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Venous/arterial Disease Flashcards

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1
Q

Describe the clinical features of intermittent claudication/peripheral arterial disease?

A

Variable period of exercise –> ischaemic pain in limb

Relieved by rest

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2
Q

How would you clinically assess someone with suspected intermittent claudication?

A
  • history of symptoms and risk factors
  • examine legs/feet for signs of ischaemia
  • feel for femoral, popliteal and foot pulses
  • measure ABPI
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3
Q

How do you measure/calculate ABPI?

A

Measure BPs manually, using doppler probe, in both arms + ankle (using posterior tibial, dorsals pedis and peroneal arteries if possible)

ABPI = highest ankle pressure / highest arm pressure

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4
Q

What is a normal ABPI?

A

0.9 - 2.1

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5
Q

What ABPI value would indicate claudication?

A

0.4 - 0.85

severe = 0 - 0.4

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6
Q

Which investigations should be done if considering revascularisation for lower limb ischaemia?

A

Duplex USS

MR angiography

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7
Q

What are the first steps in management of intermittent claudication?

A

STOP SMOKING
Lifestyle advice
Supervised exercise program –> exercise to maximal pain

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8
Q

What is the next step in management of intermittent claudication if lifestyle measures don’t work?

A

Angioplasty + stent

Surgery –> use of prosthesis/vein to bypass area of occlusion

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9
Q

What are the clinical features of critical limb ischaemia?

A

Pain in toe/foot AT REST due to ischaemia (nerve ending pain)
Worse at night, helped by getting up and walking about

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10
Q

What might you find on examination in critical limb ischaemia?

A 
Cool to touch
Absent pulses
Colour change
Hairless
Thick nails
Shiny skin
Venous guttering
Ulcers
Gangrene
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11
Q

What are the management options for critical limb ischaemia?

A 
Pain control - paracetamol + opioid + antiemetic
Imaging if considering revascularisation
- duplex USS, MR angiography
Angioplasty or bypass surgery
Amputation
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12
Q

What are varicose veins?

A

Dilated, tortuous, superficial veins

–> due to abnormal transmission of deep vein pressure

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13
Q

Which veins are usually affected in varicose veins?

A

Long and short saphenous veins

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14
Q

What are primary varicose veins?

A

Exist with normal deep vein pressures

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15
Q

What are secondary varicose veins?

A

Due to raised deep vein pressures e.g. post DVT

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16
Q

How does a DVT lead to the development of varicose veins?

A

Increases the deep vein pressure due to:

  • deep vein obstruction
  • deep valve incompetence
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17
Q

What are the risk factors for varicose veins?

Study These Flashcards
A

Age
Pregnancy
Obesity

18
Q

What are the symptoms of varicose veins?

Study These Flashcards
A

Variable, often asymptomatic

  • achy, heavy, legs
  • burning, throbbing, muscle cramping
  • swelling
  • itching
  • skin discolouration
19
Q

What are some complications of varicose veins?

Study These Flashcards
A
  • bleeding
  • thrombophlebitis
  • discolouration: haemosiderin deposits due to blood breakdown
  • lipodermatosclerosis
  • ulceration
20
Q

Which investigation should be done for varicose veins?

21
Q

What in the initial, non interventional management of varicose veins?

Study These Flashcards
A

Information

Graduated compression stockings

22
Q

When are graduated compression stockings contraindicated?

23
Q

What are the interventional management options for varicose veins?

Study These Flashcards
A

Endovenous:

  • foam sclerotherapy
  • ablation (mechanical, laser or radio frequency)

Surgical

24
Q

What is the definition of an aneurysm?

Study These Flashcards
A

Part of artery with dilatation > 50% of its original diameter

25
How is screening for AAA done in the UK?
Abdominal USS | Offered to men when they turn 65
26
What are the possible different findings on AAA screening and how are they managed?
``` No aneurysm (< 3cm) --> no further screening ``` ``` Small AAA (3-4.4cm) --> repeat scan every year ``` ``` Medium AAA (4.5-5.4cm) --> repeat scan every 3 months ``` ``` Large AAA (>5.5cm) --> refer to surgeon within 2 weeks ```
27
Which type of imaging is used to give more information after USS?
CT (arterial phase)
28
What are the clinical features of an unruptured AAA?
Usually asymptomatic Abdominal/back pain Pulsatile mass on abdominal palpation
29
What are the clinical features of a ruptured AAA?
Intermittent or continuous abdominal pain --> radiates to back, iliac fossa or groin Collapse Expansile mass (expands and contracts) Shock
30
What are the two options for repair of an AAA?
Open repair | EVAR - endovascular aneurysm repair (stenting)
31
How is an open repair of AAA carried out?
Laparotomy Clamp aorta and iliacs Dacron Graft placed
32
What are the features of EVAR?
Stent inserted via femoral artery Avoids major surgery, faster recovery Failure rates higher than with surgery so more likely to require further interventions
33
What are the 3 parts of Virchow's triad which predispose to VTE?
Hypercoagulable state Endothelial injury Circulatory stasis
34
How do you investigate a suspected PE?
Pre-test probability --> Well's score - if moderate/high risk --> scan - if low risk --> check D-dimers - D-dimer high --> scan - D-dimer normal --> VTE excluded
35
Which scan is gold standard for PE?
CTPA
36
Which scan can be used if CTPA is contraindicated?
V/Q scan
37
How do you investigate a suspected DVT (without PE)?
Doppler USS leg
38
What is the treatment for a DVT?
``` Oral anticoagulation (DOAC - direct oral anticoagulation e.g. apixaban or rivaroxaban) ```
39
What is the treatment for PE (depending on risk)?
High risk --> thrombolysis (fibrinolysis), then DOAC | Intermediate/low risk --> DOAC
40
How long should a provoked VTE with a reversible factor be treated?
3-6 months
41
How long should a provoked VTE with an irreversible factor be treated?
Depends on factor | 3-6 months or lifelong
42
How long should an unprovoked VTE be treated?
Long term | unless risk of bleeding

Cardiology (14 decks)

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