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95 Cards in this Set
- Front
- Back
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what are the some of the types of PVD? (10)
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1.peripheral atherosclerosis
2.acute arterial occlusion 3.systemic vasculitis a.takayasu's arteritis b.thromboangiitis obliterans c.wegner's granulomatosis d.temporal arteritis e.polyarteritis nodosa 4.schonlein-henoch purpura 5.kawasaki disease 6.rayhaud's phenomenon 7.moyamoya disease 8.coronary-subclavian steal syndrome 9.klippel-trenaunay syndrome 10.behcet's disease |
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what population has highest incidence of peripheral atherosclerosis? why?
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elderly
prevalence increases w/ age |
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what body location does peripheral atherosclerosis effect more?
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lower extremities
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what's usual cause of death in pts w/ peripheral atherosclerosis?
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heart attack or stroke
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what PVD disorder is this?
a.injury to vessel wall b.macrophages further damage, engulf LDLs c.fatty streaks formation d.smooth muscle cells cover fatty streaks forming a artheromatous plaque e.plaques obstruct vessel lumen |
peripheral atherosclerosis
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name some risk factors of peripheral atherosclerosis? (8)
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1.hyperhomocysteinemia**
2.DM 3.essential HTN 4.tobacco use 5.dyslipidemia 6.family hx 7.obesity 8.physcial inactivity |
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what PVD disorder is this?
1.dependent rubor* 2.intermittent claudication 3.rest pain 4.unhealing skin lesions on affected extremity 5.decreased or absent pulses 6.auscultation of bruits over affected artery* 7.subcutaneous atrophy* 8.hair loss 9.coolness and pallor 10.cyanosis |
peripheral atherosclerosis
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diagnosis methods for which PVD disorder?
1.transcutaneous oximetry* 2.doppler ultrasound 3.duplex ultrasound scanning 4.MRI 5.contrast angiography |
peripheral atherosclerosis
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name some tx options for peripheral atherosclerosis. (4)
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1.stop smoking
2.treat hyperlipidemia 3.revascularization: a.PTA, b.stent, c.vascular bypass 4.amputation |
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risks associated w/ tx of peripheral atherosclerosis. what increases these risks?
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MI or stroke
coronary ischemia, CHF, past CABG |
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what should be avoided in anesth mgmt of pts w/ peripheral atherosclerosis? why?
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tachycardia, HTN, anemia, diastolic hypotension
may have associated ischemic heart disease |
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which position is preferred for peripheral atherosclerosis pts?
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low lithotomy
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why do pts with peripheral atherosclerosis have blunted hemodynamic changes w/ aortic cross clamping?
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increased collateral circulation
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what drug could be beneficial during postop managment of pts w/ peripheral atherosclerosis? why?
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temporary infusion of dexmedtomidine (Precedix)
smooth emergence w/out SNS stimulation |
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most common origin of systemic emboli that lead to acute arterial occlusion? other origins include?
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heart
abdominal aorta, iliac/femoral arteries |
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most common location where systemic emboli lodge in acute arterial occlusion?
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bifurcations of arterial vessels
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what PVD disorder is this?
1.sharp demarcation of skin color changes* 2.sudden onset of pain, paresthesia, and motor wkness distal to occlusion 3.severe extremity ischemia 4.loss of pulse 5.cool skin |
acute arterial occlusion
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treatment of acute arterial occlusion. (4)
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1.surgical embolectomy
2.heparin 3.intraarterial thrombolysis 4.amputation |
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what PVD disorder is this?
inflammatory, vasospastic disorder of vessels |
systemic vasculitis
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cause of systemic vasculitis? (5)**
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1.trauma**
2.radiation** 3.infection 4.immune-mediated events 5.antibody-antigen immune complexes |
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why is it hard to differentiate systemic vasculitis from other disorders?
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because s/s are nonspecific
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Takayasu's arteritis
a.prevelence b.etiology c.population |
a.prevelence = rare
b.etiology = idiopathic c.population = oriental women |
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pathology of what PVD disorder ?
1.chronic, progressive occlusive vasculitis of the aorta/its branches, pulmonary, and systemic arteries 2.leads to narrowing, thrombosis, and aneurysms |
Takayasu's arteritis
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s/s of what PVD disorder?
a.CNS = hold head in drooping fashion to prevent passing out b.CV = ischemic heart; valve dysfunction; conduction defects c.Resp = pulm HTN d.Renal = artery stenosis |
Takayasu's arteritis
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Takayasu's arteritis
treatments? (4)* |
1.ACE inhibitors or Ca2+ channel blockers*
2.corticosteriods 3.anticoagulants 4.surgical intervention |
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Takayasu's arteritis
anesth mgnt goals. (6)****** hint: -meds? -preop eval? -avoid? -monitoring? |
1.corticosteriods during surgery if on therapy for disorder*
2.evaluate preop abilty to hyperextend head* 3.avoid hypotension* 4.avoid excessive hyperventiliation* 5.monitor SBP in upper & lower extremities* 6.EEG monitor for carotid artery involvement |
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Thromboantiitis obliterans
population. (3)*** |
1.men*
2.asian, eastern european, & israeli descent* 3. < 45 yo* |
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Thromboangiitis obliterans
most significant predisposing factor? |
tobacco
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what PVD disorder is this?
occlusion of small & middle-sized arteries & veins in extremities |
Thromboangiitis obliterans
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another name for Thromboangiitis obliterans?
