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
What is the only effective agent for PAD
Statins, PSK9s
Cilostazol- improve walking distance+ ASA ok
Antiplatelet- Clopidogrel
Ticagrelor
What are surgical treatment for PAD
Endovascular Intervention- Vascualr bypass ● Self-expanding and balloon-expandable stents ● Atherectomy ● Laser ● Cryoplasty ● Mechanical thrombectomy ● Intra-arterial thrombolytic therapy ● Stent-grafts placed in the aorta ● Aneurysm coiling/Vascular embolization Vascualr bypass AAA repair Carotid endarectomy
What is difference in arteriosclerosis vs atherosclerosis?
Atero- narrow d/t damage, stiffness, or plaque in wall
Ahtero- plaques no narrow
What are the main veins responsible for PVD?
Great and small saphenous
During PAD, if the pain or lack of pulse is distal where is the occlusion?
Proximal
Pain in buttocks
Diminished pulse
Occlusion Common Iliac
What is the main PE during PAD exam?
Palpate dorsalis pedis
If strong, then proximal up to aorta is fine
Touch all pulses
Where is the ideal place to listen for Abdomen bruits?
Umbilicus
press down, tune out bowel sounds
Sqssh or nothing-NOT good
What are atypical symptoms of PAD?
Foot ankle pain or fatigue
4th toe resting pain
Back, hip, leg chronic w/ disc dz, consider vascular
R/o gout via 2+ dorsalis pedis pulse
WHat is surgical intrvention for PVD?
Severe varicose veins
Venous ablation
