CV 2

Question 1

LVAD- left ventricular assist device

Answer 1

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

Question 2

Indication LVAD

Answer 2

indication in L heart failure: bridge transplant and destination therapy. 40% bridge, 40% det if candidate for transplant, 15% destination, 5% native recovers

Question 3

Precautions- LVAD

Answer 3

drive line from LVAD + power source availability

Question 4

Prognosis w LVAD

Answer 4

similar to heart transplant for exercise and QQl similar to transplant

Question 5

Peripheral VASCULAR disease (PVD) - def, categories

Answer 5

• 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

Question 6

Peripheral Artery disease - def

Answer 6

• 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

Question 7

peripheral artery disesase - s/s

Answer 7

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

Question 8

peripheral artery disease- risk factors + sequelae

Answer 8

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*

Question 9

PAD - dx

Answer 9

1. 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
2. 5-0.8 = moderate - refer to vascular specialist
3. Doppler
4. MR
5. Angiography

Question 10

PAD - chronic changes

Answer 10

thickening of nailbeds, drying of skin, loss of hair on feet and toes, temp. differences, muscle atrophy, diminished sensation, diminished strength

Question 11

PAD - severe disease

Answer 11

ulcerations, gangrene, pain, diminished fct. capacity

Question 12

PAD - tx

Answer 12

NON-invasive and invasive

Question 13

PAD - non- invasive tx

Answer 13

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.

Question 14

PAD - invasive tx.

Answer 14

angioplasty / stents
surgical bypass ( graft bypass)
amputation

Question 15

bridge to transplant =

Answer 15

40% o VADs are used for bridge to transplant, for pt’s waiting for a heart transplant

Question 16

destination therapy =

Answer 16

elected ppl. use VAD’s as long-term (permanet) support as a substitute for cardiac transplant

Question 17

PVD vs PAD

Answer 17

PVD (peripheral vascular disease) is more broader refers to arteries and veins
PAD (peripheral arterial disease refers only to arterial blood vessels)!!!

Question 18

intermittent claudication is a

Answer 18

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

Question 19

silent ischemia can be caused by

Answer 19

PAD because of intermittent claudication. IT happens when arteries become blocked without symptoms !!! It is suspected when systolic BP is lower @ankle

Question 20

PAD can have the 6 P’s

Answer 20

pain, 
paresthesia ( pain relieved when limb is elevated), paralysis, 
pulsessnes ( no pulse),
pallor (pale )
perishing cold

Question 21

PAD used drugs of tx

Answer 21

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.