Vascular Disease Flashcards Preview

AP: Cumulative > Vascular Disease > Flashcards

Flashcards in Vascular Disease Deck (55):
2

What are the physiological functions of blood vessels? (3)

Regulation of blood to tissues

Synthesis/secretion of vasoactive/antithrombic substances

Delivery of immune cells

 

3

What are the measurement of the aorta in cm?

~3cm from the origin

~5-6 cm long

4

What are the 3 branches off the arch of the aorta from left to right?

Brachiocephalic

Left common carotid

Left subclavian

5

What are the layers of the aorta?

Intima (innermost)--endothelial cells

Media--smooth muscle cells, elastic/collagen fibers 2:1

Adventitia--collagen (strength), vaso vasorum (vasculature that perfuses the outer layer) 

 

6

What factors constitute an AAA? (3)

50% increased localized diameter

>4 cm in thoracic aorta

>3 cm in abdominal aorta

7

Define a true aneurysm.

Involves all 3 vessel layers 

2 types: fusiform, saccular

8

Define a pseudoaneurysm.

Only involves the inner 2 layers: intima and media.

 

9

Pseudoaneurysms are more unstable.  True or false?

False affects the intima and media and is contained in the adventitia.

10

Label the types of aneurysms.

11

 ________ is the origin of 90% of aneurysm cases. 

 

Atherosclerosis

Note: Usually occurs in males > 50 y/o.

12

What are cofactors leading to the cause of aneurysms? (4)

Smoking

Hypertension

High cholesterol

Loss of elastin

13

Men are ___ times more likely to have an aneurysm than women.

8

14

Abdominal aneurysms are often asymptomatic.  True or false?

True

15

What are the clinical presentations of an aneurysm in the following areas:

Compression of esophagus/trachea
Recurrent laryngeal nerve
Dilation of aortic ring

Compression of esophagus: Wheezing, coughing, dyspnea, difficulty swallowing

RLN stretching: hoarseness

Aortic ring: Pt presents with aortic regurge

16

What are classic signs of an aortic aneurysm rupture?

Hypotension

Low back pain

Pulsative abdominal mass

Note: Only 1/2 pts present with these signs.

17

What is the gold standard for treating AAA?

What is the treatment for less severe ones?

surgical repair with prosthetic graft 

endovascular graft

18

When is surgical repair of a AAA considered? (Think of diameter.)

> 4.5 - 5 cm in diameter

19

What other co-existing conditions with pts with AAA have? (5)

Ischemic heart disease

HTN

COPD

Diabetes

Renal dysfunction

20

What kind of access do we need prior to surgery?

Large IV

Art line

Central line

21

What important factors do we need to consider intra-op?

Smooth induction to prevent cardiovascular swings.

Major blood loss may occur.

Hemodynamic changes that can occur during clamping/unclamping.

22

What hemodynamic changes occur during cross clamping?

Increased afterload--> increased BP

Decreased preload

Decreased perfusion distal to the clamp

Note: Depending on where the clamp is placed, renal perfusion can be compromised.

23

What hemodynamic changes occur during unclamping? (3)

Sudden decreased afterload --> decreased BP

**need vasoconstrictor to anticipate the change

Lactate washout 

 

24

What is an aortic dissection?

The splitting of the intima from the adventitia along the length of the vessel.

25

What are the 2 types of aortic dissection?

Type A 

Type B

26

What is a "Type A" aortic dissection? (3)

Involves the proximal, ascending aorta

Represents 2/3 of dissections

High risk of extruding into coronary and arch vessels

27

What is a "Type B" aortic dissection?

Distal dissection limited to the thoracic and abdominal aorta

29

What is the pathogenesis of aortic dissection? (4)

Chronic HTN

Aging

Connective tissue disorder like Marfan's

Trauma

30

What type of aortic dissection presents as:

sudden, severe pain with ripping/tearing in anterior chest

Type A

31

What type of aortic dissection presents as:

sudden severe pain between scapulae

Type B

32

What other catastrophic events can occur from a dissecting aorta? (4)

MI

Stroke

Renal failure

Loss of pulse in extremities

Note: All occur as a result of occlusion of the propagating hematoma.

