CARDIO- PAD,PVD Flashcards
Which organ has best collateral circulation (small side vessels)
Brain
Access Allen test during any ABG and cather**
What tag team together in perfusion?
atherosclerosis and CAD- 2-3x death Inc. with age 10% have classic claudication- Same risk factors DM, smoking, dyslipidemia, HTN, sedentary, obese, M, age * INc plasma homacysteine
Describe your typical venous insufficiency patient?
F- hormone linked 40's-70's multiple pregnancies Rarely seek treatment d/t min symptoms Venus reflux- 2x CHD, 5x w/ PAD
What is interesting about atheroscleroiss?
Plaques w/in vessel walls. Artery lipid laden inflammatory material
Chronic- body adapts and collateralizes
Acute- worry easier to occlude.
Statin stablize plaques- affect lipid core
Have it here, means you have everywhere
What is interesting about venous insufficiency?
Dilation
Inc. Pressure cause more dilation
Reflux- d/t damage valves, flow goes down instead of up
PE- ache, cramp, pain, itchy, sore, RLS
TX- Duplex ultrasound- doppler and US
Mrs. Sprout only has pain in her legs if she doesnt support herself. What is this?
Psedoclaudication
Spinal cord impinge S/s
Mrs. Sprout 72 however c/c heavy legs, pain in ankle with walking and rest, and swelling?
Denies itching, sores, or hyperpigmentation
PAD- atherosclerosis MC
What is next step in examing Mrs. Sprout claudication?
General
Lungs
CV- bruits carotid
Abm- bruits, aortic pulse-bounding= AAA, femoral bruits- RENAL or SMA,IMA stenosis
PV- skin, hair loss, ulcers, edema, bulging veins
**Feel ALL PULSES AND grade them
What is hyperemia in foot when leg is in dependent position but not when it’s elevated above the heart; underlying cause is PAD
Dependent Rubor
S/S- toe ulcers DRY, nail necrosis
What are common findings on CV for PAD?
Auscultation
+/-Carotid bruits- d/t aortic stenosis
Valvular stenosis or regurgitation- you will NOT hear BRUITS
What has high SN and SP?
ABI- great test
Normal 0.90
<0.70 refer
<40 severe admit
Changes risk for relative risk for vascular events MI, ischemic stroke, or vascular death
LIMITS- DM, RF- arteries become calcified
Mrs. Sprout has ischemic resting pain. What Fontain and Rutherford does this indicate.
Fontaine- III
Rutherford- Grade II- CAt 4
Fontaine- I Asymptomatic- IV gangrene
Rutherford Grde 0-III, Cater 0-6 Asymptomatic- major tissue loss
Mrs. Sprout needs a workup d/t ischemic resting pain. What is workup?
1 DVT **Venous duplex ultrasound
MR angiography and spiral CT both involve contrast, more expensive, and not as accurate/precise
Mrs. Sprout ischemia d/t PAD needs surgical intervention. What is gold standard for diagnostic?
Digital subtraction angiography
○ Invasive, requires intra-arterial access
○ contrast
○ provides the Road Map for any endovascular intervention or surgery
○ conjunction with a therapeutic procedure
○ Bones are subtracted digitally
○ This has become the preferred method!
What medical treatment help collaterals vessels develop?
**Exercise- Resistance Ideal Stop smoking Statin DM control Wt loss HTN control
