Cardio Week 5 - PAD Flashcards
Peripheral artery disease
History of leg pain with activity
Cycle of peripheral artery disease
PAD —> leg pain —> decreased activity —> deconditioning —> Worsening PAD
Asymptomatic PAD
ABI less than or equal to 0.9 without symptoms
Atypical leg pain
Pain with activity, not reproducible in terms of pace, time or rest
Claudication
Pain with activity reproducible in terms of pace, time and rest
Critical limb ischemia
- ABI < 0.3 or 0.4
- Pain at rest
- Non healing wounds and gangrene
- Without revascularization, the pt is likely to require amputation
Neurogenic Claudication
- Spinal stenosis
- Peripheral Neuropathy
- Peripheral nerve pain
- Sciatica
- Restless leg syndrome
Qualities of spinal stenosis
- Impacted by back postition during exercise whether flexed or extended
- Common with bike test
How can peripheral neuropathy be reproduced?
Can be reproduced with special tests or nerve conduction velocity
How can peripheral nerve pain and sciatica be alleviated?
Position change
When is restless leg syndrome present?
Usually present at night, not usually present during activity
Other LE causes of Pain
- Muscle spasms or cramps
- Chronic compartment syndrome
- Hip or knee OA
- Symptomatic baker’s cyst
- Venous disease producing claudication
5 P’s of PAD
- Pain
- Pulselessness
- Pallor
- Paresthesia
- Paralysis
ABI value of greater than or equal to 1.3
- Non compressible
- Likely PAD (narrowed on the inside)
- Measure toe pressures
ABI of 1.00 to 1.29
Considered WNL
ABI value of greater than 1.1
- With risk factors and history should be viewed with suspicion
ABI value of 0.91 to 0.99
Considered borderline PAD
ABI value of 0.41 to 0.90
Considered moderate to mild PAD
ABI value of less than or equal to 0.4
Considered severe disease correlating with critical limb ischemia
Toe Brachial Index (TBI) Measurement
Accurate when ABI values are not possible due to non-compressible pedal pulses
- Divide toe pressure by the higher of the two brachial pressures
- Less than or equal to 0.7 diagnostic for LE PAD
Segmental Pressures
BP measured along the LEs to localize an area of decline in systolic pressure
Pulse Volume Recordings
- Measure ratio of volume changes during systole and diastole
- Relative lack of blood flow during diastole indicative of arterial disease
Exercise ABI Testing
- Confirms the PAD diagnosis
- Assesses the functional severity of claudication
- May detect PAD in the presence of normal resting ABI
Plantar Flexion Exercise ABI
- Used if exercise ABI is impractical
- May be able to reproduce a treadmill-derived fall in ABI
- Can be performed anywhere
- Inexpensive
- Does not measure functional capacity as a treadmill test can