33

What are complications of aortic dissection? 

Rupture 

Occlusion of aortic branch vessels

Distortion of the aortic annulus

34

What does the rupture of aortic dissection result in?

cardiac tamponade

hemomediastinum

hemothorax

35

What does occlusion of the aortic vessels result in? 

carotid stroke

coronary MI

 

36

How do we treat an aortic dissection intra-operatively?

 

Stop progression of the dissection by:

decreasing BP --> Beta Blockers

decreasing LV contraction --> Sodium Nitroprusside

37

Symptomatic pts with >____% blockage yield the greatest benefit from an endarterectomy.

50%

38

Pts who have already suffered a stroke will yield the most benefit to a carotid endarterectomy. True or false?

False, yields minimum benefit.

39

What do you consider during a carotid endarterectomy pre-op evaluation?

Neurological status

CAD

Renal disease

Chronic HTN

Effect of changes in head position

40

What is the anesthetic technique for carotid endarterectomies?

Regional: Cervical Plexus Block allows trial occlusion of carotid to evaluate neuro changes. Pt is awake.

GA: Infer neuro changes from EEG

41

What are the cons to performing a cervical plexus block for a carotid endarterectomy?

no cerebral protection

 

42

What are the benefits to GA for a carotid endarterectomy?

decreased CMRO2

ability to regulate PO2, PCO2

43

What are the drugs of choice for induction for a carotid endarterectomy? (2)

Thiopental

Propofol

Note: Because they lower CMRO2 and redistribute blood flow to potentially ischemic areas.

Etomidate for hemodynamically unstable pts.

Fentanyl/Alfentanyl

44

What are anesthetic considerations intraoperatively for carotid endarterectomies?

Control BP

Carotid cross-clamping/unclamping

PROMPT emergence to assess neuro function

45

What are post-operative concerns for carotid endarterectomies? (5)

HTN (carotid sinus activation) / Hyptension (baroreceptor reactivation)

MI/Infarction (MI is leading cause post-op complications)

Neurological complications

Airway obstruction

Nerve injury (hypoglossal, RLN, SLN)

46

In what time frame does a carotid endarterectomy incident occur?

8-12 hours post op

47

Peripheral disease may result from: (3)

atherosclerosis

thromoembolism (acute)

vasculitis

48

70% of pts > 75 y/o are affectedby peripheral atherosclerosis.  True or false?

true

49

What are the clinical presentations of peripheral atherosclerosis? (4

Claudication (cramping)

Ulceration

Skin necrosis

Decreased arterial pulses

50

How do we pharmacologically treat peripheral atherosclerosis? (4)

Anti-platelet therapy

Lipid-lowering therapy

DM meds

HTN meds

51

What are causes of acute arterial occlusions? (4)

Thrombi originating from:

heart
stenosed aorta
damaged endothelium
bypass grafts

52

What condition:

vasospasm of digital arteries with cold/stress
extreme vasoconstriction
tricolor phasic response- white/blue/red
Affects women 20-40 y/o

Raynaud's Syndrome

53

What medications alleviate symptoms of Raynauds? (2)

Calcium channel blockers

Alpha antagonists

54

Avoid EPI in local anesthetics when treating pts with Raynaud's.  True or false?

True

55

Where do DVTs normally occur and what is a considerable risk of a DVT?

Calf veins or more proximally

Pulmonary embolism

56

What are the clinical symptoms of a 2º DVT, or, pulmonary embolism? (4)

Acute dyspnea

Tachypnea

Chest pain

Non-productive cough

57

What are DVT risk factors? (5)

Morbid obesity

Stasis of blood flow

vascular damage

Hypercoagulable states

Advanced age