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Flashcards

Lecture 04 PAD and VTE

Mia Li 536 Cardiopulm Patho English 62 cards

Cards in this deck (62)

  1. 1T/F: CAD and PAD share the same risk factors.T.
  2. 2Why are larger arteries more susceptible to PAD?Because they have higher pressure and increased turbulence within the vessel, resulting in a higher chance of endothelial damage.
  3. 3PAD in UE/LE is more common.LE.
  4. 4List some risk factors of PAD.1. Age > 50 y.o.
    2. family history of PAD/CAD or stroke
    3. Elevated homocysteine
    4. Elevated C-reactive protein
    5. Smoking
    6. High blood pressure
    7. High cholesterol
    8. Diabetes
    9. Overweight
    10. Inactive lifestyle
  5. 5Why is high homocysteine level bad for your arteries?It increases the likelihood of atherosclerosis.
  6. 6T/F: chronic inflammation also increases the risk of PAD.T.
  7. 7How does increased shear stress cause arteriogenesis?increased shear stress --> increased GF, monocyte, EC/SMC activation, proliferation --> increased NOS, PGDF, MCP-1 --> Increased capillary diameter and blood flow --> REMODELING of existing arteries (ARTERIOgenesis)
  8. 8How does increased hypoxia and ischemia result in angiogenesis?Increased hypoxia/ischemia --> Increased inflammation, hypoxia induced factors, EC activation, pericyte recruitment, proliferation and migration --> Increased VEGF and HIF -1 --> Increased capillary density and blood flow --> ANGIOgenesis.
  9. 9What are the three stages of PAD progression?1. Asymptomatic but lowered ABI
    2. Intermittent claudication (upon exertion)
    3. Critical limb ischemia (resting pain and tissue loss)
  10. 10T/F: Intermittent claudication does NOT resolve upon resting.F. (Usually relieved by rest)
  11. 11T/F: Intermittent claudication is usually worse when the person is standing, but gets better once he/she lifts his/her leg up.F.
    Worsens by elevating legs.
    Usually does NOT occur when sitting/standing (because blood can get through).
  12. 12If the patient has symptoms in both thigh and calf, he/she is likely having PAD at the _______ level.femoral artery
  13. 13If the patient is having symptoms at calf, ankle, foot, he/she is most likely having PAD at the ______ level.Popliteal
  14. 14What are the 6 Ps associated with PAD?1. Pulselessness
    2. Pain
    3. Paralysis
    4. Pallor
    5. Paresthesia
    6. Poor temperature (poikilothermia)
  15. 15What is an auscultation sign of PAD?Bruits at the atherosclerotic arteries.
  16. 16What are some atrophic skin changes in patients with PAD?1. Thin and shiny
    2. Dry and scaly
    3. Hair loss
    4. Rubor of dependency
    5. Brittle nails
    6. Non-healing wounds and may become gangrenous
  17. 17A capillary refill time of _____ and a Buerger's test of ______, OR a venous filling test of _____ are all positive tests for PAD.Capillary refill: > 2 sec
    Buerger's test: if red returns at <0 angle
    Venous filling: if >20sec is needed for vein to refill
  18. 18ABI, which stands for ________, compares the (systolic/diastolic) pressure at _______ to _______.ABI, which stands for [ankle-brachial index], compares the [systolic] pressure at [posterior tibial or dorsalis pedis] to [brachial artery].
  19. 19ABI of ________ is considered normal.>0.9
  20. 20ABI of ______ suggests possible intermittent claudication.0.5 - 0.9
  21. 21ABI of <0.5 suggests _______Critical ischemia
  22. 22A more accurate diagnosis of PAD location can be estimated using the _______.Limb segmental pressure
  23. 23When invasive procedures are planned, _______ or ______ can be done.1. color doppler
    2. angiogram
  24. 24What are the medications can be used to manage symptoms of PAD?1. Lipid-lowering drugs (statin)
    2. Anti-hypertensives (BB, CCB, ACEi)
    3. Oral hypoglycemic and insulin
    4. Anti-coagulants (heparin, coumadin)
    5. Arterial vasodilators (BB, CCB, ACEi)
  25. 25What are some invasive medical managements for PAD?1. Angioplasty (stent placement)
    2. Bypass surgery
    3. Atherectomy (intraluminal plaque reduction)
  26. 26T/F: A patient with PAD history has the same probability of getting fatal and nonfatal cardiovascular event.T. (15 - 30%)
  27. 27A DVT is a blood clot ( ________) that forms in a deep vein of the LE, either partially or totally blocking the flow of blood.thrombus
  28. 28A PE, (pulmonary embolism), is caused when:1. a DVT or part of it breaks off from the vein
    2. The breakaway clot travels through the bloodstream, to the heart and into the lung.
    3. The clot blocks a vessel in the lung, interrupting blood supply.
  29. 29T/F: DVT is more common in LE than UE.T.
  30. 30What are the 3 components of Virchow's Triad?1. Hypercoagulable state
