E3: PAD Flashcards
Pathophysiology of PAD
Atherosclerosis in the lower extremities.
Who does PAD primarily occur in?
Those over 70 years of age. (15-20%)
40% of patients with PAD also have CAD, this puts them at __________ risk of CV death.
2-5 Fold increased.
The clinical presentation of PAD is often ________ delaying diagnosis and prevention of complications.
Asymptomatic.
This term defines pain when walking in the buttocks, claves, and thighs. This pain is often relieved with rest, although severe cases have pain at rest. The pain occurs due to partial occlusion of the aortic and iliac arteries.
Intermittent Claudification
What PAD patients are at the highest risk of ulceration, infection, or necrosis?
Those with diabetes and/or smoking history.
When would PAD present as a medical emergency?
When full occlusion of the artery occurs. This requires revascularization to prevent limb loss.
partial blockage of the _________ arteries leads to pain in the buttocks, thigh, and hips.
Aorta and Iliac
partial blockage of the _________ artery leads to pain in the thigh and calf.
Femoral
partial blockage of the _________ arteries leads to pain in the calf, ankle, or foot.
Popliteal
Tibial
ABI of 1-1.4
Normal
ABI of 0.8-0.9
Some PAD
ABI of 0.5-0.8
Moderate PAD
ABI <0.5
Severe PAD.
What are our three treatment options for acute limb ischemia resulting from complete occlusion of an artery?
- Thrombolytics
- Endovascular procedures
- Surgical Procedures
What should all patients presenting with acute limb ischemia be administered?
Systemic Heparin
For symptomatic PAD, what is the long term antiplatelet therapy?
Aspirin 75-325 mg once daily to reduce the risk of MI, Stroke, and vascular death.
In asymptomatic PAD, what is the long term antiplatelet therapy?
Antiplatelet therapy with 75-325 mg aspirin is** reasonable** to reduce risk of MI, stroke, and vascular death.
In symptomatic PAD after lower extremity revascularization, what is the long term anti-platelet therapy?
Aspirin + Clopidogrel to decrease the risk of limb related events.
If a patient is not responding to the maximally tolerated statin dose in chronic PAD management, what drug should be added?
Ezetimibe
When should anti-hypertensives be added to a chronic PAD management plan?
If the patient also has hypertension. However, one of the anti-hypertensives should be an ACEi or ARB.
This drug is an effective therapy to improve symptoms and increase walking distance in patients with claudication.
Cilostazol.
The mechanism of this drug is to inhibit PDE3 (phosphodiesterase 3).
This leads to an increase in cAMP. Which causes:
1. Reversible platelet inhibition.
2. Vasodilation.
3. Inhibition of vascular smooth muscle cell proliferation.
Cilostazol.
Cilostazol Onset of effect.
2-12 weeks to increase walking distance.
