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Yr3 CARDIOVASCULAR > Condition- PVD (acute & chronic) > Flashcards

Condition- PVD (acute & chronic) Flashcards

1
Q

Define Peripheral Vascular Disease

A

Occurs due to atherosclerosis causing stenosis of arteries via a multifactorial process involving modifiable and non-modifiable risk factors

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2
Q

What is the main cause of PVD?

A

ATHEROSCLEROSIS

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3
Q

What are the classifications of PVD?

A
  1. CHRONIC LIMB ISCHAEMIA:
    • Intermittent Claudication
    • Critical Limb Ischaemia
  2. ACUTE LIMB ISCHAEMIA
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4
Q

Which of the three different types of PVD and limb ischaemia is the most severe?

A

CRITICAL LIMB ISCHAEMIA => tissue loss (ulcers+ gangrene)

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5
Q

What is acute limb ischaemia?

A

A sudden decrease in arterial perfusion in a limb

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6
Q

List some causes of acute limb ischaemia

A
  • thromboembolic event
  • AF
  • trauma
  • iatrogenic- pos angioplasty/sugery
  • Choleserol from long bone #
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7
Q

List some modifiable risk factors for PVD

A
  • Diet- high cholesterol
  • Smoking
  • Lack of exercise
  • High BP
  • Obesity
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8
Q

List some non-modifiable risk factors for PVD

A
  • Genetics
  • FHx: of hyperlipidaemia/ Hypertension/ T2DM
  • Age
  • Gender: Male
  • PMHx: of T2DM
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9
Q

What level of vascular stenosis is required for a patient with PVD to be symptomatic?

A

50%

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10
Q

List some common presenting symtpoms of someone with Intermittent Claudication

A
  • Cramping pain on exercise aftere a set distance/ time (=claudication distance)
  • Rapidly relieved on rest
  • Pain absent on rest/ at
  • Calf pain/ Buttock pain
  • risk factors present
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11
Q

List two arteries which are commonly claudicated and state which part of the body may feel pain

A
  • Calf claudication = superficial femoral disease
  • Buttock claudication = iliac disease (internal or common)
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12
Q

List some common presenting symptoms of a patient with Critical limb ischaemia

A
  • Pain at rest
  • Pain at night (relieve by dangling leg over the edge of the bed)
  • Ulceration
  • Gangrene

SIGNS:

  • Shiny scaly skin (due to SC tissue loss)
  • thickened toe nails
  • Loss of hair over dorsum of foot
  • Dependent rubor
  • Muscle atrophy
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13
Q

Which classification system is used to classify PVD?

A

FONTAINE CLASSIFICATION

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14
Q

Describe the different stages of the Fontaine Classification system which is used to classify symptoms of PVD

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Ischaemic pain
  4. Ulceration/ Gangrene
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15
Q

List some signs and symptoms of acute limb ischaemia

A

6Ps

  • Pain
  • Pulseless
  • Pale
  • Paralysis
  • Paraesthesia
  • Perishingly Cold

Other symptoms:

  • Atrophic skin
  • Hairless
  • Punched-out ulcer (often painful)
  • Colour change when raising leg
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16
Q

What is the first line examination for a patient presenting with PVD

A

ANKLE BRACHIAL PRESSURE INDEX (ABPI)

17
Q

How is ABPI calculated?

A

Ankle SBP/ Brachial SBP

18
Q

What are the typical ABPI values for:

i. Normal people
ii. Intermittent claudication
iii. Critical limb ischaemia
iv. the range where tissue loss occurs

A

i. Normal people: 1-1.2
ii. Intermittent claudication: 0.5-0.9
iii. Critical limb ischaemia: <0.5
iv. the range where tissue loss occurs: <0.2

19
Q

Which investigation would you conduct on a patient with suspected chronic limb ischaemia

A
  • History + exam
  • BEDSIDE: ABPI + ECG (check for AF=clots)
  • BLOODS: lipid profile + HbA1c, FBC (anaemia), U+Es (renal disease)
  • IMAGING:
    • Gold standard: MRI/CT angiogram
    • US Duplex scan
20
Q

Why is it important not to place a pressure cuff on a patient with an ABPI of less than 0.8?

A

this will worsen the ischaemia

21
Q

How are patients with Chronic Limb Ischaemia managed?*

A
  1. CONSERVATIVE: diet mods, smoking cessation, exercise
  2. MEDICAL: preventative (BP + BM control), statins, anti-platelets (clopidogrel)
  3. SURGICAL:
    • Percutaneous Transluminal Angioplasty +/- stent
    • Surgical reconstruction (Bypass)
    • Amputation
22
Q

How is acute limb iscahemia managed?*

A
  • EMBOLECTOMY- wire fed through vessel and withdrawn with balloon
  • THROMBOLYSIS
  • POST-EMBOLECTOMY: anticoagulated with heparinà warfarin
23
Q

State two major complication treating acute limb ischaemia*

A
  • Reperfusion Injury: tissue damage caused when blood supply returns to the tissue after a period of time
  • Swelling causing COMPARTMENT SYNDROME

Yr3 CARDIOVASCULAR (34 decks)

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