2.6 Atherosclerosis Beyond the Coronary Arteries Flashcards
A patient has atherosclerosis in one part of their body. How likely is it that they will have it in other areas?
Incredibly likely (generalised disease)
What are the four causes of vascular disease?
- Atherosclerosis
- Dissection
- Vasculitis
- Aneurysm
What is meant by Peripheral Arterial Disease? Where is it most commonly found in the body?
- Atherosclerosis of the peripheral arterial tree
- Common in lower limb arteries
Why can stenosis be asymptomatic under certain conditions? When does this become problematic?
- If narrowing occurs over time, then the body has time to develop a collateral blood supply, thus allowing blood to still be delivered to tissues.
- If the degree of stenosis within an essential vessel (or cumulative degree in multiple vessels) becomes too high, then ischaemia can occur
Chronic Limb Ischaemia vs Chronic Limb Threatening Ischaemia
Chronic Limb Ischaemia: Symptoms and signs of limb ischaemia that have developed over time
Chronic Limb Threatening Ischaemia: Limb ischaemia that cannot meet rest demands of limb
What is chronic limb threatening ischaemia?
Collection of signs and symptoms depicting loss of limb perfusion; inadequate to maintain healthy tissues at rest
Intermittent claudication; three criteria
- Typically in the calf
- Reproducible
- Rapidly resolves with rest
Is intermittent claudication relieved by bending over?
No
Is intermittent claudication brought on by standing?
No
Is intermittent claudication sharp or shooting pain?
No
Is intermittent claudication brought on at rest?
No
Is claudication upstream or downstream of the cause?
Downstream
Diagnosis criteria of chronic limb threatening ischaemia
- Pain at rest for greater than 2 weeks
- Ulceration
- Gangrene
How to test of Buerger’s sign
- Raise foot up from lying position until it goes pale
- Ask patient to swing legs around and off the table; leave for a few minutes
- If affected limb goes red, blood is being shunted to the periphery. This is a sign of ischaemia
Three classifications of acute limb ischaemia?
- Subcritical
- Critical
- Irreversible
What are the 6 Ps of acute limb ischaemia signs
- Pain
- Pallor
- Pulseless
- Paraesthesia
- Paralysis
- Perishingly cold
Are peripheral artery disease patients at a higher risk of MI/CVA?
Yes, due to the systemtic nature of atherosclerosis
Why is it important not just to treat the presenting complaint in PAD and CVA patients?
- Because, without addressing the underlying cause, the patients condition continues to worsen
- By aggressively tackling the modifiable risk factors, we create a foundation of health, thus working to improve patient’s long-term outcomes
What is the most important modifiable risk factor for PAD?
Smoking
How does smoking influence outcomes in PAD patients?
- More likely to progress to chronic limb-threatening ischaemia
- More likely to require vascular reconstruction
- More likely to require amputation
- More likely to die
Other than cold-turkey what are two other ways that have been shown to be effective at quitting smoking?
- Nicotine replacement therapy
- Champix (nicotine receptor agonist)
How much more common is PAD in diabetics vs non diabetics?
2 times as common
Each 1% increase in HbA1c leads to a __% increase in risk of PAD
28%
What HbA1c should we aim for?
6.5-7%
