Vascular Disorders Flashcards
(40 cards)
Signs of Arterial/venous disorders
Arterial: cold, white, dead, horrible pain
Venous: red, hot, swollen, pain,
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)
What are the three types of arteriosclerosis? Describe the process of each one.
- ) 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
Describe Arteriosclerosis
thickening and hardening of arterial walls, loss of elasticity of medium or large vessels.
Atherosclerosis
- complications
- causes
Complications:
- ischemic heart dz
- Stroke
- Aneurysm
- PVD
Causes:
- DM
- Smoking
- HTN
- Obesity
- Fx of early heart disease
- Hypercholesterolemia
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
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
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
What % of carotid artery stenosis requires surgical interventions?
80%
-some may refrain from recommending surgery in any asymptomatic pt
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
Describe the appearance of Strep pharyngitis
beefy, red tonsils w/ exudate, petichiae on roof of mouth, strawberry tongue.
- 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
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.
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
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.
Thoracic Aortic Aneurysm may be secondary to collagen vascular diseases, what are these?
- Marfans Syndrome
- Ehlers-Danlos Syndrome
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
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.
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
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
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
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)
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.
How do you reverse heparin?
-stop the heparin drip and administer protamine.
