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CLIN MED II- CARDIOLOGY > VASCULAR DISEASE > Flashcards

VASCULAR DISEASE Flashcards

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1
Q

arterial vasc ds- atherosclerotic peripheral vascular ds

can affect what arteries?

A

aorta and iliac
femoral and popliteal
tibial and pedal

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2
Q

atherosclerotic PVD
- aorta and iliac

  • present in what kind of pts
  • inc risk in?
  • distal lesions in what pts?
A
  • 30% of 70 yo w out RF, 3-% of 50 yo WITH RF
    inc risk- DM, tobacco use, >70 yo

distal aorta/proximal common iliac lesions- white male smoker 50-60 yo

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3
Q

atherosclerotic PVD

aorta and iliac- SS

A

2/3 ASYMP (not classic)

MC- intermittent claudication (pain from insuff BF when there is inc demand from exercise), inc cramp in calf
- butt/thigh cramp
- erectile dysnfunc

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4
Q

atherosclerotic PVD

aorta and iliac- how are symp relieved

A

relieved with rest, reproducible w same exertion

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5
Q

atherosclerotic PVD

aorta and iliac- signs

A
  • absent or weak femoral and distale pulses
  • bruit over aorta, iliac, or femoral
  • leriches syndrome (triad of impotence, claudication, and dec femoral pulse)
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6
Q

atherosclerotic PVD

aorta and iliac- work up

A

ABI reduced <0.9 is PAD
ABI <0.4 is critical limb ischemia

ABI measured using dorsalis pedis and posterior tibial aa.

CT angio and MRI to identify lesion

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7
Q

atherosclerotic PVD

aortia and iliac- tx

conservative, meds, and surgical options

A

conservative- control RFs (smoking)

meds-
- control HLD, HTN
- high dose statins DAILY, plavix DAILY
- control pain- pletal
- dec morbidity- ASA

surgical
- angio or stenting at 30-50% closure
- bypass at 90% closure

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8
Q

atherosclerotic PVD

femoral and popliteal
- when does it occur and where

A

occurs decade after aortoiliac
- at site of adductor hiatus

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9
Q

atherosclerotic PVD

femoral and popliteal- signs and symptoms

A

symptoms
- calf cramp
- red foot, blanching w elevation
- hairless, shiny, atrophy muscle
- some gangrene or ulcer

signs
- dec pedal and popliteal pulses

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10
Q

atherosclerotic PVD

femoral and popliteal- work up

A

reduced ABI <0.9
duplex doppler
CTA
MRI

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11
Q

atherosclerotic PVD

femoral and popliteal- tx
conservative, meds, and surgical

A

conservative- reduce RFs, exercise
meds-
- high dose statins and plavix DAILY, ASA, pletal

surgical-
- fem-popliteal bypass
- angioplasty or stent
- thromboendarectomy if angio or stent fails

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12
Q

atherosclerotic PVD

tibial and pedal- clin features

A

severe pain in foot, relieved by dependency (hang foot off bed/remove gravity)
- pain or numbness in foot w walking
- primarily diabetics

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13
Q

atherosclerotic PVD

tibial and pedal- symptoms and signs

A

may NOT have SS of claudication
- pain and ulcerations
- dependency, dangle foot off bed for relief
- dorsal foot pain wakes pt up
- critical limb ischemia common

signs
- absent pedal pulses
- pallor on elevation
- cool, hairless, atrophied skin

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14
Q

atherosclerotic PVD

tibial and pedal- work up

A
  • ABI low (critical lim <0.4)
  • DSA (digital subtraction angio)
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15
Q

atherosclerotic PVD

tibial and pedal- tx

A
  • good foot care
  • non healing ulcerations after 2-3 weeks need revasc to avoid amputation
  • bypass to distal tibial
  • amputation
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16
Q

acute arterial occlusion of a limb
- initial sign

A

SUDDEN pain in extremity with absent extremity pulse
- cardiac emboli (afib), thrombosis, hypercoaguable

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17
Q

acute arterial occlusion of a limb
- signs and symptoms

A

6 Ps- pain (localized), pallor, pokilothermia, pulselessness, paresthesia, paralysis

livedo reticularis- lacy pattern on skin/mottled vascular pattern

initial- pain, pallor pokilo, pulseless
later/final- paresthesia, and then paralysis

