present?
severe, tearing pain --> stroke, syncope, MI, intestinal ischemia, or renal failure, depending on the location and arteries involved
_____% of AAA patients are asymptomatic, then present with sudden death.
70
Name 2 manifestations of venous thromboembolic disease.
1. PE 2. DVT
PAD has a _____ increased risk of CV death.
6-fold
What are the signs of PAD?
1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor
30% of pts present with _____, then die.
abdominal discomfort or severe pain radiating to the back
DX? • 68 yr old male in for routine exam • H/O revascularization for angina in 2009 • In 2011 developed symptoms of left calf cramping on walking 1 block, relieved by rest • Risk factors: 50 pack years smoking, LDL 135, and diabetes • Physical exam: – Right carotid: artery bruit – Left leg: absent femoral and pedal pulses – Right leg: normal femoral and pedal pulses
L leg claudication, probably at the level of the iliac artery
What are the risk factors for thrombophilia?
1. severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
How are AAAs repaired?
endovascular infrarenal aortic repair
What are the risk factors for aortic dissection?
1. HTN 2. drugs (cocaine) 3. CT disorders (Marfans, Ehlers-Danlos) 4. bicuspid aortic valve 5. coarctation 6. pregnancy 7. trauma
What are Ischemic rest pain/ischemic ulcers?
Pain in the distal foot or heel, worsened by leg elevation and improved by dependency; painful ulcers
Name 2 manifestations of venous thromboembolic disease.
1. PE 2. DVT
What are the risk factors for thrombophilia?
1. severe inherited (homozygous protein C deficiency) 2. mild inherited (heterozygous factor V Leiden) 3. acquired (infection, inflammation, estrogens)
What are the mechanisms of aortic dissection?
1. disruption of the intima (tear) 2. rupture of the vasa vasorum
