Ch. 3 Arterial Testing Flashcards
Chronic occlusive disease (3)
Claudication,
Ischemic rest pain
Tissue loss
Claudication
Pain in muscles usually occurring during exercise (activity); subsides with rest.
Results from inadequate blood supple to muscle.
Discomfort is predictable and subsides within minutes after exercise (activity).
Level of disease usually proximal to location of symptoms
Pseudo-claudication mimics vascular symptoms but is neurogenic or orthopedic in origin.
Side note: pt history may state 4 block claudication. This means the pt c/o pain after walking 4 blocks.
Ischemic rest pain
Severe symptom of reduced blood flow
Occurs when limb not dependent; BP decreased (such as when sleeping). Affects forefoot, heel, toes.
Tissue loss
Necrosis or death of tissue
Due to deficient or no blood supply
Acute arterial occlusion.
State symptoms, causes, and emergency or not?
Symptoms = 6 P’s: pain, pallor, pulselessness, paresthesia, paralysis, polar
Possible causes = thrombus, emboli, trauma
Emergency situation since no time for development of collateral channels.
Vasospastic Disorders
Raynaud’s phenomenon- what are the symptoms and changes in skin color?
Symptoms of intermittent digital ischemia occur due to cold exposure or emotional stress.
Changes in skin color may include pallor, cyanosis, or rubor
Primary Raynaud’s 3 characteristics.
Ischemia due to digital arterial spasm
Common in young women; may be hereditary, bilateral
Benign condition
Secondary Raynaud’s 3 characteristics
Also known as obstructive Raynaud’s syndrome
Normal vasoconstriction of arterioles present with a fixed artery obstruction. Ischemia constantly present.
May be the first manifestation of Buerger’s disease
Skin changes - Color
Pallor- Result of deficient blood supply; skin pale
Cyanosis- concentration of deoxygenated hemoglobin, causes bluish discoloration
Rubor- Suggests dilated vessels or vessels dilated secondary to reactive hyperemia; skin is reddened
Lesions (arterial)
Ulcerations located: tibial area, foot, toes
Deep and more regular in shape
Quite painful
Gangrene: tissue death due to lack of blood supply
Duration of ulceration (e.g. days?)
What should capillary filling be like?
An increase in cap refill time denotes decreased art perfusion.
Normal cap refill time is < 3 sec
What does a palpable “thrill” indicate?
It may indicate a fistula, a patent dialysis access site or post stenotic turbulence.
What are the palpable pulses?
AO, fem, pop, dorsalis pedis (DPA), PTA
Pero art is NOT palpable
What are the risk factors for arterial disease
Diabetes HTN Hyperlipidemia Smoking Other
How is diabetes a risk factor?
A. Atherosclerosis: more common;occurs at a younger age
B. Higher incidence of disease: distal pop and tib arts
C. Medial calcification develops in LE arteries; this is associated with increased risk for cardiovascular evens; death usually related to heart disease.
D. Poor sensation (neuropathy) may lead to increased injury.
E. Higher incidence of gangrenous change, amputations.
How is HTN a risk factor?
Two opinions: May cause or enhance the development of atherosclerotic process.
How is hyperlipidemia a risk factor
A. Elevated plasma lipids assoc. with atherosclerosis development.
B. Frequent cause: Diet high in animal fat; metabolic issues based on heredity.
How is smoking a risk factor?
Studies suggest chemicals in cigarettes irritate the artery’s intimal lining causing vasoconstriction
What are other risk factors?
non controllable factors like age and family history
What is the most common arterial pathology?
Atherosclerosis (obliterans) - thickening , hardening , loss of elasticity of artery walls.
These changes occur in the intima and media layer of vessel
Risk factors of atherosclerosis
smoking, hyperlipidemia, family history. Less important factors- HTN, diabetes, sedentary lifestyle, and arterial wall shear/stress.
Most common sites of atherosclerosis
Carotid bifurcation
Aorto-iliac system
CFA bifurcation
SFA distal
What is Leriche Syndrome?
What is it caused by?
Example of atherosclerosis caused by obstruction of the AO; occurs in males and is characterized by:
fatigue in hips, thighs, or calves with exercise
absence of femoral pulses
impotence
often times, pallor and coldness of LE
What is an embolism? what form may they come in and what are the most frequent causes?
It is an obstuction of vessel by forein substance or blood clot.
Emboli may be solid, liquid or gaseous
Most frequent causes: small plaque breaks loos (e.g. atherosclerotic lesion, arteritis, or angiographic procedure); travels distally until it lodges in smallest vessel
Example: Blue toe syndrome (trash foot). Toe ischemia results; often improves, mainly from collateralized branches.
What is a true aneurysm and what are two examples
dialation of all three arterial wall layers
Ex:
fusiform - diffuse, circumferential dilatation
Saccular: localized “sac-like”
What is a dissecting aneurysm
This happens when a small tear of the inner wall allows blood to form cavity between two wall layers. Often occurs in thoracic aorta.
Describe a pseudoaneurysm
This results from a defect in main artery wall (e.g. post catheter insertion). Must have a communication from main artery to pulsatile structure outside vessel wall
What is the most common location of a true aneurysm and what are other locations?
Most common - infrarenal aorta. Other locations- throacic ao femoral pop renal
True/ False
Pt’s with one aneurysm have a higher incidence of 2
More often of the CFA or Pop A as opposed to elsewhere
Cause unknown; (e.g. ? poor nutrition, infection, or atherosclerosis)
All true
What is the most frequent complication of an aneurysm?
Rupture of AO aneurysm; embolization of the peripheral aneurysms
Both types can accumulate thrombus inside
What are some non-atherosclerotic lesions?
Arteritis Coarctation of the AO Dissection Vasospastic disorders Entrapment syndrome
What is arteritis, what can it affect, types, and charateristics?
Can affect tibial, pero arts, or smaller more distal arterioles.
Inflammation of arterial wall can lead to thrombosis.
Type: Buerger’s disease (thromboangiitis obliterans)
Occurs primarily in men < 40 yr old who smoke heavily
Pts present with occlusions of distal arteries
Rest pain and ischemic ulceration present.
