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Flashcards in Vascular Disorders Deck (40)
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1

Signs of Arterial/venous disorders

Arterial: cold, white, dead, horrible pain

Venous: red, hot, swollen, pain,

2

What are some factors contributing to blood flow disturbances?

-atherosclerosis and vasculitis
-acute vessel obstruction d/t thrombus, embolus, or vasospams (Raynauds)
-abnormal vessel dilation (arterial aneurysms or varicose veins)
-Compression of blood vessels by extravascular forces (Tumors or edema)

3

What are the three types of arteriosclerosis? Describe the process of each one.

1.) Atherosclerosis: plaque build up made up of fat, cholesterol, or calcium

-moenckeberg medial calcific sclerosis; calcium deposits in the muscular middle layer

-arteriosclerosis: vessel wall thickening and luminal narrowing in the small arteries and arterioles

4

Describe Arteriosclerosis

thickening and hardening of arterial walls, loss of elasticity of medium or large vessels.

5

Atherosclerosis
-complications
-causes

Complications:
-ischemic heart dz
-Stroke
-Aneurysm
-PVD

Causes:
-DM
-Smoking
-HTN
-Obesity
-Fx of early heart disease
-Hypercholesterolemia

6

Clinical Presentation of Atherosclerosis:
-cardiac
-peripheral arteries
-Kidneys
-Genitals
-Neurologic

-Cardiac: angina

Arteries in Arms/Legs
-intermittent claudication

Kidneys:
-high BP or kidney failure

Genitals: difficulties w/ sex or ED in men.

Neurologics:
-sudden numbness/weakness in arms/legs
-difficulty w/ speech
-drooping face muscles
-TIA

7

What is Carotid Artery Dz?
What is an initial presentation of CAD and how does this present?

-a vascular dx that can block the carotid arteries to the brain and cause paralyzing strokes.

-TIA is an initial presentation of CAD.
--can present as transient hemispheric or monocular blindness(amaurosis fugax), aphasia, slurred speech, and mental confusion.
--usually resolves in 24hrs

8

How do we medically evaluate the carotids?

-physical exam
-Duplex ultrasound (see how blood moves through arteries and veins) * NEXT INITIAL BEST STEP. :)
-MRA
-CTA
-Angiography * Gold standard

9

What % of carotid artery stenosis requires surgical interventions?

80%

-some may refrain from recommending surgery in any asymptomatic pt

10

Rheumatic Fever
-what is this?
-what causes this?
-who gets this?

-inflammatory dz follow strep pyogenes infection (i.e. strep pharyngitis)

Cause:
-antibody -cross-reactivity
-develops 2-4weeks post Group A strep infection

Who gets this:
-children 6-15 yrs

11

Describe the appearance of Strep pharyngitis

beefy, red tonsils w/ exudate, petichiae on roof of mouth, strawberry tongue.

12

-Major manifestations of Rheumatic Fever
-Minor Criteria for Rheumatic Fever

-migratory arthritis
-Carditis, valvulitis (myocarditis which can manifest as CHF w/ SOB)
-Eythema marginatum
-Sydenhams Chorea (rapid movements w/o purpose of the face and arms)

Minor Criteria:
-fever 100.8-102.0
-Athralgia
-elevated ESR or CRP
-leukocytosis

13

What is the "Modified Jones Criteria" for dx of Rheumati Fever?

-Two major criteria
-One major criteria plus two minor criteria
*exception: chorea or indolent carditis.. if you have either of these you automatically have Rheumatic Fever.

14

Tx Rheumatic Fever

-Aspirin (be careful in children; Reyes Syndrome)
-NSAIDS (ibuprofen or steroids)
-Abx (PCN or Clarithromycin Zpack)
-Heart failure:
--ACEi
--Diuretic
--Beta blocker
-corticosteroids

15

What is an aortic aneurysm/dissection?
-where is aneurysm most common?
-what is the most common cause of aneurysm
-most common cause of dissection

Aneurysm= bulges in weak areas of the vessel wall.

dissection= inner lining of the aortic wall tears.

-aneurysm is commonly found in the abdominal aorta.

-most common cause of aneurysm is atherosclerosis

-most common cause of dissection is high blood pressure.

16

Thoracic Aortic Aneurysm may be secondary to collagen vascular diseases, what are these?

-Marfans Syndrome
-Ehlers-Danlos Syndrome

17

Describe the Crawford Classification of Thoracoabdominal/ Abdominal aortic aneurysms and the location of each.

