23- Clinical Correlation PAD Flashcards
cramping and pain in legs with walking a certain distance
claudication
key HPI findings for PAD
- claudication
- rest pain
- black ulcers or toes
- chronic ulcers that don’t heal
- painful ulcer despite neuropathy
what is metabolic syndrome characterized by?
- hyperinsulinemia or hyperglycemia
- hypertriglyceridemia and low HDL
- HTN
- obseity
how effective is waistline in diagnosing metabolic syndrome?
80% of patients can be diagnosed by waistline alone
> 40 in male
35 in female
for every 1% increase of HgA1c , risk factor for PAD goes up …
28%
highest odds risk factors for PAD
smoking followed by diabetes
describe the skin of someone with PAD
thin, atrophic lack hair brittle rigid nails cold hemosiderin depostis waxy apeparance
how to PAD ulcers appear?
gangrenous, granular with a lot of fibrotic tissue
what is dependent rubor?
foot looks red when dependent and pale with elevation
what would a normal doppler be described as?
triphasic
normal arterial flow and usually associated with a palpable pulse
severe PAD would appear _____ with doppler
monophasic or absent
ABI = ______________/ ___________
lower extremity systolic pressure/ brachial artery systolic pressure
falsely elevated ABI
> 1.3
indicates a heavily calcified vessel (diabetes)
ABI normal
0.9-1.3
ABI associated with PAD and intermittent claudication
0.5-0.9
ABI associated with critical limb ischemia and ulceration and rest pain
what are the guidelines for obstruction with segmental pressures?
20-30 mm dif. between adj cuffs
30 mm change along lef from thigh to ankle
20mmHg or more between opposite leg same level
what is wagner’s ischemic index?
ischemic index = leg pressure/ arm pressure
what wagner ischemic index score would indicate successful healing
above 0.34 in arteriosclerosis or 0.45 in diabetes
how do pitch and loudness relate to blood flow with doppler readings
high pitch = faster moving blood cells
louder = more cells being hit
B doppler waveform =
ventricles contract and aortic valve opens
c doppler waveform =
ventricles relax, valve open, reflux in large arteries
D doppler waveform =
aortic valve closes, pressure increased in large vessels
E doppler waveform =
return to diastolic baseline
toe pressure _________ or below is predictive of nonhealing ulcer
30 mmHg
the transcutaneous PO2 =
arterial PO2
PVD treatment includes (5)
- antiplatelet therapy with ASA or clopidogrel/plavix
2. LDL
