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Flashcards in Peripheral Vascular Disease Deck (47)
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1

70% of AAA patients are ______, then present with sudden death.

asymptomatic

1

What is the greatest risk factor for PAD?

diabetes (4-fold)

2

What are the 4 major risk factors for AAA?

–Age –Gender –Smoking –Family history

2

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

2

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

3

AAA denoted by diameter of _____ or ____.

> 3.0 cm; 50% increase in size relative to proximal normal segment

4

What are the 4 major risk factors for AAA?

–Age

–Gender

–Smoking

–Family history

4

At what aneurism size does the 5 year rupture rate exceed 1 in 4?

5 cm diameter

5

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

6

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

7

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

8

How will you treat PAD with antithrombotic medication?

1. aspirin/clopidogrel

9

What is aortic dissection?

when the vessel loses its integrity and essentially unravels

10

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)

11

What are the mechanisms of thrombophilia?

1. increased thrombin production 2. enhanced platelet activation/ aggregation 3. endothelial damage 4. fibrinolytic inhibition

12

What are the signs of PAD?

1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor

13

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

15

_____% of AAA patients are asymptomatic, then present with sudden death.

70

16

Name 2 manifestations of venous thromboembolic disease.

1. PE 2. DVT

18

PAD has a _____ increased risk of CV death.

6-fold

19

What are the signs of PAD?

1.decreased/absent pulses 2. bruits 3. muscle atrophy 4. severe = pallor of feet w/ elevation, dependent rubor

20

30% of pts present with _____, then die.

abdominal discomfort or severe pain radiating to the back

21

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

22

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)

23

How are AAAs repaired?

endovascular infrarenal aortic repair

24

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

26

What are Ischemic rest pain/ischemic ulcers?

Pain in the distal foot or heel, worsened by leg elevation and improved by dependency; painful ulcers

27

Name 2 manifestations of venous thromboembolic disease.

1. PE 2. DVT

28

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)

29

What are the mechanisms of aortic dissection?

1. disruption of the intima (tear) 2. rupture of the vasa vasorum