Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD) Flashcards
What is coronary artery disease ?
soft deposits of fat known as plaque, hardening over time and with age that reduces the blood flow in the coronary arteries
- mostly caused by atherosclerosis
- can lead to angina & acute coronary syndrome
What are the developmental stages of CAD ?
- Endothelial injury
- Fatty Streaks
- Fibrous Plaque
- Complicated Lesions
What causes endothelial injury ?
- HTN
- tobacco use
- hyperlipidemia
- hyperrhomocysteinemia
- Diabetes
- infections
- toxins
What is the fatty streak ?
where the lipids accumulate and migrate into the smooth muscle cells
- earliest lesion of atherosclerosis
What is fibrous plaque ?
collagen covers the fatty streak and causes the lumen to narrow
- blood flow reduces and fissure can develop
What is complicated lesions ?
where the plaque ruptures which causes platelets to accumulate, forming a thrombus which can totally occlude the artery
- further narrowing or total occlusion
What are the 2 branches of the left coronary artery ?
- left anterior descending
- left circumflex artery
What does the left coronary artery supply blood to ?
- left atrium and ventricle
- interventricular septum
- portion of the right ventricle
What does the right coronary artery supply blood to ?
- right atrium
- right ventricle
- portion of posterior wall of left ventricle
What are some modifiable risk factors for CAD ?
- elevated serum lipids
- HTN
- tobacco use
- physical inactivity
- obesity
- diabetes
- substance abuse
What are non-modifiable risk factors for CAD ?
- increase in age
- ethnicity
- gender
- genetic link
What are some treatment options for CAD ?
- identifying high risk pt’s (screenings)
- health promotion (modifiable changes)
- physical activity (FITT)
- nutritional therapy (complex carbs and low cholesterol)
What are some seasonings/oils someone with CAD should eat primarily ?
- vegetable oils
- nuts (walnuts)
- some fish oil and shellfish
- seeds (pumpkin, sunflower)
- margarine
What meds does someone with CAD take ?
- Lipid Lowering Therapy: -statins, niacin, etc
- Antiplatelet Therapy: ASA (aspirin) & Clopidogrel (Plavix)
What is peripheral artery disease ?
progressive narrowing and degeneration of the arteries of the upper and lower extremities
- also because of plaque but atherosclerosis is the leading cause
- involves thickening of the artery walls
- increases with age
- common in the legs
Where do diabetic patients more commonly get PAD ?
in the arteries below the knee
What are some risk factors of PAD ?
- smoking (greatest risk)
- hyperlipidemia
- hyperuricemia
- HTN
- earlier onset of diabetes
- high homocysteine levels
- obesity/sedentary lifestyle/stress
What are some symptoms of PAD ?
- claudication pain
- rest pain
- thin, shiny, taut, dry skin
- loss of hair on lower legs
- cool skin temperature
- reactive hyperemia
- thickened or brittle nails
- erectile dysfunction
What causes claudication pain ?
not enough blood is flowing to the muscles causing damage
- caused by exercise
- resolves within 10 mins of rest
- reproducible pain
What causes rest pain in PAD ?
blood flow is insufficient to meet basic requirements of distal tissues
- happens mostly at night when cardiac output decreases
What are the 6 P’s in PAD ?
- pain: rest or claudication pain
- pallor: with elevation
- pulselessness
- paresthesia: due to nerve tissue ischemia
- paralysis
- poikilothermia: cold, inability to regulate body temp
Where are arterial ulcers found in PAD ?
- bone prominences
- ends of toes
- lateral ankle
What is critical limb ischemia ?
chronic ischemia rest pain lasting more than 2 weeks, non healing arterial leg ulcers, or gangrene of leg
- high risk for limb loss
What are some complications that can happen because of PAD ?
- blood clots
- arterial ulcers
- delayed wound healing
- wound infection
- tissue necrosis leading to gangrene
- critical limb ischemia
What is gangrene ?
localized death and decomposition of body tissue
- results from obstructed circulation or bacterial infection
What are some diagnostic tests for PAD ?
- doppler ultrasound
- segmental blood pressures
- ankle brachial index
- duplex imaging
- angiography
- magnetic resonance angiography
What is a segmental blood pressure ?
uses a doppler ultrasound and sphygmomanometer at the thigh, below the knee and at the ankle while the pt is supine
- decrease off of more than 30 mmHg means PAD
What is duplex imaging ?
shows blood flowing through the artery and the specific degree of stenosis of the artery
- beneficial because it shows an entire region
What is a normal ABI score ?
0.91 to 1.3
What is a mild PAD ABI score ?
0.71 to 0.9
What is a moderate PAD ABI score ?
0.41 to 0.7
What is a severe PAD ABI score ?
< 0.4
Do you elevate or dangle legs for PAD pain ?
dangling legs
- can cause reactive hyperemia to occur which is ok
What is reactive hyperemia ?
redness of the skin when in a dependent (dangling) position
How does exercise help with PAD ?
walking is the most effective exercise for pt’s with claudication pain
- 30 to 60 mins/day
- 3-5x week
What is wound care for a ulcer and gangrene ?
- ulcer: cover with dry, sterile dressing
- gangrene: betadine because it helps protect the skin and control odor
What is some skin care for PAD ?
- gentle lotion in extremities (avoid chemicals)
- avoid soaking feet
- avoid lotion between toes
- avoid extreme heat or cold
- no tight or restrictive clothing
What medications does some with PAD take ?
- Antiplatelets: aspirin, clopidogrel (take both if high risk or if they can’t tolerate aspirin)
- Anti-claudication: Pentoxifylline (less effective), cilostazol (for less than 3 months to avoid SE, no HF pt’s)
- ACE inhibitors: for vasodilation and relief of symptoms
- Statins: to control lipids
- Diabetes meds: to manage glucose
What procedures can be done for PAD ?
- angioplasty (PCTA) stent placement
- atherectomy/endarterectomy
- peripheral artery bypass surgery
- amputation
What is a atherectomy/endarterectomy ?
surgical removement of plaque
What are some post procedure assessments ?
- assess 6 P’s q 15 mins then hourly
- monitor for bleeding/hematoma
- monitor for signs of thrombosis/embolization
- monitor for signs of compartment syndrome
- encourage early and frequent ambulation to promote perfusion
