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24 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are the 5 common types of peripheral vascular disease?
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1. Atherosclerosis (Arteritis Obliterans)
2. Arteritis connective tissue dz 3. Trauma 4. Buerger disease 5. Entrapment |
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What is Buerger disease?
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Thromboangiitis Obliterans involves small to medium arteries most often affect arteries of the wrist & hands. Strong association with smoking, M>W classic “corkscrew” appearance of arteries to the hand
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http://vasculitis.med.jhu.edu/typesof/buergers.html
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What are the 2 major risk factors for PVD?
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Smoking
DM (X5) |
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Name & describe 2 common entrapment syndromes resulting in PVD
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Thoracic outlet syndrome - compression of the neurovascular structures in the area just above the first rib and behind the clavicle.
Popletial artery entrapment - young man with intermittent claudication of calf & foot arch with walking but NOT running |
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What is the difference between claudication and pseudoclaudication?
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Pseudo-claudication occurs with lumbar spinal stenosis. Sx exacerbated with any manuever that exends the spine esecially walking downhill. Relieved by sitting down NOT by standing still.
Claudication is relieved with rest (sitting down or STANDING still) |
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What 4 noninvasive interventions decrease intermittent claudication due to atherosclerosis?
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Stop smoking
regular exercise (30 min daily) pentoxifylline treatment (Trental 400mg tid) - lowers blood viscosity & increases erthrocyte deformability. Cilostazol (Pletal) 100mg bid phosphodiesterase inhibitor that increases the cAMP in platelets and blood vessels. Pletal is contraindicated in patients with congestive heart failure of any severity. |
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What is the best test for functional impairment in PVD and how is it done & analyzed?
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Ankle-brachial index before & after exercise
nml 1 to 1.1 abnml <.95 intemittent claudication < 0.8 rest claudication < 0.4 limb threatenting < 0.25 |
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Which drugs can be used to treat Raynaud's syndrome?
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1. Calcium channel blocker such as Nifedipine
2. Prazosin -Alpha-1 adrenergic blockers 3. Losartan - angiotensin receptor blockers 4. Occasionally Viagra |
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Atherosclerotic disease of the carotid artery provides more risk for which of these: MI, stroke. or TIA?
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Higher risk for MI than stroke or TIA
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When is carotid endarterectomy indicated?
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>70% stenosis
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Describe the medical treatment of TIAs
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h/o TIAs but no significant lesion found & no atrial fibrillation pt should have following antiplatelets agents usually ASA + extended release persantine or Plavix instead of ASA + Persantine
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When should you suspect spontaneous dissection o the internal carotid artery? How is it treated?
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Unilateral HA associated with ither a TIA or a dilated pupil. Can also present as neck pain in a pt with HTN. Look for cholesterol emboli on the retina. Usually resolves
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What are the predisposing factors for aortic dissection?
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HTN, cystic medial necrosis, bicuspid valve, coarctation of the aorta, 3rd tirmester of pregnancy, Marfan's syndrome
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6 reasons
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Describe Thorasic aneurysm classification schemes
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Debakey
I) ascending & descending II) asencing III) Desending Stanford Type A ascending Type B descending |
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Describe the sx of proximal and descending aoritc rupture
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Proximal -aortic regurgitation, hemopericardium, usually severe ant chest pain
Descending - severe interscapular pain sometimes migratory |
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What diagnositic modalities are used for a suspected aortic rdissection /rupture?
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CT or MI
TES is accurate for descending aorta dissections |
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What are the surgery thersholds for a thorasic aortic anneurysm?
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5-6 cm ascending
6-7 descending Marfan's aortic root >5.5-6 cm >5.0 cm for pregnancy Surgery is also indicated for compression of adjacent stuctures or trauma is involved |
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What are the recommendations for management of abdominal aortic aneurysms?
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Abdominal AA tend to rupture rather than dissect
< 3 cm no further testing 3-4 cm annual U/S 4-4.5 biannual U/S >4.5 cm refere to vascular specialist >5.5cm surgery now If growth >0.5 cm in 6 months or is >5.5 cm |
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What are the s/sx of atheroembolism?
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Livedo reticularis
blue toes ischemic ulceration |
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Describe the treatment for Type A aortic anneursyms?
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Ascending aortic anneursyms have the greatest risk for complications. Reduce BP immediately with Beta blocker and Nitroprusside if necessary in preparation for surgery.
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Describe the treatment for Type B or deBakey III AAs?
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Decrease BP may be managed medically if pain is relieved
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What are the morbidity & mortalisty stats forf repair of AAAs?
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Rupture 50% mortality
~4% elective 70% perioperative morbidity is from MI Endoluminal stenting is promising |
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What abnmlity is present in 70% of pts with coactation of the aorta
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Bicuspid aortic valve.
Other problems include membranes in LA, Mitral valve problems, LV problems (All left sided problems) Also associated with Turner's syndrome |
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What are the classic PE findings with coartation of the aorta? list 3 WHat is a common associated condition?
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Upper body HTN
delayed lower pulses may have absent femoral pulse Notching of ribs on CXR May have aneurysmal dilation and rupture of circle of Willis |
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