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Cardio Unit 2 > Cardio Week 5 - PAD > Flashcards

Cardio Week 5 - PAD Flashcards

1
Q

Peripheral artery disease

A

History of leg pain with activity

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2
Q

Cycle of peripheral artery disease

A

PAD —> leg pain —> decreased activity —> deconditioning —> Worsening PAD

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3
Q

Asymptomatic PAD

A

ABI less than or equal to 0.9 without symptoms

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4
Q

Atypical leg pain

A

Pain with activity, not reproducible in terms of pace, time or rest

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5
Q

Claudication

A

Pain with activity reproducible in terms of pace, time and rest

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6
Q

Critical limb ischemia

A
  • ABI < 0.3 or 0.4
  • Pain at rest
  • Non healing wounds and gangrene
  • Without revascularization, the pt is likely to require amputation
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7
Q

Neurogenic Claudication

A
  • Spinal stenosis
  • Peripheral Neuropathy
  • Peripheral nerve pain
  • Sciatica
  • Restless leg syndrome
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8
Q

Qualities of spinal stenosis

A
  • Impacted by back postition during exercise whether flexed or extended
  • Common with bike test
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9
Q

How can peripheral neuropathy be reproduced?

A

Can be reproduced with special tests or nerve conduction velocity

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10
Q

How can peripheral nerve pain and sciatica be alleviated?

A

Position change

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11
Q

When is restless leg syndrome present?

A

Usually present at night, not usually present during activity

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12
Q

Other LE causes of Pain

A
  • Muscle spasms or cramps
  • Chronic compartment syndrome
  • Hip or knee OA
  • Symptomatic baker’s cyst
  • Venous disease producing claudication
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13
Q

5 P’s of PAD

A
  • Pain
  • Pulselessness
  • Pallor
  • Paresthesia
  • Paralysis
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14
Q

ABI value of greater than or equal to 1.3

A
  • Non compressible
  • Likely PAD (narrowed on the inside)
  • Measure toe pressures
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15
Q

ABI of 1.00 to 1.29

A

Considered WNL

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16
Q

ABI value of greater than 1.1

A
  • With risk factors and history should be viewed with suspicion
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17
Q

ABI value of 0.91 to 0.99

A

Considered borderline PAD

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18
Q

ABI value of 0.41 to 0.90

A

Considered moderate to mild PAD

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19
Q

ABI value of less than or equal to 0.4

A

Considered severe disease correlating with critical limb ischemia

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20
Q

Toe Brachial Index (TBI) Measurement

A

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

21
Q

Segmental Pressures

A

BP measured along the LEs to localize an area of decline in systolic pressure

22
Q

Pulse Volume Recordings

A
  • Measure ratio of volume changes during systole and diastole
  • Relative lack of blood flow during diastole indicative of arterial disease
23
Q

Exercise ABI Testing

A
  • Confirms the PAD diagnosis
  • Assesses the functional severity of claudication
  • May detect PAD in the presence of normal resting ABI
24
Q

Plantar Flexion Exercise ABI

A
  • 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
25
Q

Color Duplex Ultrasonography

A

Color indicates the area with high or low blood flow

26
Q

Magnetic Resonance Angiography (MRA)

A

Can see exactly where blood flow decreases

27
Q

Computed tomographic angiography (CTA)

A

Requires iondinated contrast and ionizing radiation

28
Q

Medical Management for PAD

A
  • Smoking cessation
  • Intensive antihypertensive therapy
29
Q

What is Clopidogrel (plavix)

A
  • Antithrombotic, blocking ADP receptors in platelets
  • Treating and preventing stroke and MI with PAD
30
Q

What is aspirin?

A

Antithrombotic, less effective than plavix

31
Q

What is cilostazol (pletal) and what does it do?

A

Phosphoesterase inhibitor produces vasodilation, inhibits platelet aggregation, not to be used for pts with CHF

32
Q

What is Pentoxifylline (trental) and what does it do?

A

Phosphoesterase inhibitor that improves blood flow through occluded areas and inhibits platelet aggregation, but does not improve walking distance as much as pletal

33
Q

When does plavix have a better effect than aspirin?

A

For CVA, PAD, all patients

34
Q

When is aspirin better than plavix?

A

For a MI

35
Q

What is pletal favored for?

A

Improving claudication

36
Q

What is plavix favored for?

A

Improving ischemia

37
Q

Interventions

A
  • Education
  • Exercise protocol for PAD
  • Home exercise
38
Q

Exercise protocol for PAD

A
  • 5 to 10 minute warm-up and cool-down each
  • Treadmill or track walking
  • Resistance exercise complementary, but not a substitute for walking
39
Q

Intensity for exercise protocol for PAD

A

Sufficient to cause claudication within 3 to 5 minutes

40
Q

Time for exercise protocol for PAD

A

Until moderately severe claudication reached

41
Q

Rest for exercise protocol for PAD

A

Until claudication resolves in either sitting or standing

42
Q

Plan (FITT)

A
  • Frequency - 3 to 5 supervises sessions/week
  • Intensity slowly increase by either speed or grade to reach claudication in 3 to 5 minutes
  • Time: 35 building to 50 minutes of walking each session + warm-up/cool down
  • Up to 6 months
  • Type: treadmill or track walking
  • OutcomesL 100-150% improvement in maximal walking distance and quality of life
43
Q

Surgical interventions

A
  • Critical limb ischemia or failure of conservative options
  • Endovascular: placement of stent graft, usually for aneurysms
  • Angioplasty with/without stents
  • Thrombolysis
44
Q

Bypass grafting options

A
  • Aortoiliac/aortofemoral reconstruction
  • Femoropopliteal bypass (above knee and below knee)
  • Femorotibial bypass
45
Q

What does stripping venous valves do?

A

Improves blood flow and decreases turbulence in the artery

46
Q

Factors leading to CLI

A
  • Diabetic micro angiopathy
  • Atherosclerosis usually secondary to DM, HTN, or smoking
  • CHF w/ severely decreased cardiac output
  • Vasospastic diseases
  • Smoking and other tobacco use
  • Infection
  • Skin and soft tissue injuries
47
Q

Education intervention

A
  • Effect of elevating legs
  • Energy conservation
  • Signs of other arterial disease: CAD, CVA, CRI
  • Exercise program
48
Q

What is diagnosis of PAD based on?

A

History and physical exam

Cardio Unit 2 (13 decks)

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