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18
Q

acute arterial occlusion of a limb
- work up

A
  • doppler (little to no flow)
  • angiograph
  • dont delay w MRI or CT
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19
Q

acute arterial occlusion of a limb
-tx

A

IMMEDIATE REVASC
- within 3 hrs, by 6hrs its irreversible
- IV heparin
- TPA (tissue plasminogen activator)- clot buster
- thromboembolectomy
- risks of amputation

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20
Q

occlusive cerebrovascular ds
clin features

A

definition- blocked or narrowed vessels to brain

SUDDEN onset weakness and numbness of extremity
or
face aphasia, dysarthria, or unilateral blindness (amaurosis fugax)

  • can manifest as emboli, TIA (reversible if collateral flow establishes), can turn into stroke

aphasia and dysarthria- both cause trouble speaking

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21
Q

occlusive cerebrovascular ds- risk of turning into stroke from what artery?

Study These Flashcards
A

1/4 ischemic strokes from arterial source, 90% from proximal internal carotid artery

22
Q

occlusive cerebrovascular ds
- signs and symptoms

Study These Flashcards
A
  • TIA last seconds to minutes
  • stroke >24 hrs
  • emboli to retinal artery (amaurosis fugax)
  • carotid artery bruit, loudest mid neck (hold breath)
23
Q

