ANGINA DE PECHO
CARDIOPATIA ISQUEMICA AGUDA
ENFERMEDAD DE RAYNAUD
ISOINMUNIZACION AL RH
INSUFICIENCIA CARDIACA CONGESTIVA
INSUFICIENCIA VENOSA PERIFERICA
TETRALOGIA DE FALOT
ESTENOSIS DE VALVULAS CARDIACAS
INSUFICIENCIA VALVULAR CARDIACA
DEFECTOS DEL SEPTO AURICULO-VENTRICULAR
DUCTO ARTERIOSO PERSISTENTE
SX DEL SENO ENFERMO
DEFECTOS DE LA CONDUCCION VENTRICULAR
Essentials of Diagnosis[pic]
• Dilated, tortuous superficial veins in the lower extremities.
• May be asymptomatic or associated with fatigue, aching discomfort, bleeding, or localized pain.
• Edema, pigmentation, and ulceration suggest concomitant venous stasis disease.
• Increased frequency after pregnancy.
Abnormallydilated veins develop in several locations, giving rise to varicoceles, esophageal varices, and hemorrhoids. However, varicose veins are most commonly
found in the legs as abnormally dilated, elongated, and tortuous alterations in the saphenous veins and their tributaries. Saphenous vein varicosities develop in 15% of adults. Risk factors include female gender, pregnancy, family history, prolongedstanding, and history of phlebitis.
The long saphenous vein and its tributaries are most commonly involved, but the short saphenous vein may also be affected. These vessels lie immediately beneath the skin and superficial to the deep fascia.
An inherited vein wall or valvular defect appears to play a role in the development of most primary varicosities. Secondary varicosities may result from valvedamage following thrombophlebitis, trauma, DVT, arteriovenous fistula, or nontraumatic proximal venous obstruction (pregnancy, pelvic tumor). Venous reflux caused by valvular incompetence is characteristic of both primary and secondary varicose veins. At the saphenofemoral junction and the perforating veins of the medial calf and thigh, the superficial and deep veins of the leg communicate; valveincompetence in these segments permits blood flow to be bidirectional. Thus, high venous pressures (> 300 mm Hg) from within the deep system that occur during calf compression associated with walking are transmitted to these superficial veins, which dilate. With long-standing disease, the surrounding tissue and skin may develop secondary changes such as fibrosis, chronic edema, and skinpigmentation and atrophy.
The severity of the symptoms is not necessarily correlated with the number and size of the varicosities. Dull, aching heaviness or a feeling of fatigue brought on by periods of standing is the most common complaint. Itching from an associated eczematoid dermatitis may occur above the ankle.
Dilated, tortuous, elongated veins on themedial aspect of the thigh and leg are usually readily visible with the patient standing. Smaller, flat, blue-green reticular veins, telangiectasias, and spider veins may accompany varicose veins and are further evidence of venous dysfunction. Secondary tissue changes may be absent even in the presence of extensive large varicosities; however, with superficial or deep venous insufficiency andlong-standing varicose veins, the signs of chronic venous insufficiency appear. These may include brownish pigmentation and thinning of the skin above the ankle, edema, fibrosis, scaling dermatitis, and venous ulceration. Duplex ultrasonography is used to detect the precise location of incompetent valves. The Brodie-Trendelenburg test can help differentiate saphenofemoral valve incompetence from...