CV 2 Flashcards
LVAD- left ventricular assist device
treatment , is a left ventricular operated device, surgically implanted (pulsatile or non pulsatile), implanted to abdomen has a wire and a battery. W pulsatile LVAD you can get a pulse pressure, heart beat
- non pulsatile LVAD= no BP or pulse
Indication LVAD
indication in L heart failure: bridge transplant and destination therapy. 40% bridge, 40% det if candidate for transplant, 15% destination, 5% native recovers
Precautions- LVAD
drive line from LVAD + power source availability
Prognosis w LVAD
similar to heart transplant for exercise and QQl similar to transplant
Peripheral VASCULAR disease (PVD) - def, categories
- afect 8mil Americans older than 60 y.o.
- pathologic cond. for blood vessels for extremities UE+LE and abdominal organs
-categ. (underlying pathological findings):
1.inflammatory disorders,
2- arterial oclusive disorder,
3 - venous disorder,
4 - vasomotor disorder
Peripheral Artery disease - def
- Atherosclerosis OCCLUSIVE disease of peripheral arteries to legs. IS a progressive disease like CAD(coronary artery disease), it has vascular reactivity and it happens usually before the bifurcation of the common iliac arteris
peripheral artery disesase - s/s
INTERMITTENT CLAUDICATION (=received w REST, v imp.) and it cause SILENT ISCHEMIA -pain,, paresthesia ( when limb is elevated, tingling), paralysis of leg , diminished pulses, cool limb , PALLOR
peripheral artery disease- risk factors + sequelae
RF: smoking, HTN, high cholesterol, males and increased age
SEQUELAE: MI, CVA, gangrene, amputation, arterial ulcers, paresthesia, paralisis of leg, diminished pulses a lot or sometimes having pulse but still having PAD (periph. art. disease)
S/S** bilateral ( because the occlusion happens at ILiac bifurcation)= very similar to diabetic neuropathy*
PAD - dx
- ANKLE BRACHIAL INDEX (ABI) = systolic BP arm divided by systolic BP of lower extremities and it has High sensitivity (95%) and specificity (95%). So you take BP in arms and ankles ipsilateral and divide the systolic BP.
- most common diagnosis is the ABI =Normal 1-1.4 - 5-0.8 = moderate - refer to vascular specialist
- Doppler
- MR
- Angiography
PAD - chronic changes
thickening of nailbeds, drying of skin, loss of hair on feet and toes, temp. differences, muscle atrophy, diminished sensation, diminished strength
PAD - severe disease
ulcerations, gangrene, pain, diminished fct. capacity
PAD - tx
NON-invasive and invasive
PAD - non- invasive tx
lifestyle modifications, treat. HTN + high cholesterol, meds: anti-platelet(aspirin) and anti-coagul.( warfarin) meds, antithrombotic drugs. Also lose wt, increase physical activity, and foot care.
PAD - invasive tx.
angioplasty / stents
surgical bypass ( graft bypass)
amputation
bridge to transplant =
40% o VADs are used for bridge to transplant, for pt’s waiting for a heart transplant
destination therapy =
elected ppl. use VAD’s as long-term (permanet) support as a substitute for cardiac transplant
PVD vs PAD
PVD (peripheral vascular disease) is more broader refers to arteries and veins
PAD (peripheral arterial disease refers only to arterial blood vessels)!!!
intermittent claudication is a
Vessels narrow by 50% symptom of a disease, caused by occlusion of arteries w exercise =>pain, ache and cramping in the legs (it happens w PAD) => LIMPING. Intermittent claudication is relieved w rest
silent ischemia can be caused by
PAD because of intermittent claudication. IT happens when arteries become blocked without symptoms !!! It is suspected when systolic BP is lower @ankle
PAD can have the 6 P’s
pain, paresthesia ( pain relieved when limb is elevated), paralysis, pulsessnes ( no pulse), pallor (pale ) perishing cold
PAD used drugs of tx
Antithrombotic- reduce the formation of thrombus
Anticoagulants- reduces the ability of the blood to clot
Antiplatelet- limits the aggregation or migration of platelets thus preventing clots.
