Exam 2- Blood Vessels (part 2)

What pulses are easily palpable in infants?

Brachial, radial and femoral

Where is it recommended to get blood pressure in infants

Upper arm or thigh

What should you evaluate in infants

Capillary reviled

What is a very rapid capillary refill in infants

Very rapid (less than 1 second)

What is a prolonged capillary refill in infants

Prolonged (longer than 2 seconds)

What is common in children and has NO PATHOLOGICAL significance

Venous hum

What causes a venous hum in children

Turbulent of blood flow in the internal jugular veins

What occurs less commonly in children than adults?

Venous thrombosis

What is venous thrombosis associated with in children?

Placement of venous access devices

(Tube inserted during cancer treatment)

What percent of children present with hypertension?

1-3%

What are the most often causes of hypertension in children

Kidney/renal disease

Coarctation

Pheochromocytoma

With increasing cardiac output beginning in the first trimester of pregnant women, the pulse may what?

More easily palpated with abrupt rise and rapid fall

With increasing blood volume in pregnant women second trimester, what are easier to see?

Jugular and v waves

TRUE or FALSE

Jugular venous pressure should remain normal in pregnant women

TRUE

What happens with blood pressure in pregnant women

Gradually falls until 16-20 weeks of gestation, then gradually rises to pre-pregnant levels

What may indicate pregnancy-induced hypertension?

Sustained systolic pressure greater than 140 or diastolic pressure greater than 90

What is a common finding as the pregnancy progresses?

Peripheral edema

What can develop during pregnancy and in the postpartum period?

Varicose veins

What may be more difficult to find in older adults

Dorsalis pedis and posterior tibial

Superficial vessels are more apt to appear _________________in older adults

Tortuous and distended

What may cause increased systolic pressure in older adults

Loss of vessel elasticity

Hypertension in older patients is?

Greater than 130/80

What is giant cell arthritis

Temporal arthritis

What is an inflammatory disease of the branches of the aortic arch, including the temporal arteries

Temporal arthritis

How do you find temporal arthritis

Palpate temporal arteries

Temporal arthritis is arterial wall?

Thickening and thrombosis

Temporal arthritis leads to?

Ischemia of master, tongue, optic nerve, etc/

Who usually gets temporal arthritis

Older than 50 yrs old

Symptoms of temporal arthritis

Flu-like symptoms

Polymalgia rheumatica involving hips neck and shoulders

Headache in temporal area

Loss of vision are common

Tongue pain, jaw Claudication

Swollen, tender, modular temporal area

What is the main thing to look for with temporal arthritis

Temporal pulse may be strong weak or absent

Describe an arterial aneurysm

Localized dilation 1.5 times normal diabetes

Arterial aneurysm is more common in

4x more common in men

Signs of arterial aneurysm

Palpate pulsatile swelling or a thrill over artery

Auscultation a bruit over the aneurysm

Dissection of an arterial aneurysm causes?

Severe "ripping" pain

How can we sometimes see an arterial aneurysm on an X ray?

Some calcification in the wall of artery

What is a pathological communication between an artery and a vein?

Ateriovenous fistula

Arteriovenous fistula may be?

Congenital or acquired

Congenital arteriovenous fistula typically

Don't have symptoms

How is an arteriovenous fistula commonly aquired?

Damage form catheterization

Ateriovenous fistula may cause?

Significant arterial to venous shunting of blood

Ateriovenous fistula may result in?

Aneurysm dilation

Lower extremity edema, varicose vein so or Claudication

What can be found in the area with an arteriovenous fistula?

Continuous bruit or thrill over the area

What is stenosis of extremity blood supply by atherosclerosis?

Peripheral arterial disease

What is a differential diagnosis of peripheral arterial disease

Pain in muscle after exercise that disappear with rest

Amount of exercise needed to cause discomfort is predictable

With peripheral arterial disease, the limb appears________ but pulses are ______

Limbs healthy

Pulse are weak or absent

What is most common in severs peripheral arterial disease

Ulceration

What may occur with the muscles with peripheral arterial disease

Muscles may atrophy

What is exaggerate spasm of the digital arterioles that usually are in response to cold exposure or emotional and can cause intense pain from digital ischemia?

Raynaud phenomenon

What color can the raynaud phenomenon be?

Pallor (white)

Cyanosis (blue)

Reperfusion (red)

The skin of the digits may appear like what during raynaud phenomenon

Shiny, smooth and tight from loss of subcutaneous tissue

How do you resolve raynaud phenomenon?

Warm running water (NOT HOT)

What is it when atrial fibrillation can lead to clot formation within the atrium, which may be dispersed throughout the arterial system?

Arterial embolism disease

What is the most common symptom with arterial embolism disease

Pain

Parenthesis may also develop

With arterial embolism disease, what may occur?

Occlusion of small arteries and necrosis of the tissue supplied

What may occur without warning with venous thrombosis

Pulmonary embolism

Venous thrombosis can be the result of?

Trauma

Prolonged immobilization

Malignancy

Trauma

Use of contraceptive

How do we find a venous thrombosis?

Tenderness in the area with some edema

What is the backflow of blood into the right atrium during systole?

Tricuspid regurgitation

What is the most common cause of tricuspid regurgitation

Right ventricular dilation

Mild tricuspid regurgitation can be seen in what percent of the normal adult population

75%

With severe disease of tricuspid regurgitation what are the symptoms

Symptoms of right sided heart failure

-ascites or peripheral edema

What may occur with tricuspid regurgitation

Holosytolic murmur in the tricuspid region

Pulsatile liver

Peripheral edema

What is the accumulation of fluid within the pericardial space leading to the compression and dysfunction of the heart chambers?

Cardiac tamponade

What results from chronic inflammation and subsequent scarring of the pericardium?

constrictive pericarditis

What are 2 things we may see with examining children?

Systolic blood pressure different between arm and leg

Femoral pulses weaker than radial pulses or absent

Strawberry tongue is associated with?

Kawasaki disease

What is an acute small vessel vasculitis in children

Kawasaki disease

Kawasaki disease may result in?

Coronary artery aneurysms

-fever lasting 5 or more days, weight loss, fatigue, myalgias and arthritis

What is determined by hypertension that occurs after the 20th week of pregnancy and the presence of proteinuria?

Preeclampsia- eclampsia

Eclampsia is what?

Preeclampsia with seizures

What results from chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension in older adults?

Venous ulcers