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Cardiology > Acute and Chronic Limb Ischaemia > Flashcards

Acute and Chronic Limb Ischaemia Flashcards

1
Q

3 causes of Chronic Limb Ischaemia

A

Atherosclerosis
Vasculitis
Buerger’s disease

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2
Q

Risk factors for chronic limb ischaemia

A 
Age
Hypercholseterolaemia
Hypertension
Male
Smoking
Diabetes
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3
Q

Which classification system is used to stage symptoms of chronic limb ischaemia?

A

Fontaine classification

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4
Q

Describe the stages of the fontaine classification for chronic limb ischaemia

A

I - Asymptomatic, incomplete blood vessel obstruction

II- Mild claudication A)at distance greater than 200m B)distance less than 200m

III- Pain at rest, mostly in feet

IV- Necrosis and gangrene

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5
Q

What factors are included in history for diagnosis of chronic limb ischaemia?

A

Caludication - exercise tolerance, effect of incline, change over time, relief by rest, wsite, character, unilateral/bilateral
Rest pain - type, relieving factors
Tissue loss - duration, history of trauma, peripheral sensation
Risk factors - PMH, DH, SH, OH

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6
Q

Signs of chronic limb ischaemia

A

Ulceration
Pallor
Hair loss

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7
Q

What needs to be examined to diagnose chronic limb ischaemia?

A

Signs on inspection
Feel for capillary refill, temperature, pulses, peripheral sensation
Auscultate - Doppler - dorsalis pedis, posterior tibial

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8
Q

Special tests for chronic limb ischaemia

A

Ankle Brachial Index - ABPI

Buergers test

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9
Q

Explain conditions demonstrated by ABPI

A

Symptom free = ABPI of 1
Intermitent claudication = ABPI 0.5-0.95
Rest pain = ABPI 0.3-0.5
Gangrene and ulceration = ABPI less than 0.2

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10
Q

Explain Buerger’s test

A

Elevate legs
1)Pallor
2) less than 20 degrees -severe ischaemia
Hang feet over the edge of the bed - slow to regain colour - Hyperaemic sunset foot

Normally 1/3 of capillaries are opne- in CLI autoregulation lost –> all open

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11
Q

Management options for chronic limb ischaemia

A

Best Medical therapy
Severe - BMT, angioplasty/stent/surgical bypass
Critical -> Above plus endovascular reconstruction

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12
Q

Best Medical Therpay for Chronic limb ischaemia

A 
Antiplatelets
Statin
BP control
Smoking cessation
Exercise
Diabetic control
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13
Q

Investigations for chronic limb ischaemia

A

Duplex USS
CTA/MRA
Digital subtraction and angiogram

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14
Q

Surgical bypass complications

A 
Bleeding
Infection
Pain
Scar
DVT
PE
MI
CVA
LRTI
Death
Damage to vein/nerve.artery
Distal emboli
Graft failure
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15
Q

Acute limb ischaemia occurs due to which 3 causes

A

Thrombus
Emboli
Trauma - compartment syndrome

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16
Q

What elements of history are illicited to diagnose Acute limb ischaemia?

A 
History of chronic limb ischaemia
Risk Factors
Cardiac hisotry
Onset
Duration
Function
Social Hisotry - smoking, diet, exercise,
17
Q

Presentation of Acute Limb Ischaemia

A 
6 Ps
Pallor
Pain
Paraesthesia
Paralysis
Pulseless
Perishingly Cold
18
Q

What syndrome can occur in Acute Limb Ischaemia?

A 
Compartment syndrome
Muscle ischaemia, inflammation, oedema, venous obstruction
Tense tender calf
Rise in creatinine kinase
Risk of renal failure (myoglobulinaemia)
19
Q

What are the features of compartment syndrome?

A

Muscle ischaemia, inflammation, oedema, venous obstruction

Tense tender calf

20
Q

What risk is associated with compartment syndrome?

A

Rise in creatinine kinase

Risk of renal failure (myoglobulinaemia)

21
Q

Management of Acute Limb Ischaemia

A 
Bloods -
ECG
Nil by mouth
Analgesia
Anticoagulation

If limb is slavageable Embolectomy
Thrombosis in situ - mechanical thrombectomy/thrombolysis
Open embolectomy +/- bypass

22
Q

What percentage of diabetic patients will develop foot ulcers?

A

15%

23
Q

What needs to be investigated in diabetic foot disease?

A

Osteomyelitis
Gas gangrene
Necrotising fasciitis

24
Q

Management of diabetic foot disease

A

Revascularisation

Amputation

25
Q

Definition of acute limb ischaemia

A

Sudden decrease in perfusion of limb that threatens its viability

26
Q

Causes of potential embolisation leading to acute limb ischaemia

A 
CLI
Atrial fibrillation
MI
Symptomatic AAA
Peripheral aneurysms
27
Q

Differentials for acute limb ischaemia

A

Critical chronic limb ischaemia
Acute DVT
Spinal cord or peripheral nerve compression

28
Q

Investigations for acute limb ischaemia

A 
Bloods - including lactate, thrombophilia screen, group and svae
ECG
Doppler US
CT angiography
CT arteriogram if limb salvageable

Cardiology (7 decks)

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