Vascular Medicine

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Symptoms of Vascular Medicine

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Editor-in-Chief: Amjad AlMahameed, MD, MPH, RPVI, FACP. Beth Israel Decaoness Medical Center and Harvard Medical School. Boston, USA

Vascular medicine is a rapidly advancing discipline that is concerned with the study of the the blood vessels and their diseases. It encompasses the evaluation and treatment of the following disease states:

1. Arterial disease, such as carotid, renal, mesenteric and other peripheral (limb) arterial abnormalities, including acute and chronic syndromes as well as long-term complications.
2. Diseases of the veins, such as varicose veins, thrombophlebitis, venous thromboembolic disease (DVT and PE) and its long-term sequelae.
3. Diseases of the lymphatics, such as lymphedema.
4. Associated medical disorders, such as hypercholesterolemia, hypertension, diabetes.
5. Nonatherosclerotic vascular disease, such as vasculitidis, thromboangiitis obliterans (Buerger's disease), fibromuscular dysplasia, pernio, atheromatous embolization, HIV and other vasculopathies.
6. The appropriate use of noninvasive and invasive assessment and management of these problems

## Contents

* 1 Arterial Diseases
* 1.1 Occlusive Disease
* 1.1.1 Peripheral Arterial Disease of the Lower Extremities
* 1.1.2 Peripheral Arterial Disease of the Upper Extremities
* 1.1.3 Extracranial Carotid Artery Stenosis
* 1.1.4 Renal Artery Stenosis
* 1.1.5 Mesenteric Artery Stenosis
* 1.2 Aneurysmal Disease
* 1.2.1 Aortic Aneurysms
* 1.2.1.1 Thoracic Aortic Aneurysms
* 1.2.1.2 Abdominal Aortic Aneurysms
* 1.2.2 Iliac and Popliteal Aneurysms
* 1.2.2.1 Splenic, Renal, and mesenteric aneurysms
* 1.3 Diseases of the Aorta
* 1.3.1 Aortic Aneurysms
* 1.3.1.1 Thoracic Aortic Aneurysms
* 1.3.1.2 Abdominal Aortic Aneurysms
* 1.3.2 Acute Aortic Syndromes
* 1.3.2.1 Acute Aortic Dissection
* 1.3.2.2 Intramural Hematoma
* 1.3.2.3 Penetrating Ulcer of the Aorta
* 1.3.3 Aortitis
* 1.3.4 Occlusive Aortic Disease
* 1.4 Nonatherosclerotic Vascular Syndromes
* 1.4.1 Vasculitidis
* 1.4.2 Buerger's Disease
* 1.4.3 Fibromuscular dysplasia
* 1.4.4 Cold-Induced Vasculopathies
* 1.4.4.1 Pernio
* 1.4.4.2 Frostbite
* 1.4.5 Atheromatous embolization
* 1.4.6 Other Arteriopathies
* 1.5 Complications of Vascular Access
* 1.5.1 Pseudoaneurysms
* 1.5.2 Arterial-Venous Fistula
* 1.5.3 Retroperitoneal Hematomas
* 2 Venous Disease
* 2.1 Venous Thromboembolic Disease
* 2.1.1 Acute Deep Venous Thrombosis
* 2.1.2 Post-Phlebetic Syndrome
* 2.1.3 Acute Pulmonary Embolism
* 2.1.4 Chronic Thromboembolic Pulmonary Hypertension
* 2.1.5 Varicose Veins
* 3 Lymphatic Disease
* 3.1 Lymphedema
* 4 The Vascular Laborartory
* 4.1 Introduction to Vascular Ultrasounds Physics
* 4.2 Criteria for Carotid Stenosis
* 4.3 Criteria for Renal Stenosis
* 4.4 Criteria for Mesenteric Stenosis
* 4.5 Ankle Brachial Index and Segmental Blood Pressure Measurement
* 4.6 Arterial Duplex of the Peripheral Arteries
* 4.7 Graft Surveillance
* 4.8 Venous Ultrasounds
* 5 Thrombosis
* 5.1 Thrombophilic States
* 5.1.1 Heparin-Induced Thrombocytopenia

## Arterial Diseases

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### Occlusive Disease

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#### Peripheral Arterial Disease of the Lower Extremities

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#### Peripheral Arterial Disease of the Upper Extremities

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#### Extracranial Carotid Artery Stenosis

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#### Renal Artery Stenosis

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#### Mesenteric Artery Stenosis

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### Aneurysmal Disease

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#### Aortic Aneurysms

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##### Thoracic Aortic Aneurysms

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##### Abdominal Aortic Aneurysms

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#### Iliac and Popliteal Aneurysms

[edit | edit source]

##### Splenic, Renal, and mesenteric aneurysms

[edit | edit source]

### Diseases of the Aorta

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#### Aortic Aneurysms

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##### Thoracic Aortic Aneurysms

[edit | edit source]

##### Abdominal Aortic Aneurysms

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#### Acute Aortic Syndromes

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##### Acute Aortic Dissection

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##### Intramural Hematoma

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##### Penetrating Ulcer of the Aorta

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#### Aortitis

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#### Occlusive Aortic Disease

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### Nonatherosclerotic Vascular Syndromes

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#### Vasculitidis

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#### Buerger's Disease

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#### Fibromuscular dysplasia

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#### Cold-Induced Vasculopathies

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##### Pernio

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##### Frostbite

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#### Atheromatous embolization

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#### Other Arteriopathies

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### Complications of Vascular Access

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#### Pseudoaneurysms

[edit | edit source]

#### Arterial-Venous Fistula

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#### Retroperitoneal Hematomas

[edit | edit source]

