[DSA] Skin Changes in Cardiopulmonary Disease

Question 1

6 Ps of Acute Limb Ischemia

Answer 1

Arterial occlusion - may lead to amputation if no emergent intervention

Paresthesia

Perishing cold

Pulseless

Pain

Paralysis

Pallor

Question 2

Venous changes in the skin due to cardiopulmonary dz manifest how?

Answer 2

Superficial varicosities

Edema

Systemic HTN may contribute, usually chronic

Question 3

Patient w/ hx of HTN presents with reddish brown discoloration and thickening of the skin over the past several months. Pt also reports varicose veins and swollen feet.

What caused the change in skin color?

Answer 3

Hemosiderin deposits from red cell breakdown

This is Stasis Dermatitis

Question 4

Pt w/ history of DM and CAD presents with erythema, warmth, and swelling to the lower legs. States that sometimes there’s some fluid coming from the same area. What is one of the top differentials?

Answer 4

Cellulitis

Question 5

What are the classic signs of bacterial endocarditis?

Answer 5

Bacteria FROM JANE

Bacterial endocarditis

Fever

Roth Spots

Osler Nodes - fingers and toes, tender, hours to days

Murmur

Janeway lesions - irregular macules to soles and palms

Anemia

Nail bed hemorrhage

Emboli

Question 6

Are Xanthomas chronic or acute?

Answer 6

Chronic

Question 7

What is the most common form of xanthoma?

Answer 7

Xanthelasma palpebrum - xanthomas on eyelids

Question 8

What lab should you check if patients present with eruptive xanthomas?

Answer 8

Cholesterol panel - pt has hyperlipidema

Question 9

What sx suggest vascular claudication?

Answer 9

Provoked by walking uphill

increased metabolic demands

Absent pulse

Question 10

A patient with increasing weakness after walking, increased lordosis with forward walking may be suspicious for what type of claudication?

Answer 10

Neurogenic

Bending over takes pressure off nerves

Question 11

Risk factors for PVD and central vascular disease (there’s a lot)

Answer 11

Tobacco/nicotine

Vaping

Sedentary lifestyle

Obesity

Diet - high salt, fat, low fiber

HTN

Hyperlipidemia

DM

ETOH excess

FH - genetic predisposition

Question 12

What therapeutic lifestyle changes (TLC) would you suggest to a patient to modify sx of cardiovascular disease?

Answer 12

Smoking cessation

Exercise

Weight loss

Support/compression hose

Psychosocial support

Regular f/u

This is the same as the plan to prevent complications, but you add medications to modify risk factors

Question 13

Skin changes: Diagnostic evaluation for cardiopulmonary dz

Answer 13

CBC

Lipid panel

Fasting blood sugar

EKG

CXR

Ankle/brachial index

Venous/arterial doppler US based on clinical exam

Interventional radiology or cardiology for diagnostic arteriogram and therapeutic intervention