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Cardiology > peripheral vascular disease > Flashcards

peripheral vascular disease Flashcards

1
Q

what is intermittent claudication?

A
  • when insufficient blood reaches exercising muscle
  • the patient is pain free at rest but after variable periods of exercise develops ischaemic pain in the affected limb, which is relieved by further rest
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2
Q

what are the risk factors for intermittent claudication?

A
  • male
  • age
  • diabetes
  • smoking
  • hypertension
  • hypercholesterolaemia
  • fibrinogen
  • alcohol
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3
Q

what are the non invasive investigations of lower limb ischaemia?

A
  • measurement of ABPI

- duplex ultrasound scanning

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4
Q

what are the invasive investigations of lower limb ischaemia?

A
  • magnetic resonance angiography
  • CT angiography
  • catheter angiography
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5
Q

how do you measure ABPI?

A
  • ankle pressure/brachial pressure
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6
Q

what are the normal values for ABPI?

A
  • normal = 0.9-0.12
  • claudiaction = 0.4-0.85
  • severe = 0-4.5
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7
Q

what are the different ways to treat lower limb ischaemia?

A
  • guardian therapy
  • improvement of claudiaction symptoms
  • exercise training and drugs
  • angioplasty/stent
  • surgery
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8
Q

what is the guardian therapy?

A
  • smoking cessation
  • lipid lowering
  • antiplatelets
  • hypertension Rx
  • diabetes Rc
  • life style issues
  • information
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9
Q

what exercise should be recommended for lower limb ischaemia?

A
  • 1 hour per day - 30 mins 3 times per week for minimum of 6 months
  • 20-200% improvment in walking distance
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10
Q

what drugs should be given for lower limb ischaemia?

A
  • cliostozol
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11
Q

what surgery would be given to treat lower limb ischaemia?

A
  • endarterectomy

- bypass

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12
Q

what is critical limb ischaemia?

A
  • at rest there is pain in toe/foot
  • occurs when sleeping and lying down
  • can be ulcers/ gangrene
  • severe ischaemia + damage (trauma/footwear)
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13
Q

what are the symptoms of critical limb ischaemia?

A
  • pain at rest
  • toes and forefoot
  • requires strong analgesia
  • worse at night
  • helped by sitting and putting led in a dependent possition
  • helped by getting up and walking about
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14
Q

what are the critical limb ischaemia risk factors for amputation?

A
  • smoking

- diabetes

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15
Q

what is an aneurysm?

A
  • dilation of a vessel by more than 50% of its normal diameter
  • normal aortic diameter is 1.2-2cm
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16
Q

what is a true aneurysm?

A
  • all 3 vessel walls are intact
17
Q

what is a false aneurysm?

A
  • there is a breach in the vessel wall (surrounding structure act as vessel wall)
18
Q

what are the morphologies or aneurysms?

A
  • saccular
  • fusiform
  • mycotic - arteries secondary to an infection process, involving all 3 layers of the artery
19
Q

what happens in an abdomial aortic aneurysm?

A
  • medial degeneration
  • regulatin of elastin/collagen in aortic wall
  • aneyrysmal dilation
  • increase in aortic wall stress
  • progressive dilation
20
Q

what increases chance of abdominal aortic aneurysm?

A
  • male

- increases with age >65

21
Q

symptoms of AAA?

A
  • mostly asymptomatic
  • identified by imaging for other pathology
  • surveillance programme
  • symptoms may be trashing pain
  • may mimic renal colic
22
Q

what happens in an AAA rupture?

A
  • sudden onset epigastric /central pain
  • may radiate through to back
  • may minic renal colic
  • collapse
23
Q

what would you find on examination of a ruptured AAA?

A
  • may look well
  • hypo/hypertensive
  • pulsatile, expansile mass +- tender
  • transmitted pulse
  • peripheral pulses
24
Q

what are the outcomes of a ruptured AAA?

A
  • 75% will not make it to hospital
  • more retroperitoneal, contained rupture
  • free intra-peritoneal rupture is rapidly fatal
  • 50% operative mortality
25
Q

how do you manage AAA?

A

operation may cause more harm than doing nothing

- intervention should be offered at 5.5cm small ones - should just be watched or if it grown 1cm/year

26
Q

how to duplex ultrasound?

A
  • aP diameter
  • involvement of iliac arteries
  • but it only tells us there is an aneurysm and its AP diameter
27
Q

what does a CT scan allow us to see?

A
  • shape, size and iliac involvement
  • allows for management planning
  • only imagine method to identify ruptured AAA
28
Q

how do you manage AAA?

A
  • laparotomy
  • clamp aorta + iliacs
  • dacron graft
  • tube vs bifurcated graft
  • endovascular aneurysm repair (EVAR) = exclude AAA from insde the vessel
29
Q

what is acute limb iscahemia?

A
  • sudden loss of blood supply to a limb = occlusion of native artery or bypass graft
30
Q

what are the causes of sudden occlusion (acute limb ischaemia)?

A
  • embolism
  • atheroembolism
  • arterial dissection
  • trauma
  • extrinsic compression
31
Q

clinical features of acute limb ischaemia?

A
  • pain
  • pallor
  • pulseless
  • perishingly cold
  • paraesthesia
  • paralysis
32
Q

how can you ddescribe the pain for acute limb ischaemia?

A
  • severe, sudden onset, resistant to angina

- calcification tenderness with tight compartment intricate muscle necrosis

33
Q

how can you describe the pallor for acute limb ischaemia?

A
  • limb initally white with empty veins

- later capilaries fill with stagnated de oxygenated blood

34
Q

what is the time line for acute limb ischaemia clinical features?

A
  • 0-4 hours = white foot, painful, sensorimotor deficit
  • 4-12 hours = mottles, blaches on pressure
  • > 12 hours = fixed mottling, non blanching, compartments tender/red
  • paralysis
35
Q

what is the management of acute limb ischaemia?

A 
ABC = resusitate and investigate
FBC = U/Es, CK Coag +-troponin
ECG = MI, dysrhythmia
CXR = underlying malignancy
arterial imagine
36
Q

what is diabetic foot sepsis?

A 
encompasses
- diabetic neuropathy
- peripheral vascular disease
- infection
this leads to tissue ulcertaion, necrosis and gangrene which may lead to limb amputation
37
Q

what can diabetic foot sepsis come from?

A
  • small punctured wound
  • infection from the nail plate
  • from a neuro-ischaemic ulcer
38
Q

why is diabetic foot sepsis a problem?

A
  • the pressure of pus builds up in this rigid compartment rapidly leading to impairment of capillary blood flow and further ischaemia and further tissue damage
39
Q

what are the clinical findings of diabetic foot sepsis?

A
  • pyrexia
  • tachcardic
  • tachypnoeic
  • confused
  • kassmauls breathing

Cardiology (40 decks)

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