Chronic Lower Limb Ischaemia Flashcards
What occurs when insufficient blood reaches exercising muscle?
intermittent claudication
A patient with intermittent claudication is always in pain. T/F?
False
pain-free at rest
What are the stages of the Fontaine scale?
I - asymptomatic IIa - after > 200m IIb - after < 200m III - rest pain (night time worst) IV - tissue loss (gangrene)
What 2 pressures are used to calculate ABPI?
Ankle Brachial Pressure Index:
ankle pressure / brachial pressure
What should you check for before measuring ABPI?
calcified vessels e.g. diabetes
What are Doppler effects (used in Duplex US scan)?
shifts in wavelength caused by movement of source or reflecting surface
What are the non-invasive tests used to diagnose intermittent claudication?
Duplex US
ABPI
What are the invasive tests used to diagnose intermittent claudication?
MR or CT angiography
What are the risk factors of intermittent claudication?
male old diabetes smoking hypertension hypercholesterolaemia fibrinogen alcohol
What is ‘Gaurdian therapy’?
Treatment to slow the progression of intermittent claudication, targets: smoking hypertension lipid lowering antiplatelets diabetes lifestyle issues
INFORMATION
How can IC symptoms be improved?
exercise training - prolongs time until pain
drugs
angioplasty/stenting
surgery
What is the drug indicated in IC patients with no tissue necrosis or rest pain?
Cilostazol - inhibitor or PDE3 -> increase cAMP -> increase protein kinase A -> inhibition of platelet aggregation.
PKA also inhibits MLCK.
= vasodilatory effect
What can cause ulcers/gangrene in critical limb ischaemia?
trauma / footwear
What are symptoms of critical limb ischaemia?
(nerve) pain at rest (toe and foot)
requires strong analgesia
worse at night
What are some relieving factors of critical limb ischaemia?
helped by sitting in and leg in a dependent position
helped by getting up and walking about