occlusive cerebrovascular ds
- work up

Study These Flashcards
A
  • duplex US for carotid stenosis
  • mra
  • cta
23
Q

occlusive cerebrovascular ds- tx

Study These Flashcards
A
  • CVA management
  • > 60% carotid stenosis, intervene (carotid endarectomy, angioplasty/stenting)
  • 25% recurrent CVA if no intervention
  • 30-50% stenosis, monitor and RF mods
24
visceral artery insufficiency - what happens - causes
acute emboli or thrombus to major mesenteric vessel - low flow state from CHF or hypotension - 2 out of 3 (SMA, IMA, celiac) blocked to show symptoms (collateral circ usually will take over with 1 blockage)
25
visceral artery insufficiency - clinical features
- chronic-->Gi is at rest, adequate blood flow - ischemic---> after eating, GI demands blood flow and blockage causes ischemia (not adequate) - severe POST PRANDIAL abd pain - wt loss w fear of eating - ischemic colitis - IMA intestinal mucosa slough off
26
visceral artery insufficiency- signs and symptoms acute, chronic, IC
acute- severe, steady epigastric/periumbilical pain - high WBC, lactic acidosis, hypoten, abd distenstion chronic- other atherosclerosis, epi/peri pain lasrt 1-3 hrs after eating, pt limits eating ischemic colitis- LLQ pain tender, abd cramp, mild bloody diarrhea
27
visceral artery insufficiency - work up
- CT w contrast - US (proximal lesion) - colonoscopy (for IC)
28
visceral artery insufficiency- tx
acute- surgical exploration chronic- angio and stenting IC- support until collateral circ established - surgical resection for perforation
29
thromboangitis obliterans/buerger ds what is it clin features
inflamm and thrombotic proess of DISTAL most arteries and sometimes veins - SMOKERS. - male - SEVERE ischemia feet, fingers, hands - pt usually <40 yo - pain in distal ext, tissue loss, amputation unless STOP SMOKING
30
thromboangitis obliterans/buerger ds important sign
gangrene on finger tips !!!!!!!!!! pain in distal ext, tissue loss, amputation unless smoking cessation
31
thromboangitis obliterans/buerger ds - work up - tx
MRA or invasive angiography STOP SMOKING if not working, poor prognosis (amputation)
32
giant cell arteritis
sys inflamm of medium/large vessels - temporal artery - >50 yo - polymyalgia rheumatica assoc
33
giant cell arteritis - not tx what happens - associated with? - signs and symptoms
can cause blindness if not tx can be assoc w varicella/zoster ss: unilat temporal headache, jaw claudication, diplopia, elevated ESR/CRP
34
giant cell arteritis- work up and tx
ESR, CRP elevated temp artery bx temp US (thickening) tx- high dose prednisone, low dose aspirin
35
aortic aneurysm - what is it - mc in - symp?
weakness and dilation of vessels wall, genetic defect, syph, GCA, trauma, marfans, ehlers danlos, or atheroscle damage to intima MEN, SMOKERS - asymp till rupture - if abd aorta is >3 cm---> AAA. - risk of rupture >5 cm
36
common site of AAA? what arteries do they usually include?
90% are below the renal arteries usually involve aortic bifurcation and common iliac arteries
37
AAA- SS
incidental finding US or CT - rupture--> severe pain, palpable abdominal mass, hypotension, LETHAL
38
AAA- work up screening, reg work up, suveillance
work up - screen men 65-75 smokers, 1st degree relative screen women - abd US, CT scan for diameter and location - surveillance: annual US, 6 month US approaching 5cm, CTA w contrast for repair once reaches 5 cm
39
AAA- tx
>5.5 cm or rapid expansion (0.5 cm in 6 month)---> INTERVENE - open surgical repair, graft sutured to nondilated graft above and below vessel - endovasc repair, stent graft lines aorta to exclude AAA - mi complication
40
thoracic aortic aneurysm - rf, SS, testing, DX, criteria for tx
ASYMP - RF: HTN, 50-60 yo, collagen d/o - SS: back/neck pain, STABBING, dysphagia/hoarseness, JVD - rupture is fatal - CXR--wide mediastinum -Dx--CT - >6 cm for REPAIR (surgical or endovasc)
41
peripheral artery aneurysms - ss, clin feature, defining feature, dx, tx
- asymp till critically symp - emboli or thrombosis - popliteal, usually BIL, most have AAA too PULSATILE MASS dx- US, MRA, CTA, screen for AAA tx- surgical repair w bypass
42
aortic dissection - SS, complications, gold standard, dx, tx
intimal tear, blood goes into media of vessel SS- searing CP back, abd, or neck, HTN complications- syncope, hemiplegia, or renal insuff may develop MRA is GOLD STANDRARD dx w/ CT abd and chest CXR shows widened mediastinum
43
varicose veins
superficial veins distended due to venous reflux - prolonged sit/stand, pregnant, obese - GREAT SAPHENOUS VEIN - use compression stocking, leg elevation, exercise for relief - tx- surgical stripping, thermal ablation, sclerotherapy
44
superficial venous thrombophlebitis
partial or comp occlusion of a vein AND inflamm changes - induration, red, tender alone superifial vein (or site of recent IV line) - S.AUREUS - can be caused by hypercopagulopathy in ABD CANCER tx- Heat and NSAIDS, abx for infx
45
chronic venous insuffciency- clin features
loss of wall tension in veins---venous statis---assoc w DVT/leg injury/or varicose veins hemosiderian deposits--DARK pigment (breakdown fo HgB into intestitial space) PREVENTION IS KEY
46
chronic venous insuff- SS and TX
SS- pitting edema at ANKLE, itching/dullpain with standing, ulcerations above ankle, shiny/thin/atrophied dark pigment skin tx- elevate legs, avoid sit/stand, compression stockings, surgical ligation or stripping
47
superior venal caval obstruction - ss, dx, tx
sweling neck, face, upper ext dilated veins upper chest and neck - PARTIAL or COMP obstruction of SVC (secondary to neoplastidc or inflamm process in mediastinum) BEND over or LAY DOWN---exaggerates symptoms dx- CT tx underlying cause, stenting
48
DVT - clin features, ss, rf, dx, prevention, tx - if PE suspected what tests
lower ext and pelvis - virchows triad - inc w major surgeries, bed rest, trauma, cancer rf- age, obesity, air travel, IBD, lupus no SS or swelling/warmth dx- duplex US, D dimer elevated (not dx) prevention- compression devices on bedridden pt, heparin, anticoag ## Footnote if PE suspected--- CTA and VQ
49
acute mesenteric vein occlusion
post prandial pain AND evidence of hypercoaguable state - thrombolysis tx - aggressive long term anticoag ## Footnote ex) GI cancer pt most likely to develop

CLIN MED II- CARDIOLOGY (16 decks)

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