another aspect of cardiac pathology is in the periphery: there are a variety of disorders that can affect the aorta, arteries, and veins. aneurysms are ballooning of arteries due to weakened vessel lining, and can be in the head (berry aneurysms), chest (thoracic aorta), stomach (abdominal aorta). aortic dissection is when blood flows into the media of vessels due to vessel wall degeneration. aneurysms can also occur less commonly in the aortic arch as well as atherosclerotic arteries in the periphery.
other peripheral disorders: acrocyanosis is vasospasm of the peripheral arteries in response to cold, while erythromelalgia is somewhat the opposite, peripheral vasodilation in response to warmth. peripheral arteries can also have mini-aneurysms, called peripheral artery aneurysms, which share risk factors with atherosclerosis and affect the popliteal and iliofemoral artery the most. peripheral artery disease is limb ischemia and pain which results from atherosclerosis; made worse upon elevation of the limb. raynaud's is vasospasm of the arteries of the digits and nose which can be primary or secondary to other underlying diseases. buerger's disease is a peripheral artery diseases of segmented inflammation that is aggravated by smoking or reversible with the cessation of smoking.
questions
aneurysms...
1. what is an aneurysm?
2. where do aneurysms commonly occur?
3. what are berry aneurysms?
abdominal aneurysms...
4. abdominal aneurysms occur more frequently in which gender? √ men
5. AAA's most commonly due to... √ atheroma
6. what are some common risk factors for developing an AAA? X†√
7. symptoms of AAA. X√
8. describe the presentation of a patient who might raise suspicion for an AA diagnosis. √
9. what occurs with the rupture of an AAA? †√
10. what does treatment of an AAA entail? †√
thoracic aneurysms...
11. compare thoracic and abdominal aneurysms.
12. TAA's occur more frequently in which gender?
13. what is the symptom presentation of a patient with a TAA?
14. how is the diagnosis of TAA's made?
15. how fast do TAA's enlarge? at what size will they rupture?
16. what is the untreated mortality of TAA's at 1 and 5 years?
17. what is the prognosis of a ruptured TAA?
aortic branch aneurysms...
18. how common are aortic branch aneurysms compared to TAA's or AAA's?
19. how is the diagnosis of ABA's made?
aortic dissection...
20. what is aortic dissection? √
21. what are the risk factors for aortic dissection? †
22. describe the patient populations at highest risk for aortic dissection. †
23. what are the symptoms of aortic dissection? X√
24. what are some signs of aortic dissection? X√
25. suspect aortic dissection in patients with... †
26. CXR of aortic dissection will show... √
27. if CXR is positive, which tests are done to confirm diagnosis of aortic dissection? †
28. which tests can help distinguish aortic dissection from an MI? √
29. what is the prognosis of patients with aortic dissection who undergo surgery? √
30. what is the prognosis of patients with aortic dissection who are untreated? √
acrocyanosis...
31. what is acrocyanosis?
32. acrocyanosis is more prevalent in which patient populations?
33. what is the relationship between acrocyanosis and atherosclerosis?
34. what are some risk factors for acrocyanosis?
35. signs and symptoms of acrocyanosis?
erythromelalgia...
36. what is erythromelalgia? √
37. what triggers erythromelalgia and what makes it better? √
38. what other condition might erythromelalgia resemble and how might it be distinguished from this condition? X
39. what are the differential diagnoses for erythromelalgia? X
40. what are the treatments for erythromelalgia? √
peripheral arterial aneurysms...
41. what are peripheral arterial aneurysms? √
42. which peripheral arteries are most prone to aneurysms? X√
43. what kind of patient is at higher risk for PAA's? X√
44. common causes for PAA's? XX√
45. what are the signs/symptoms of PAA? †
46. how is diagnosis of PAA's made? †
47. what is the prognosis of patients with PAA? †
peripheral arterial disease...
48. what is PAD? √
49. what are the demographic trends with this PAD? √
50. what is the first symptom of PAD? √
51. what area of the body is PAD most prevalent? √
52. describe the effect of elevating a limb afflicted with PAD. √
53. eventually, PAD might result in... √
54. what are the tests used to diagnose PAD? †√√
55. what are some blood tests used to diagnose PAD? †††√
56. what are the treatment strategies for PAD? √
57. naturopathic treatment also includes... √
raynaud's phenomenon...
