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34 Cards in this Set
- Front
- Back
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What is dependent rubor?
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- When pts hang their legs off exam get red foot b/c blood is pooling in the capillary beds, happens with PVD
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Why do you get claudication & rest pain with PVD?
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- Accumulation of anaerobic metabolites, lactic acid from anaerobic pathway
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How does low shear stress lead to atherogenesis? what is the difference with high shear stress?
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- Endothelial cells sensitive to shear stress → build-up of atherogenic material in vessel wall
- High shear stress causes post-stenotic dilation |
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What is the difference between claudication & rest pain?
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- Claudication comes on with exercise, resolves after, benign
- Rest pain worse in supine, demands prompt attention, may have tissue loss (ulcer, dry gangrene) |
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What are the 5 P’s of ischemia?
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- Pulselessness, pallor, pain, paralysis, paresthesia
- Demands immediate attention |
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What happens to the pressure & flow across stenosis?
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- Increased flow leads to greater energy loss → greater pressure drop
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What do you see on PE with PVD?
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- Decreased pulses, bruits, muscle atrophy, atrophic shiny skin, hair loss, nail atrophy,
ulceration/gangrene (toes or foot), dependent rubor |
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What is the ankle brachial index (ABI)? What is a normal value? What diagnoses severe vascular disease?
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- Dopples systolic occlusion pressure at ankle/systolic pressure of the arm
- Falsely elevated w/ calcified arteries (diabetics, dialysis) - Measures at rest & with exercise can diagnose claudication - Normal value: >0.9, severe disease <0.4 |
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Why can arterial plethysmography be better than ABI for pts with diabetes & dialysis? What do you look at?
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- b/c measures small increase in cuff pressure w/ systole & is not affected by vascular calcification
look at amplitude & shape of waveform to determine whether there is arterial occlusive disease |
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what is the gold standard for PVD?
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- Contrast angio
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What lifestyle changes can you recommend for patients with claudication?
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- Regular exercise program
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What is the best drug therapy for claudication?
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- Pletal (cilastozol = PDEi → vascular SM dilation
- Effective when combined with risk factor control |
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Can diabetes cause a microvascular occlusion in the periphery?
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- NO!!! – often can accelerate PVD, associated w/ retinopathy & neuropathy
- More involvement of distal tibial, less SFA & iliac |
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Why are diabetics prone to foot ulcers?
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- Sensory neuropathy confounds problem, impaired inflammatory response
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What is a false aneurysm?
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- Hematoma contained by adventitia or perivascular clot
- Could be due to a punctured hole in the artery during surgery |
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At what measurement do you have a AAA? Why is it at risk of rupturing?
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- >5-5.5cm
- Law of LaPlace = T = rP/w → as radius increases tension increases |
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What is an aortic dissection?
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- Spontaneous disruption of intima, “false channel” within wall of aorta
- Propagation of tear distally |
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What are risk factors for dissection?
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- Poorly controlled HTN, AS, collagen abnormalities (Marfans, Ehlers-Danlos)
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What is the difference b/w type A & B?
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- Type A: involve Ascending aorta
More common, more dangerous b/c may extend to involve carotids, coronary arteries, pericardial sac Treatment: Emergency surgery - Type B: descending aorta Treatment: can be treated medically, control BP in ICU |
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What is the subclavian steal?
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- Occlusion of proximal left subclavian artery, gets retrograde delayed flow from vertebrals, asymptomatic except w/ exercise, can develop CNS symptoms w/ arm exercises
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What are some symptoms of TIA of carotid origin?
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- Hemispheric event (dysarthria, aphasia, hemiplegia, monoplegia)
- Amaurosis fugax (“fleeting blindness”) - <24 hrs |
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what is the most common test for extracranial carotid disease?
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- Duplex ultrasound, assesses flow patterns & physical characteristics of plaque, only test required for >90% of patients
- Diagnostic criteria is the velocity of the blood |
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When should you use MRA to detect stenosis?
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- Tends to overestimate so should use in pts with symptoms (TIA) or looking for brain injury
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What are features of RAS? Can you treat with ACEi?
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- Early onset, difficult to control HTN, flash pulmonary edema
- Treating with ACEi makes it worse! b/c you need that pressure through the glomerulus |
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What are the causes of renovascular HTN?
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- Fibromuscular dysplasia (abnormal thickening of vessel media), women & children
- Atherosclerosis (older age, superimposed essential HTN) |
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How do you treat renovascular HTN?
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- Fibromuscular dysplasia → balloon angioplasty/stent
- Atherosclerosis → PTA, initial treatment of choice, operative bypass |
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What is virchow’s triad?
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- HES: hypercoagulability, endothelial injury, statis of flow
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What predisposes you to hypercoaguability?
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- Antithrombin III, protein C & S deficiency, factor V leiden deficiency = most common
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What is phlegmasia cerulean dolens? Phlegmasia alba dolens?
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- Painful purple leg & painful white leg
May be limb threatening due to reduced arterial perfusion |
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How do you diagnose a DVT?
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- Venogram used to be “gold standard” but too costly & timely
- Now use duplex ultrasound |
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How do you treat a DVT?
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- Heparin
- Elevate leg, convert to oral Coumadin - IVC interruption if anticoagulation contraindicated (IVC filter) |
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What happens in postphlebitic syndrome?
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- DVT can destroy valves in LE → venous reflux → venous HTN, tissue edema, hypoxia, inflammation → venous ulcers
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How do you treat a venous ulcer?
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- Compression therapy, vein valve transplant
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What are varicose veins?
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- Enlarged saphenous tributaries, caused by reflux in greater saphenous
- Benign, no increased risk of DVT - Treatment only for symptoms |