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Buerger's disease
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what PVD disorder is this?
1.raynaud's phenomena* 2.forearm, calf, foot claudication 3.rest pain 4.ulcerations 5.skin necrosis |
Thromboantiitis obliterans
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what exacerbates Thromboangiitis obliterans?
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cold
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Thromboangiitis obliterans
treatment options? (4) |
1.stop smoking*
2.corticosteriods* 3.vasodilators* 4.antiplatelets* |
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what's interesting about giving corticosteriods, to Thromboangiitis obliterans
pts? |
not proven to work
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what is a major reason why revacularization is not performed?
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diseased vessels are too small
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Thromboangiitis obliterans
#1 anesth mgmnt goal. how? |
avoid events that will further damage ischemic extremities
1.noninvasive BP monitoring 2.avoiding epinephrine in regionals (avoid accentuating vasospams) |
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what PVD disorder is this?
necrotizing granulomas in inflamed vessels in kidneys, lungs, brain, airway, or CV system |
Wegener's granulomatosis
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what PVD disorder is this?
a.CNS = cerebral arterial aneurysms; peripheral neuropathy b.Resp = sinusitis*; pneumonia*; laryneal stenosis; epiglottic obstruction; V/Q mismatch;hemoptysis; bronchial destruction c.CV = infarction of tips of digits* d.kidneys = azotemia*; renal failure*; hematuria |
Wegener's granulomatosis
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Wegener's granulomatosis most common cause of death?
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renal failure
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Wegener's granulomatosis diagnosis?
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test for antineutrophil cytoplasmic antibodies
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Wegener's granulomatosis treatment?
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cyclophosphamide
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side effects of cyclophosphamide? (4)
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1.depression of immune sys
2.hemolytic anemia 3.leukopenia 4.decreased plasma cholinesterase activity |
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Wegener's granulomatosis intubation considerations?
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avoid trauma during intubation by:
a.being careful during DVL b.using smaller diameter ETT c.sxn airway to remove necrotic debris |
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what factor effects which induction meds you would use for Wegener's granulomatosis pts?
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kidney function
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is sux ok to use w/ Wegener's granulomatosis? why or why not?
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no
contraindicated b/c of muscle atrophy |
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what PVD disorder is this?
inflammation & occlusion of arteries in head & neck |
Temporal arteritis
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when should you suspect Temporal arteritis ?
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pt > 50 w/ unilateral headache
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what PVD disorder is this?
1.sudden unilateral HA* 2.ischemic optic neuritis* 3.jaw claudication 4.scalp tenderness |
Temporal arteritis
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Temporal arteritis tx?
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corticosteriods
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what PVD disorder is this?
affects small and medium-sized arteries |
Polyarteritis nodosa
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Polyarteritis nodosa population. (4)
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1.females 20-60 yo
2.hepatitis b antigenemia 3.allergic rxns to drugs 4.AIDS |
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what PVD disorder is this?
1.glomerulitis* 2.seizures* 3.renal failure* 4.myocardial ischemia 5.peripheral neuropathies 6.HTN |
Polyarteritis nodosa
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Polyarteritis nodosa tx. (4)*
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1.cyclophosphamide*
2.corticosteriods 3.removal of offending drugs* 4.tx of underlying disease |
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What PVD disorder is this?
affects arterioles & capillaries in skin, kidneys, GI tract, and large joints |
Schonlein-Henoch Purpura
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Schonlein-Henoch Purpura population
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children
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Schonlein-Henoch Purpura tx
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usually a benign disease but corticosteriods if renal dysfunction evident
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Kawasaki disease population
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children
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Kawasaki disease cause
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retrovirus
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Kawasaki disease other name
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mucocutaneous lymph node syndrome
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what PVD disorder is this?
1.conjunctivitis 2.coronary artery aneurysms 3.swollen & erythematous hands/feet 4.rash on trunk 5.cervical lymphadenopathy 6.ectasis (dilation of tubular vessel) 7.fever 8.inflamed mucous membranes |
Kawasaki disease
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Kawasaki disease complications (5)
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1.pericarditis
2.myocarditis 3.cerebral hemorrhage 4.angina 5.MI |
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Kawasaki disease tx (2)
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1.gamma globulin
2.ASA |
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during Kawasaki disease anesth mgnt, when would it be beneficial to give a peripheral nerve block?
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to interrupt SNS activity to inflamed arteries if digits are at risk for ischemia
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what PVD disorder is this?