I. Left subclavian to renal arteries
II. Left subclavian to iliac bifurcation
III. Midthoracic to infrarenal
IV. distal thoracic to infrarenal

18

Thoracic Aortic Aneurysm Clinical Presentation/Tx

Clinical presentation:
-most are asymptomatic
-sub sternal, back or abd pain
-dyspnea, stridor, brassy cough (trachea pressure)
-Dysphagia (pressure on esophagus)
-Hoarseness (pressure on recurrent laryngeal nerve)
-Neck and arm edema from SVC compression

Tx:
-start beta blockers and call surgeon.

19

Where do 90% of AAA originate?
-when do we surgically intervene on abdominal aortic aneurysms?

-below the renal arteries

-Surgical intervention begins when aneurysm is greater than 5cm

20

Screening for AAA
-clinical presentation

Screening:
-abd ultrasonography is highly sensitive and specific for AAA
-1x screening in men 65-75 who have never smokes.
-1x screening in men 65-75 who never smoked but who have a 1st degree relative who required repair of an AA or died of ruptured AAA.

Clinical presentation:
-aysmptomatic
--picked up on routine physical exam w/ prominent aortic pulsation
-symptomatic:
--midabdominal or lower back pain with prominent aortic pulsations

21

Arterial Embolism/Thrombosis
-what is an embolism
-what is thrombosis
-what are the types of embolisms
-common sites of arterial embolization

Embolism= sudden interruption of blood flow to an organ or body part d/t embolus adhering to the wall of an artery blocking the flow of blood.

Thrombosis= formation of a blood clot inside a blood vessle, obstructing the flow of blood.

Types of Embolisms:
-thromboembolism
-cholesterol
-fat
-air
-septic (bacteria containing pus)
-tissue
-foreign body

Sites:
-Bifurcations: femoral**, aortic, iliac
-Popliteal
-upper extremities
-cerebral
-Mesenteric

22

What are the 6 P's of acute limb ischemia?

-pain
-pallor
-pulselessness
-paresthesia (burning, prickly, itching, tingling)
-paraparesis (paralysis
-poikilothermia (variation of body temp regionally)

23

Arterial Embolic Dz Management

-pt w/ threatened extremity should not delay revascularization & arteriography

-Rapid systemic anticoagulation ( heparin bolus/cont. drip)

-Surgery; embolectomy

-Thrombolytics in appropriately selected patients.

24

How do you reverse heparin?

-stop the heparin drip and administer protamine.

25

Disorders of Venous Circulation : definition of each
-varicose veins
-thrombophlebitis
-veno-occlusive disorders

Varicose veins: enlarged tortuous veins usually on let

Thrombophlebitis: vein inflammation, thrombi usually form at venous cusps of deep veins where altered or stataic blood flow causes clot formation, may also be superficial(MC is saphenous vein)

Veno-occlusive disorders...idk she didnt tell me.

26

Thrombophlebitis:
formation of clot depends on the presence of at least one of Virchows Triad...name these!

-venous stasis
-injury to vessel wall
-hypercoagulable state (Factor V liden deficiency, maylar rash, lupus anticoagulant)

27

Venous Stasis -Presentation
-Tx

-progressive edema of the leg begins at the ankle and calf
-dull aching discomfort
-worse at the end of day and improves with elevation
-varicositis
-skin changes:
--stasis dermatitis
--brownish pigmentation (hemochromatosis)
-Brawny induration
-skin is thin, shiny, atrophic and cyanotic

Tx:
- limit standing
-intermittent elevation of legs during day
-daily use of thigh-high compression stockings
-regular exercise
-cold compress
-abx used for septic thrombophlebitis

28

Endothelial injury:
-damage from what?

-sheer stress
-HTN
-bacteria
-chronic inflammation
-biomaterials of implants/devices

29

Hypercoagulability
-causes

-severe trauma/burn
-disseminated cancer
-late pregnancy
-race
-advanced age*
-cigarette smoking*
-hormonal contraceptives*
-obesity

30

Beurgers Dz
-aka
-what is this?
-associated with what habit?
-pathophysiology

aka: Thromboangitis Obliterans

what is this:
-recurring progressive inflammation and thrombosis of small and medium arteries and veins of the hands and feet.

-associated with the use of tobacco.


pathophys:
-mechanism still largely unknown
-inflammatory rxn of the vessel wall which leads to vasculitis and ischemic changes in distal parts of limbs