## Venous Disease

[edit | edit source]

### Venous Thromboembolic Disease

[edit | edit source]

#### Acute Deep Venous Thrombosis

[edit | edit source]

#### Post-Phlebetic Syndrome

[edit | edit source]

#### Acute Pulmonary Embolism

[edit | edit source]

#### Chronic Thromboembolic Pulmonary Hypertension

[edit | edit source]

#### Varicose Veins

[edit | edit source]

## Lymphatic Disease

[edit | edit source]

### Lymphedema

[edit | edit source]

## The Vascular Laborartory

[edit | edit source]

### Introduction to Vascular Ultrasounds Physics

[edit | edit source]

### Criteria for Carotid Stenosis

[edit | edit source]

### Criteria for Renal Stenosis

[edit | edit source]

### Criteria for Mesenteric Stenosis

[edit | edit source]

### Ankle Brachial Index and Segmental Blood Pressure Measurement

[edit | edit source]

### Arterial Duplex of the Peripheral Arteries

[edit | edit source]

### Graft Surveillance

[edit | edit source]

### Venous Ultrasounds

[edit | edit source]

## Thrombosis

[edit | edit source]

### Thrombophilic States

[edit | edit source]

#### Heparin-Induced Thrombocytopenia

[edit | edit source]

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Electrocardiography

Overview|

History of the EKG • EKG interpretation basics • Normal sinus rhythm

EKG Complexes|

P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave

Osborn wave • H wave • K wave • Delta wave

NSSTW changes

EKG Intervals|

PR Interval • QRS Interval • ST Interval • QT Interval

Conduction System & Bradycardia|

Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block

Atrial Arrhythmias|

Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker

Ventricular Arrhythmias|

Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death

EKG Abnormalities in Disease States|

Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy •

Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction

Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation

Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy

Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium

Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block

Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes

Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome

Inherited Disease • Brugada Syndrome

Systemic Diseases • CNS Disease • Cardiac Tumors

Heart Transplantation • EKG Changes in patient with Heart Transplantation

Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries

Technical Issues and Potential Errors in Interpretation|

Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

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Cardiovascular disease (heart)

Ischaemic|

| Coronary disease|

* Coronary artery disease (CAD)
* Coronary artery aneurysm
* Spontaneous coronary artery dissection (SCAD)
* Coronary thrombosis
* Coronary vasospasm
* Myocardial bridge

|

Active ischemia|

* Angina pectoris
* Prinzmetal's angina
* Stable angina
* Acute coronary syndrome
* Myocardial infarction
* Unstable angina

Sequelae|

* hours
* Hibernating myocardium
* Myocardial stunning
* days
* Myocardial rupture
* weeks
* Aneurysm of heart / Ventricular aneurysm
* Dressler syndrome

Layers|

| Pericardium|

* Pericarditis
* Acute
* Chronic / Constrictive
* Pericardial effusion
* Cardiac tamponade
* Hemopericardium

|

Myocardium|

* Myocarditis
* Chagas disease
* Cardiomyopathy
* Dilated
* Alcoholic
* Hypertrophic
* Tachycardia-induced
* Restrictive
* Loeffler endocarditis
* Cardiac amyloidosis
* Endocardial fibroelastosis
* Arrhythmogenic right ventricular dysplasia

Endocardium /
valves|

| Endocarditis|

* infective endocarditis
* Subacute bacterial endocarditis
* non-infective endocarditis
* Libman–Sacks endocarditis
* Nonbacterial thrombotic endocarditis

|

Valves|

* mitral
* regurgitation
* prolapse
* stenosis
* aortic
* stenosis
* insufficiency
* tricuspid
* stenosis
* insufficiency
* pulmonary
* stenosis
* insufficiency

Conduction /
arrhythmia|

| Bradycardia|

* Sinus bradycardia
* Sick sinus syndrome
* Heart block: Sinoatrial
* AV
* 1°
* 2°
* 3°
* Intraventricular
* Bundle branch block
* Right
* Left
* Left anterior fascicle
* Left posterior fascicle
* Bifascicular
* Trifascicular
* Adams–Stokes syndrome

|

Tachycardia
(paroxysmal and sinus)|

| Supraventricular|

* Atrial
* Multifocal
* Junctional
* AV nodal reentrant
* Junctional ectopic

|

Ventricular|

* Accelerated idioventricular rhythm
* Catecholaminergic polymorphic
* Torsades de pointes

Premature contraction|

* Atrial
* Junctional
* Ventricular

Pre-excitation syndrome|

* Lown–Ganong–Levine
* Wolff–Parkinson–White

Flutter / fibrillation|

* Atrial flutter
* Ventricular flutter
* Atrial fibrillation
* Familial
* Ventricular fibrillation

Pacemaker|

* Ectopic pacemaker / Ectopic beat
* Multifocal atrial tachycardia
* Pacemaker syndrome
* Parasystole
* Wandering atrial pacemaker

Long QT syndrome|

* Andersen–Tawil
* Jervell and Lange-Nielsen
* Romano–Ward

Cardiac arrest|

* Sudden cardiac death
* Asystole
* Pulseless electrical activity
* Sinoatrial arrest

Other / ungrouped|

* hexaxial reference system
* Right axis deviation
* Left axis deviation
* QT
* Short QT syndrome
* T
* T wave alternans
* ST
* Osborn wave
* ST elevation
* ST depression
* Strain pattern

Cardiomegaly|

* Ventricular hypertrophy
* Left
* Right / Cor pulmonale
* Atrial enlargement
* Left
* Right
* Athletic heart syndrome

Other|

* Cardiac fibrosis
* Heart failure
* Diastolic heart failure
* Cardiac asthma
* Rheumatic fever

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