    2. Circulatory stasis
    3. Vascular wall injury
  31. 31Common causes of vascular wall injury:1. trauma/surgery
    2. venepuncture
    3. chemical irritation
    4. heart valve disease or replacement
    5. atherosclerosis
    6. indwelling catheter
  32. 32Common causes of circulatory stasis.1. atrial fibrillation
    2. LV dysfunction
    3. immobility/paralysis
    4. venous insufficiency/ varicose vein
    5. venous obstruction from tumour/obesity/pregnancy
  33. 33What are the causes of hypercoagulable state?1. malignancy
    2. pregnancy/peripartum
    3. estrogen therapy
    4. trauma/surgery
    5. inflammatory bowel disease
    6. nephrotic syndrome
    7. sepsis
    8. thrombophilia
  34. 34The initial thrombus has mostly _____ and ______, while the extension has mostly _______ and _______.Initial: RBCs and fibrin
    Extension: platelets with fibrin border
  35. 35What does plasmin do?Cuts fibrin up into degradation products.(maybe complete or incomplete)
  36. 36In patients with DVT, their affected side will have skin that is _____ to touch.Warm
  37. 37Symptoms for DVT.1. swelling
    2. pain and tenderness
    3. change in color (redness)
    4. warm to touch
    5. dilation of surface veins
  38. 38Symptoms for pulmonary embolism1. acute SOB
    2. chest pain
    3. sweating
    4. rapid HR
    5. sense of 'doom'
    6. hemoptysis
  39. 39Where is the tenderness usually located in DVT?1. localized to calf
    2. along course of deep veins of medial thigh
  40. 40What is the cut-off score on Well's CPR for DVT?if <2, unlikely. if =or >2, likely.
  41. 41What are the 2 pathological criteria in Well's CPR?1. Active cancer
    2. Previous documented DVT
  42. 42What are the 2 mobility related criteria in Well's CPR?1. paralysis/paresis, ore recent plaster immobilization of LE
    2. Bedridden > 3 days or major surgery in 12 weeks
  43. 43What are the 2 venous criteria in Well's CPR?1. localized tenderness along the distribution of the deep vein system
    2. collateral superficial veins (non-varicose)
  44. 44What are the 3 edema-related criteria of Well's CPR?1. entire leg swollen
    2. calf swelling at least 3 cm > than asymptomatic leg
    3. pitting edema confined to symptomatic leg
  45. 45What is the criterion negatively associated with DVT in Well's CPR?alternative diagnosis at least as likely as DVT
  46. 46What is the test if patient is socored as 'low risk' by Wells' CPR?D-dimer
    If positive: venous duplex US.
    If negative: exclude DVT.
  47. 47What is patient scored higher than 2 in Well's CPR?Venous duplex US.
    If positive: DVT confirmed.
    If negative: repeat in 1 week
  48. 48D-dimer is a breakdown product of _______. It is used as the lab indicator of ________ level. It suggests __________.Product of breakdown of fibrin clot.
    Indicates plasmin level.
    Suggests presence of DVT that is being autolysed.
  49. 49T/F: If the vein is collapsed during venous compresison US, then DVT is present.F.
    DVT prevents vein from collapsing.
  50. 50Venography is the same procedure as ____________.Angiography
  51. 51What is the clinical cut-off for low probability, intermediate, and high probability of PE according to Well's CPR?Low: 0-1
    intermediate: 2- 6
    High: >/=7
  52. 52What are the +1 criteria for PE?1. hemoptysis
    2. cancer
  53. 53What are the +1.5 criteria for PE?1. previous PE/DVT
    2. HR >100 bpm
    3. recent surgery/immobilization
  54. 54What are the +3 criteria for PE?1. clinical signs of DVT
    2. alternative diagnosis that is less likely than PE
  55. 55Is the Well's CPR for PE more accurate in youth or elderly? In those with or without previous VTE episodes?Youth
    w/o previous VTE
  56. 56What is the clinical risk cut-off between unlikely and likely for PE?4 likely
  57. 57What if a patient with unlikely PE is tested positive for d-dimer?CXR, then ventilation/perfusion scan or CTPA (CT-pulmonary angiogram).
  58. 58What is the primary treatment for DVT?anticoagulation
  59. 59What does LMWH stand for?Low molecular weight heparin
  60. 60What are some common anticoagulation drugs1. LMWH
    2. fondaparinux
    3. coumadin
  61. 61What, aside from anticoagulation, can PE be treated with?1. thrombolytics
    2. embolectomy
  62. 62What criteria must the patient fit to undergo thrombolytic treatment?1. LBP (SBP < 90 mmHg)
    2. low bleeding risk

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536 Cardiopulm Patho Flashcards on Lecture 04 PAD and VTE, created by Mia Li on 18/09/2017.
Created by
Mia Li · Sep 2017
Updated
Sep 19, 2017
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mia liphysical therapycardiopulmonarypt536
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