1. episodic vasospastic ischemia of the digits 2.increased alpha2 adrenergic receptors in digial arteries 3.low SBP 4.increased SNS activity 5.heightened digital vascular reactivity to vasoconstrictors 6.circulating vasoactive hormones 7.decreased intravascular pressures |
Raynaud's phenomenon
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secondary Raynaud's phenomena causes. (5)*
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1.connective tissue diseases
a.scleroderma b.SLE c.RA d.dermatomyosistis 2.trauma a.percussive injury b.cold thermal injury 3.peripheral arterial occlusive disease a.thoracic outlet syndrome 4.drugs a. beta blockers b.TCAs c.antimetabolites d.ergot alkaloids e.amphetamines f.methyltrexates 4.neurologic syndromes a.reflix sympathetic dystrophy b.CVA |
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diagnosis measures for which PVD disorder?
1.digital pulse volume records 2.antinuclear antibody titers* 3.cryoglobulins 4.cold agglutins |
Raynaud's phenomena
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Raynaud's phenomena tx. (4)*
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1.conservative approach (usually)
2.Ca2+ channel blockers 3.SNS antagonists 4.surgical sympathectomy (rare) |
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Raynaud's phenomena anesth mgmnt (2)
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1.noninvasive BP
2.avoid epi w/ regionals |
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Moyamoya disease
a.prevalence b.population |
a.prevalence = rare
b.population = children & young adults |
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What PVD disorder is this?
progressive cerebrovasular occlusive disease of: a.internal carotid arteries b.anterior cerebral artery c.middle cerebral artery |
Moyamoya disease
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Moyamoya disease s/s similar to what disease state?
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bilateral internal carotid stenosis
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what PVD disorder is this?
1.hyperventilation w/ crying or exercising 2.interventricular or subarchnoid hemorrhage associated w/ cerebral aneurysms |
Moyamoya disease
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Moyamoya disease tx (2)*
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1.superficial temporal artery-middle cerebral artery anastomosis
2.encephalo-duro-arterio-synangiosis |
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Moyamoya disease anesth mgmnt (3)*
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1.preserve cerebral blood flow to meet CMRO2 needs
2.normocarbia 3.eeg monitoring |
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what effects do spinal anesth have on pts w/ Moyamoya disease?
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seizures & temporary hemiparesis due to circulatory changes and redistribution of blood
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Coronary-subclavian steal syndrome etiology?
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complication of using internal mammary artery for coronary revascularization
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Coronary-subclavian steal syndrome prevalence
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rare
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what PVD disorder is this?
proximal incomplete stenosis in left subclavian artery causes reversal of blood flow thru patent internal mammary artery graft therefore blood stolen from heart to arm |
Coronary-subclavian steal syndrome
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what PVD disorder is this?
1.SBP decreased by at least 20 mmHg in ipsilateral arm 2.angina pectoris |
Coronary-subclavian steal syndrome
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what PVD disorder is this?
occlusion of subclavian or innominate artery & reverse flow thru ipsilateral vertebral artery into distal subclavian therefore blood stolen from brain to arm |
Subclavian-steal syndrome
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WHat PVD disorder is this?
1.SBP 20 mmHg lower in ipsilateral arm 2.bruit over SC artery 3.syncope, vertigo, ataxia, hemiplegia |
Subclavian-steal syndrome
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which subclavian does Subclavian-steal syndrome occur more often?
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left SC (70% of time)
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what PVD disorder is this?
spinal cord arteriovenous malformations |
Klippel-trenaunay syndrome
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what PVD disorder is this?
1.port-wine hemangiomas on neck, trunk, and extremities 2.lesion bleeding after straining or coughing |
Klippel-trenaunay sndrome
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in Klippel-trenaunay syndrome anesth mgmnt, what do you want to avoid?
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avoid spinal or epidural anesth
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which PVD disorder is this?
chronic relapsing inflammatory disorder |
Behcet's disease
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Behcet's disease etiology
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unknown
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Behcet's disease tx (4)*
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1.steriods
2.immunosupressants 3.mydriasis drops 4.colchicine |
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during anesth mngmt of peripheral artherosclerosis what should be avoided? why?
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tachycardia
hypotension anemia diastolic hypotension b/c this disorder often r/t ischemic hear disease |
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s/s of what PVD disorder?
CV = ischemic heart; valve dysfunction; conduction defects Resp = pulm HTN Renal = artery stenosis Musculoskeletal = ankylosing spondylitis; RA |
Takayasu's arteritis
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what PVD disorder is this?
1.oral aphthous ulcers 2.painful, genital ulcers |
Behcet's disease
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what PVD disorder is this?
uveitis causing blindness |
Behcet's disease
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what PVD disorder is this?
bowel symptoms resembling crohn's and ulcerative colitis |
Behcet's disease
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what PVD disorder is this?
erythema nodosum |
Behcet's disease
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what PVD disorder is this?
1.neurologic symptoms that resemble multiple sclerosis 2.monoarthritis or polyarthritis (usually knees) |
Behcet's disease
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