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CDM 1 Exam 2 > Hyperlipidemia: PAD > Flashcards

Hyperlipidemia: PAD Flashcards

1
Q

PAD definition

A

progressive narrowing of arteries due to atherosclerosis

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2
Q

Primary indicator of PAD?

A

Intermittent claudication

Fatigue, discomfort, cramping, pain or numbness in affected extremities during exercise and resolves within a few minutes of rest

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3
Q

Critical Limb ischemia

A

chronic ischemia at-rest pain, ulcers, or gangrene in one or both legs

amputation ranges from 10-40%

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4
Q

PAD in males

A

increase with age

Black patients have highest incidence

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5
Q

PAD in females

A

increase with age

Black and Native American patients have highest incidence

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6
Q

At what age does incidence seem to jump for PAD?

A

Around age ~80

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7
Q

Global PAD rates

A

200 million pts worldwide

8.5 million pts in US

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8
Q

PAD risk factors (from greatest impact to least)

A

Smoking
Diabetes
HTN
Hypercholesterolemia

C-reactive protein
Black race
Clcr <60
Age >40

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9
Q

Risk factors for increased risk of Limb loss in pts w/ Critical Limb Ischemia

A

Factors that reduce blood flow to microvascular bed

Factors that increase demand for blood flow to the microvascular bed

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10
Q

Factors that reduce blood flow to microvascular bed?

A 
Diabetes
Renal Failure
Decreased cardiac output (severe HF or shock)
Smoking and tobacco use
*Vasospastic diseases
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11
Q

Factors that increase demand for blood flow to microvascular bed?

A

Infection

Skin breakdown or traumatic injury

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12
Q

% of Asymptomatic patients with PAD?

A

50%

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13
Q

% PAD Signs and Symptoms

A

15% - Classic (Typical) Claudication
33% - Atypical Leg pain (functionally limited)
1-2% Critical Limb Ischemia

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14
Q

Claudication signs and symptoms

A

Ache or burning in leg muscles, or other pain after short exercise

Not present at rest

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15
Q

Critical Limb Ischaemia signs and symptoms

A

Pain at rest

Ulceration or Gangrene

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16
Q

Acute Limb-threatening ischemia signs and symptoms

A

Rare but important not to miss.
Sudden onset of symptoms
“6 P’s” = Pan at rest, pallor, Pulseless, Parasthesia, Paralysis, Perishingly cold

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17
Q

How to calculate ABI?

A

Highest ankle SBP / highest brachial SBP

Can be resting or post exercise

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18
Q

ABI 1.3-1.4, >1.4, then PAD is….

A

Likely

Artery too calcified to be compressible, need Toe Brachial Index

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19
Q

ABI 1 - 1.3, then PAD is…..

A

Not likely

20
Q

ABI 0.91 - 0.99 then PAD is…

A

Maybe

21
Q

ABI is < or equal to 0.9, or resting is normal but post exercise is <0.9 or >20% drop in ABI then PAD is…

A

Diagnosis for PAD

22
Q

Mild PAD

A

Resting ABI <0.9 or post exercise <0.9

23
Q

Moderate PAD

A

Resting ABI <0.7, or post exercise <0.5

24
Q

Severe PAD

A

Resting ABI <0.5, or post exercise <0.15

25
Q

Goals in treating patients with PAD

A

Limb outcomes:
Improved ability to walk (measure in distance before get symptoms)
Prevention of progression to CLI and amputation

CVD morbidity and mortality outcomes

26
Q

Confirmed PAD -> No sig functional disability…..

A

no treatment require

annual follow up to monitor

27
Q

Confirmed PAD -> Life style limiting symptoms……

A

Supervised exercise program for 3 months
+
Drug therapy 3 months (anti platelet) + Cilostazole if claudication present

IF significant disability despite therapy, Endovascular therapy or bypass surgery might be required

28
Q

Confirmed PAD -> Life style limiting symptoms w/ evidence of inflow disease….

A

Use more extensive noninvasive or angiographic diagnostic techniques

Endovascular therapy or surgical bypass based on findings

29
Q

Nonpharmacological Therapy of PAD

A

Stop smoking
Supervised Exercise (3 times per week for 30-45 min)
Follow NCEP ATP III, DASH, or TLC
*Revascularization Therapy in advanced patients

30
Q

Supervised Exercise Therapy

A 
Frequency: 3-5 times/week
Duration: 36-45 min
Type: treadmill, track walking, etc
Length: > 3 months
Results: 100-150% increase in QOL and distance they can walk
31
Q

Revascularization Procedures for PAD

A

Endovascular:
PTA, Stent

Surgical:
Bypass, reconstruction

32
Q

Antiplatelets based off guidelines

A
  1. ASA = Best Data
  2. Aggrenox = as effective as ASA but more SE
  3. Clopidogrel = 1st line but only when cant do ASA
  4. Ticlopidine = Black box, do not use
33
Q

Cilostazol (Pletal) info

A

Platelet aggregation inhib
Vasodilation
inc HDL 10%
dec TG 15%

34
Q

Cilostazol Contraindications

A

HF (increased mortality)*****

Active Bleedings

35
Q

Pentoxifylline (Trental)

A

not recommended

Less effective than cilostazole

36
Q

Drug w/ goal to reduce ischemic events

A

ASA or Clopidogrel

37
Q

Drug w/ goal to improve claudication symptoms

A

Cilostazol

38
Q

PAD guidelines w/ Hyperlipidemia

A

Statins = yes

39
Q

PAD guidelines w/ HTN

A

ACEi may offer added protection

40
Q

PAD guidelines w/ Smoking

A

Help stop smoking

41
Q

PAD guidelines w/ Diabetes

A

Treat DM to goals

42
Q

PAD guidelines w/ Antiplatelets

A

PAD symptoms: Antiplatelets = good, ASA 1st or clopidogrel if not

NO PAD symptoms: ABI <0.9 = Antiplatelets

43
Q

Eval for Amputation if….

A

Sig necrosis of weight-bearing portion of foot

Paresis of extremity

Refractory ischemic rest pain

Sepsis

Limited life expectancy

44
Q

Angioplasty ok if…

A

life expectancy <2yr or cant do bypass

45
Q

Bypass option if….

A

life expectancy >2yrs

better life expectancy but higher risk

CDM 1 Exam 2 (16 decks)

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