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SPR2015_WEEK4 > peripheral vascular disease pathophy > Flashcards

peripheral vascular disease pathophy Flashcards

1
Q

peripheral effects of atherosclerosis

A

intermittent claudication

critical leg ischemia

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2
Q

where can you see PAD

A

1) aortoiliac
2) superficial fem
3) tibial

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3
Q

risk factors of PAD

A

1) diabetes (4x)
2) smoking
3) lipid
4) HTN

PAD HAS 6X INCR RISK OF CV DEATH

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4
Q

symptoms of PAD

intermittent claudication

A

NO SX AT REST, ONLY WITH EXERCISE

1) cramp
2) calf fatigue

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5
Q

why do you only have sx with exercise in intermittent claudication

A

because decr blood flow with exercise (insufficient supply and increased demand)

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6
Q

symptoms of PAD

ischemic rest pain/ischemic ulcers

A

SX AT REST AND EXERCISE
1) pain in distal foot/heel worse with leg elev, improved by depedency and dangle foot

2) distal ulcers on toes/heel

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7
Q

why do you have sx with exercise and rest in ischemic ulcers of PAD

A

decr blood flow with exercise and rest

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8
Q

signs of PAD

A

1) decr/absent pulses
2) bruit (abd/femo)
3) muscle atrophy
4) critical leg ischemia

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9
Q

what is critical leg ischemia

A

pallor of foot when raised

dependent rubor

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10
Q

what are important measures of arterial stenosis

A

1) radius of stenosis (Q = r^4)

2) length of stneosis

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11
Q

___ incr at higher flow velocities

A

hemodynamic severity

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12
Q

hemodynamic severity incr at ___

A

higher flow velocities

more turbulent flow
develop high resistant collaterals, high oxid stress

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13
Q

Factors that affect arterial hemodynamics

A

1) perfusion pressure
2) blood viscosity
3) arterial stenosis
4) flow velocity

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14
Q

a

A

a

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15
Q

what is the ankle-brachial index (ABI)

A

ABI = ankle SBP/arm SBP

if < 0.90 = PAD (occlusion/stenosis)
if 0.90 - 1.00 = atherosclerosis
normal = 1.10

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16
Q

why treat claudication?

A

1) prevent MI, stroke, vascular death
2) incr limb sx, exercise performance, and QOL
3) heal ulcers, decr limb loss

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17
Q

how to treat claudication?

A

1) surgery/angioplasty
2) exercise training incr muscle metab
3) drugs (cilostazol)

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18
Q

what is arterial aneurysm

A

expansion of ALL 3 ARTERIAL LAYERS

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19
Q

normal sizes of aorta in adult

A

3 cm at root
2.5 cm mid-descending thoracic
2 cm at infra renal

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20
Q

what is cut-off size for AAA

A

diameter > 3cm
or
50% incr in size relative to proximal normal

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21
Q

mechanism behind anerusym formation

A

1) weak aortic wall (decr elastin/collagen)
2) inflammation (B/T lymphocytes, mac, cytokine, autoantigen
3) proteolytic enzyme of collagen(incr MMP2/9)
4) stress (HTN, turbulent blood flow, mural thrombus)

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22
Q

WHAT DO YOU DO WITH CONTAINED RUPTURED AAA

A

GO TO CATH LAB

23
Q

a

A

a

24
Q

AAA risk factors

A

1) age
2) gender (male more)
3) smoking
4) FHx

25
Q

incr aortic diameter, incr risk of ___

A

AAA

26
Q

clinical present of AAA

A

70% asymptomatic before sudden death

30% abdominal discomfort or severe radiating pain to back

27
Q

how to dx AAA

A

1) XR
2) US
3) CT- can see prox/distal AAA,
4) MRI
5) arteriography (may miss)

28
Q

which imaging test can miss AAA

A

arteriography because VIEWS LUMEN NOT ARTERIAL WALL

29
Q

how to perform endovascular infrarenal aortic repair?

A

1) put in device into graft
2) assemble in body and put seals below the renal
3) internal iliac and hypogastric preserved b/c blood to pelvis

30
Q

a

A

a

31
Q

mechanism of aortic dissection

A

1) primary intimal tear

or

2) rupture of vasa vasorum (microcirculation of exterior wall)

32
Q

risk factor for aortic dissection

A

1) HTN (cocaine)
2) Marfan/ Ehlers-Danlos
3) bicuspid aortic valve
4) coarctation
5) pregnancy
6) aortitis
7) surgery/arterial cath
8) trauma

33
Q

clinical manifest of aortic dissection

A

SEVERE, TEARING PAIN

34
Q

with aortic dissection, disruption of arterial circulation can cause ___ (5)

A

1) stroke (carotid)
2) syncope (vertebral)
3) MI (coronaries)
4) intestinal ischemia (mesenteric)
5) renal failure (renal)

35
Q

how to medically treat aortic dissection

A

1) control change in pressure- beta blockers)
2) control BP - nitroprusside, ACE inhib, Ca2+ channel blocker
3) control pain (narocotics)

36
Q

what is assoc with chronic type A dissection

A

aortic regurg

37
Q

what is assoc with acute B dissection

A

rupture

organ ischemia

marfan’s

38
Q

predisposing patients of venous thromboembolic disease without prophylaxis

A

1) hip surgery
2) paralytic stroke
3) MI

39
Q

typical story of VTE

A

1) female student fly to Europe
2) 24 hr later, tender swollen right calf worse with standing
3) treated with LMWH hep and 6 month of warfarin
4) 2 year later, chronically swollen right calf

40
Q

2 types of acute venous thromboembolism

A

1) DVT

2) PE

41
Q

stages of chronic VTE (4)

A

1) swelling
2) visible collaterals
3) stasis dermatitis
4) ulceration

42
Q

mechanism of thrombophilia

A 
1) incr thrombin
or
2) incr platelet activ/aggreg
or
3) fibrinolytic inhibition
43
Q

risk factors for severe thrombophilia

A

homozygous protein C deficiency

RARE

44
Q

risk factors for mild thrombophilia

A

heterozygous factor V leiden

COMMON

45
Q

risk factor for acquired thrombophilia

A

infection
inflammatory
estrogens

COMMON

46
Q

how to treat thrombophilai parenterally?

A

1) heparin/LMWH
2) fondaparinaux
3) dabigatran, argatroban (thrombin inhib)

47
Q

how to treat thrombophilia orally

A

1) warfarin
2) dabigatrain
3) rivagoxaban/apixaban (factor Xa inhib)

48
Q

compare indirect vs. direct factor Xa inhib

administration

A

indirect = parenteral

direct = oral

49
Q

compare indirect vs. direct factor Xa inhib

cofactor?

A

indirect = yes, requires AT

direct = no cofactor

50
Q

compare indirect vs. direct factor Xa inhib

PF4?

A

indirect = bind PF4

direct = no bind PF4, no risk fo HIT

51
Q

compare indirect vs. direct factor Xa inhib

what does it inhib

A

indirect = free factor Xa inhib only

dirct = free factor Xa and factor Xa in prothrombinase (BETTER)

52
Q

RISK FACTORS FOR VTE?

A

1) hypercoag state
2) venous trauma
3) stasis

53
Q

VTE puts you at risk for ___

A

post phlebitic syndrome

54
Q

what does he have?

68 y/o male
H/o revasc for angina in 2009
2011 –> left calf cramp with walking relieved with rest

smoker, LDL high, diabetes

right carotid bruit
absent femoral/pedal pulses left leg

A

limb claudication

SPR2015_WEEK4 (14 decks)

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