Arterial Testing (signs, symptoms, disease mechanisms) Flashcards
Pain is ________ to disease or occlusion
distal
When does pain occur with claudication?
during exercise (activity); subsides with rest
Claudication results with:
inadequate supply to muscle
What happens with discomfort with claudication?
predictable and subsides within minutes after exercise (activity)
Where is the level of disease compared to location of symptoms?
proximal
What does pseudo-claudication mimic?
vascular symptoms but is neurogenic or orthopedic in origin.
Ischemia rest pain occurs when:
limp not dependent; decreased (such as when sleeping).
What areas does ischemia rest pain affect?
forefoot, heel, toes
Ischemia rest pain is a more severe symptom of:
diminished blood flow
Tissue loss is due to:
deficient or absent blood supply
Tissue loss is also called:
necrosis
Acute arterial occlusion symptoms include:
The 6 P’s
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Polar
Acute arterial occlusion may result from:
thrombus, embolism or trauma
Why is an acute arterial occlusion an emergency situation?
because abrupt onset does not provide for the development of collateral channels
What is Raynaud’s phenomenon?
a condition that exists when symptoms of intermittent digital ischemia occur in response to cold exposure or emotional stress
What are the 3 changes in skin color?
Pallor (white)
Cyanosis (bluish)
Rubor (dark red)
What is primary raunauds?
Ischemia due to digital arterial spasm
-benign, excellent prognosis
healthy vessel
Primary raynauds is common in:
young women
may be hereditary, bilateral; history of symptoms for 2 years without progression/evidence of cause.
Secondary Raynaud’s is also known as:
obstructive Raynaud’s syndrome
What is secondary raynaud’s?
Normal vasoconstriction responses of arterioles superimposed on a FIXED artery obstruction. Ischemia constantly present.
What may be the first manifestation of Buerger’s disease?
Secondary Raynaud’s
What is also referred to as Buereg’s disease?
Thromboangiitis obliterans
or
Presenile gangrene vessels of hands & feet blocked
What does pallor suggest?
deficient blood supply; skin pale
What does rubor suggest?
dilated vessels or vessels dilated secondary to reactive hyperemia; skin is reddened
What does cyanosis suggest?
a concentration of deoxygenated hemoglobin, causes bluish discoloration
Lesions are quite painful compared to:
venous ulcers
What is gangrene?
Death of tissue; usually due to deficient or absent blood supply
What is capillary filling?
An increase in the capillary refill time denotes decreased arterial perfusion
What is dependent rubor?
Cadaveric pallor during elevation with rubrous red discoloration with dependency
How do you grade pulses?
scale of 0 (none) - 4+ (bounding)
Aneurysms can be palpated and described as ________.
bounding
Palpable “vibrations” or “thrill” over pulse site may indicate:
a fistula, post-stenotic turbulence, or a patent dialysis access site
Are the peroneals palpable?
no
The aorta, femoral, popliteal, dorsalis pedis (DPA), posterior tibial (PTA) are considered:
palpable pulses
What is an auscultation?
Bruit
Risk factors of diabetes:
- Atherosclerosis: most common; younger age
- Higher incidence of disease: distal pop. tibial arteries
- Medial calcification develops in LE arteries
- Neuropothy
Risk factors of diabetes:
- Atherosclerosis: most common; younger age
- Higher incidence of disease: distal pop. tibial arteries
- Medial calcification develops in LE arteries
- Neuropathy
- Higher incidence of gangrene change, amputations
Risk factors of hypertension:
- Unclear whether high blood pressure is a causative factor or enhances the development of the atherosclerotic process
- Systemic hypertension is associated with greater incidence of coronary atherosclerosis. Increased BP taxes heart.
Risk factors of hyperlipidemia:
- Elevated plasma lipids closely associated with development of atherosclerosis
- Frequent cause: diet high in animal fat; metabolic problems associated with heredity
Risk factors of smoking:
Studies suggest the chemicals in cigarettes irritate the endothelial lining of the vessels, causing vasoconstriction.
What is atherosclerosis?
thickening, hardening, loss of elasticity of the artery wall
plaque buildup
What is the most common arterial pathology?
Atherosclerosis
Where do changes occur with atherosclerosis?
intima and media layer of the vessel
Major risk factors of atherosclerosis?
Smoking
Hyperlipidemia
Family hx
Less important: hypertension, diabetes, sedentary lifestyle and arterial wall shear/stress
Most common sites for atherosclerosis changes?
Carotid bifurcation
Vessel origin
Infra-renal aorto-iliac system
CFA artery
SFA at the adductor canal level*
Trifucation region
What is Leriche Syndrome?
aortoiliac occlusive disease
Leriche Syndrome is caused by:
obstruction of the aorta; occurs in males
Leriche Syndrome is characterized by:
- Fatigue in hips, thighs, or calves with exercise
- Absence of femoral pulses
- Impotence
- Often times, pallor and coldness of LE
Embolisms are characterized by:
solid, liquid or gaseous; may arise from the body or enter from without
Most frequent causes of embolisms:
small plaque break loose and travel distally until it lodges in small vessels
What is a true aneurysm?
dilatation of all three arterial wall layers
What is a fusiform aneurysm?
diffuse, circumferential dilatation
What is a saccular aneurysm?
localized out-pouching
When do dissecting aneurysms occur?
when a small tear of the inner wall allows blood to form cavity between two wall layers
Where does a dissecting aneurysms occur?
thoracic aorta
Pseudoaneurysm results from:
a defect in main artery wall
Most common location of a true aneurysm:
infrarenal aorta
other locations: thoracic aorta, femoral, popliteal, renal
Patients with one aneurysm have higher incidence of:
having more (2)
Most frequent complication of aneurysms:
Aortic - rupture
Peripheral aneurysm - emolization
Most frequent complication of aneurysms:
Aortic - rupture
Peripheral aneurysm - emolization
both can accumulate thrombus
What is arteritis?
inflammation of the blood vessels
Arteritis is associated with:
Heavy cigarette smoking
Arteritis primarily occurs in:
men < 40 years
What presents with arteritis?
rest pain and ischemic ulceration present
What is coarctation of the aorta?
PEDS
congenital narrowing or stricture of thoracic aorta; but may affect abdominal aorta
Clinical findings with coarctation of the aorta?
PEDS
- Hypertension due to decreased kidney perfusion
- Manifestations of LE ischemia (decreased pulses/segmental pressures)
What aneurysm does the intima develop a tear through which blood leaks into the lumen?
dissection
Aortic dissection can occur due to:
hypertension or severe chest trauma
Aortic dissection can extend into what?
iliacs
