Vascular System

Vasodilators

Mechanism Medication
K channel activators Minoxidil
Diazoxide
Ca channel blockers -Dipines
α1 antagonists Terazosin
Doxazosin
Prazosin
α2 agonists Methyldopa
Clonidine
Guanfacine
D1 agonists Fenoldopam
A1 agonists Adenosine
ETA antagonists Bosentan
PDE inhibitors Dipyridamole
Cilostazol
Nitrates Nitroprusside
Hydralazine

Venodilators

Mechanism Medication
μ-opioid agonists Morphine
Nitrates Nitroglycerin
Isosorbide

Indications for Repair of Abdominal Aortic Aneurysm (AAA)

  • > 5.5 cm in men
    > 5.0 cm in women
  • > 1 cm/year
  • Symptomatic AAA

Thromboembolic Diseases

Arterial Thromboembolism

  • Coronary artery disease (CAD)
  • Carotid artery stenosis (CAS)
  • Renal artery stenosis (RAS)
  • Peripheral artery disease (PAD)
    • Chronic limb ischemia (CLI)
    • Acute limb ischemia (ALI)
  • Intestinal ischemia (II)
  • Ischemic stroke (IS)

Venous Thromboembolism

  • Pulmonary embolism (PE)
  • Deep vein thrombosis (DVT)
  • Cavernous sinus thrombosis (CST)
  • Hepatic vein thrombosis

Revascularization Techniques

Technique General Indications Indications
Thrombolysis Venous thromboembolism
Arterial embolism		 PE & DVT & CST & CAD & ALI & II & IS
Thrombectomy Venous thromboembolism
Arterial embolism		 PE & DVT & CST & CAS & ALI & II & IS
Angioplasty Arterial thrombosis CAD & CAS & RAS & CLI & II
Bypass surgery Arterial thrombosis CAD & CAS & RAS & CLI & II

Fontaine Staging of Peripheral Artery Disease (PAD)

Stage Symptoms
1 Asymptomatic
2 Intermittent claudication
3 Ischemic rest pain
4 Ulceration & Gangrene

Treatment of Peripheral Artery Disease (PAD)

  • Antiplatelets
    • Aspirin
    • ADP antagonists
  • Anticoagulants :: Heparin
  • Statins
  • Supervised exercise therapy
  • PDE inhibitors :: Cilostazol
  • Revascularization
    • Percutaneous transluminal angioplasty (PTA)
    • Arterial bypass surgery

Vasculitis

Large-vessel

  • Takayasu arteritis
  • Giant cell arteritis [Temporal arteritis]

Medium-vessel

  • Kawasaki disease
  • Polyarteritis nodosa
  • Thromboangiitis obliterans [Buerger disease]

Small-vessel

  • ANCA-associated vasculitis (AAV)
  • IgA vasculitis [Henoch-Schonlein purpura (HSP)]
  • Cryoglobulinemic vasculitis

ANCA-associated vasculitis (AAV)

Vasculitis Antibodies Affected Organs
Granulomatosis with polyangiitis (GPA) [Wegener granulomatosis] PR3-ANCA [c-ANCA] Nasopharynx & Sinus & Lung & Kidney
Eosinophilic granulomatosis with polyangiitis (EGPA) [Churg-Strauss syndrome] MPO-ANCA [p-ANCA] Sinus & Asthma & Kidney & Nerve
Microscopic polyangiitis MPO-ANCA [p-ANCA] Lung & Kidney

Presentation of Kawasaki Disease {F-SCARE}

  • Fever :: > 40°C for > 5 days
  • Strawberry tongue
  • Conjunctivitis
  • Adenopathy :: neck
  • Rashes :: desquamating
  • Edema :: limbs

Presentation of Hereditary Hemorrhagic Telangiectasia (HHT) [Osler-Weber-Rendu Syndrome]

  • Telangiectasia
  • Epistaxis
  • Arteriovenous malformation (AVM)
    • Cerebral AVM
    • Pulmonary AVM
  • Paradoxical embolism