58. what is raynaud's? √
59. what is the prevalence of the disease? which gender is more affected? √
60. an episode of vasospasm can be precipitated by... √
61. describe the effect of warming on an area afflicted by raynaud's. √
62. how is the distinction between primary and secondary raynaud's made diagnostically? √
63. what is the treatment strategy for raynaud's? √
buerger's disease...
64. what is buerger's disease? √
65. describe the pathophysiology of the arteries in buerger's disease. √
answers
1. abnormal dilation of artery due to weakened vessel wall (mostly from atherosclerotic damage) or increased luminal pressure.
2. thoracic and abdominal aorta.
3. congenital aneurysms of the intracranial arteries, associated with subarachnoid hemorrhage.
4. men.
5. atheroma formation.
6. smoking, HTN, age, or being a white male.
7. usually asymptomatic.
8. elderly patient who complains of deep, boring back pain who has an abnormally prominent abdominal pulse.
9. back/stomach pain, hypotension, tachycardia.
10. immediate surgery if ruptured. control of atherosclerosis. possible replacement of AA with synthetic graft.
11. have the same causes, but TAA's are more symptomatic ("more stuff for them to press on")
12. equal.
13. asymptomatic until complications arise from thoracic compression: chest / upper back pain, cough, dyspnea, hemoptysis, tracheal deviation.
14. CXR, CTA, MRA.
15. 5mm/year, rupture at 6-7cm.
16. 65%, 20%.
17. universally fatal.
18. much less common.
19. most not caught before rupture, or found incidentally via CXR due to calcification.
20. surging of blood through media of vessels rather than lumen due to degeneration of media and increased luminal pressure.
21. atherosclerosis risk factors. CT disorders.
22. elderly african american man with hypertension.
23. sudden severe pain which resembles an MI, syncope, cardiac tamponade.
24. pulses that wax and wane, limb blood pressures that differ from each other more than 30mmHg.
25. chest/back pain, unexplained syncope, differing pulse and blood pressure in limbs.
26. enlarged mediastinal shadow.
27. CTA, MRA, TEE.
28. CK-MB and troponin.
29. 80% survival.
30. 90% mortality in 1 year.
31. painless, symmetric cyanosis of extremities in response to cold.
32. women, children.
33. there is none.
34. outdoor occupation, low BMI, cold climate.
35. affected area is persistently blue, sweats profusely, and may swell.
36. a rare disorder that involves painful paroxysmal vasodilation of arteries of hands and feet.
37. triggered by warmth and relieved by cold.
38. can resemble cellulitis, but cellulitis is more often unilateral. (not diagnostic though)
39. post-traumatic reflex dystrophies, shoulder-hand syndrome, peripheral neuropathy, causalgia, Fabry's disease, cellulitis.
40. rest, elevation, cold.
41. abnormal dilations of the peripheral arteries caused by weakened arterial walls.
42. 70% popliteal, 20% iliofemoral.
43. much more common in men (20:1), older.
44. atherosclerosis, popliteal artery entrapment, septic emboli.
45. usually asymptomatic, but if rupture may see cold, painful, pulseless extremities and large pulsatile artery (if popliteal).
46. ultrasound, MRA, CT.
47. usually does not rupture, and surgery only indicated if artery is twice the normal size or in the arm.
48. atherosclerosis that leads to lower limb ischemia.
49. 12% of US- men more than women.
50. "angina of a limb"- intermittent claudication.
51. most common in calf, may affect feet, butt, thighs, hips.
52. symptoms get worse on exertion.
53. necrosis and ulcers.
54. ankle/brachial index BP comparison, angiography, doppler ultrasound.
55. CRP-hs, homocysteine, fibrinogen, bleeding time.
56. exercise to form collateral circulation, keeping limb well below heart level, excellent hygiene.
57. blood thinners and anti-inflammatory treatments.
58. vasospasm, especially in digits and nose, with intermittent pallor, redness, cyanosis of the skin.
59. 3-5% of population, women more affected.
60. emotion, cold, or cold emotion.
61. warming helps the afflicted area and restores coloration.
62. primary: normal ESR, no underlying disease symptoms, mild symmetric attacks bilaterally. secondary: abnormal ESR, signs of underlying disease, usually severe unilateral attacks.
63. stop smoking, relax, hydrotherapy, blood thinners.
64. a type of peripheral vascular disease aggravated by smoking. (can be reversed by removal of tobacco)
65. arteries have segmented inflammation. in acute cases, occlusive thrombi.
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