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Cardiovascular System > Arterial disease of the Limbs > Flashcards

Arterial disease of the Limbs Flashcards

1
Q

Where should you feel for the aortic pulse?

A

Above the umbilicus with two hand feel for pulsation vs expansion

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2
Q

Where should you feel for the common femoral aa pulse?

A

Mid-inguinal point - 1/2 way between anterior superior iliac spine and the pubic symphysis

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3
Q

Where should you feel for he popliteal aa pulse?

A

Use both hand to feel deep in the popliteal fossa their leg relaxed in your hands

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4
Q

Where should you feel for the posterior tibial pulse?

A

1/2 way between the medial mallows and the achilles tendon

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5
Q

Where should you feel for the dorsals pedis pulse?

A

Lateral to the extensor halllucis longs tendon

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6
Q

What are causes for chronic limb ischaemia?

A

Atherosclerosis of lower limb aa

Less commonly:
Vasculits
Buerger’s disease

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7
Q

What is buerger’s disease?

A

Inflammation and thrombosis - usually limb aa (can cause gangrene)

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8
Q

What are risk factors for CLI?

A 
Male 
Age
Smoking 
Hypercholesterolaemia
Hypertension 
Diabetes
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9
Q

What classification is used to stage the CLI?

A

Fontaine classification (stage 1 - 4)

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10
Q

What symptoms occur in stage 1 of CLI?

A

Asymptomatic

Incomplete occlusion

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11
Q

What symptoms occur in stage 2 of CLI?

A

Mild claudication:
2A: when walking > 200m
2B: when walking < 200m

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12
Q

What are symptoms in stage 3 of CLI?

A

Rest pain, mostly in feet

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13
Q

What symptoms occur in stage 4 of CLI?

A

Necrosis and/or gangrene of limb

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14
Q

What pattern of symptoms are important to explore in the clinical history of CLI?

A

Claudication: Exercise tolerance and where in leg
Rest pain: type of pain and relieving factors
Tissue loss: duration, history of trauma and peripheral sensation

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15
Q

What are signs of CLI seen on examination?

A

Chronic ischaemia:
Ulceration
Pallor
Hair loss

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16
Q

What examination should you carry out in lower limb to test of ischaemia?

A

Capillary refill
Temp
Pulses
Peripheral sensation

Auscultate: doppler to the dorsals pedis and posterior tibial pulses

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17
Q

What investigations should be carried out for CLI?

A

Ankle-brachial pressure index

Buegers test

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18
Q

What levels of ABPI indicate CLI (Ankle pressure/brachial)?

A

Normal: 1
Intermittent claudication: 0.95-0.5
Rest pain: 0.5-0.3
Grangrene: < 0.3 - tissue loss

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19
Q

How do you carry out a buergers test?

A

Elevate looks and look at pallor:
< 20degrees and limb is pale = severe ischaemia

Hang feet over edge of bed:
Slow to regain colour
Dark red colour (hyperaemic sunset foot) - all capillaries open (usually just 1/3)

20
Q

What is the best medical therapy (BMT) of CLI?

A 
Antiplatelets
Statin 
BP control: aim < 140/85
Smoking cessation 
Exercise 
Diabetic control
21
Q

What are the use of anti platelets in CLI management?

A

Reduce risk of requiring revascularisation

22
Q

What are the use of statins in CLI management?

A

Inhibits platelet activation and thrombosis
Endothelial inflammation
Plaque rupture

23
Q

What is the benefit of diabetic control in CLI management?

A

Tight glycemic control prevent microvascular disease

24
Q

What is the treatment for stage 2 CLI?

A

BMT

25
Q

What is the treatment for stage 3 CLI?

A

BMT
Angioplastly/stent
Surgical bypass

26
Q

What is the treatment for stage 4 CLI?

A

BMT
Angioplasty/stent
Endovascular reconstruction
Surgical bypass

27
Q

What investigations are carried out for CLI?

A

CTA/MRA (first line)
Duplex
Digital subtraction angiogram

28
Q

What are the pros and cons of duplex USS?

A

Dynamic
No radiation/contrast

BUT
Not good in abdomen
Operator dependent
Time consuming

29
Q

What are the pros and cons of CTA/MRA?

A

Detailed - allows treatment planning

BUT
Contrast and radiation
Can over estimate calcification

30
Q

What is acute limb ischaemia?

A

Emboli: A thrombus, air bubble, piece of fatty deposit, which has been carried in the blood stream to lodge in a vessel and cause an embolism
Thrombus: a blood clot formed in situ with the vascular system and impeding blood flow

31
Q

What are causes of acute limb ischaemia?

A 
Arterial embolus (MI, AF, proximal atherosclerosis)
Thrombosis
Trauma 
Dissection 
Acute aneurysm thrombosis (popliteal)
32
Q

What do you look for in the history of ALI?

A

History of CLI
Risk factors of CLI
Cardiac history
Onset/duration of symptoms

33
Q

What are the 6 Ps of the presentation of ALI?

A 
Pain 
Pallor
Perishingly cold
Paraesthesia 
Paralysis 
Pulseless

Compare to contralateral limb

34
Q

What can ALI cause?

A

Compartment syndrome

35
Q

What is compartment sydrome

A

Increased pressure within one of the body’s compartments results in insufficient blood supply to tissue within that space

36
Q

What can increase the pressure in a muscle compartment causing compartment syndrome?

A

Muscle ischaemia
Inflammation (draws in fluid -> oedema)
Oedema
Venous obstruction (blood builds up)

37
Q

What are the symptoms and signs of compartment syndrome?

A

Tense, tender calf
Rise in creatinine kinase
Risk of renal failure (myoglobulinaemia)

38
Q

What investigations should be carried out for ALI?

A

ECG
Bloods
Nil by mouth

39
Q

What is the initial management of ALI?

A

Analgesia

Anticoagulate

40
Q

What are the management options for ALI with salvageable limb?

A

If embolus: embolectomy

If thrombus in situ: thrombolectomy/ thrombolysis OR open embolectomy +/- bypass

41
Q

What are the management options for ALI with a non-salvageable limb?

A

Palliate

Fit for surgery: Amputate

42
Q

What is diabetic foot disease?

A

Uncontrolled diabetes causing the development of neuropathy and peripheral arterial disease

Also causes:
Mechanical imbalance
Susceptibility to infection

43
Q

Why is prevention key in diabetic foot disease?

A

Limited options for surgical intervention

Footcare
Glycaemic control

44
Q

How can a diabetic improve footcare?

A

Always wear shoes
Check shoes fit
Check pressure points/plantar surface of fat regularly
Prompt and regular wound care of skin breaches

45
Q

What is the management for diabetic foot disease?

A 
Prevention 
Good wound care 
Tracking infection: systemic antibiotics 
Investigate for:
Osteomyelitis 
Gas gangrene 
Necrotising fasciitis
46
Q

What are surgical options to manage diabetic foot disease?

A

Revascularisation:
Angioplasty/stent if distal
Distal bypass

Amputation

Cardiovascular System (37 decks)

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