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PVD > Intro to PVD > Flashcards

Intro to PVD Flashcards

1
Q

What is PVD?

A

Any disease of the blood vessels or lymph system outside the heart circulation

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2
Q

What are types of PVD?

A

Arterial
Venous
Lymph

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3
Q

What is the main cause of arterial disease ?

A

Ischemia/insufficiency

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4
Q

What are 2 types of ischemia/insufficiency?

A

Acute

Chronic

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5
Q

What are some examples of acute type of ischemia?

A

Embolism

Arterial spasm

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6
Q

What are some exampled of chronic type of ischemia?

A

Arteriosclerosis obliterans
Athersclerosis
Thromboangiitis obliterans

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7
Q

What are some examples of acute venous insufficiency?

A

swelling
prominent superficial veins
DVT
thrombophelebitis

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8
Q

What are the precursors for chronic venous insufficiency?

A

varicose veins

dermatitis

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9
Q

What are some diagnostic features for Arteritis?

A

Dull ache
Tenderness
Pressure

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10
Q

What are some diagnostic features for phlebitis ?

A

pain with pressure to a vein

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11
Q

What are some diagnostic features for lymphangiitis?

A

red line seen on skin from infection

tender/sore

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12
Q

constriction of a vein

A

venospasm

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13
Q

constriction of any vessel

A

vasospasm

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14
Q

Lymphedema

A

a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system.

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15
Q

What is milroys?

A

inherited disorder that begins in infancy and causes your lymph nodes to form abnormally, leading to lymphedema.

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16
Q

milroys is what kind of lymphedema?

A

congenital

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17
Q

What is praecox?

A

Hreditary disorder often causes lymphedema in childhood or around puberty, though it can occur in your 20s or early 30s. It causes your lymph vessels to form without the valves that keep lymph fluid from flowing backward, making it difficult for your body to properly drain the lymph fluid from your limbs.( it is mostly in female)

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18
Q

Secondary lymphedema can be due to?

A

malignant obstruction
surgical removal of lymph nodes
Pressure
Radiation Treatment

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19
Q

Inflammatory lymphedema can be due to?

A

Recurrent cellulitis
Filariasis ( a parasitic disease )
Secondary to injury

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20
Q

what are some clinical manifestations of lymphedema ?

A 
intermittent claudication
pain
Numbness/stiffness
trophic changes 
Delayed capillary filling time
Absent/diminished pulses
color changes 
ulcerations
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21
Q

What are some associated presenting symptoms with PVD?

A 
medications
tobacco
alcohol
leg cramps, varicose veins , ulcers 
DM
cardiac disease 
HTN, stroke , rhematic fever
prior surgeries
collagen vascular disease 
vasospastic disease , Raynauds phenomenon
Nocturnal pain
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22
Q

Vascular exam is consisted of

A

Skin exam

Pulses

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23
Q

What should you pay attention to in skin exam portion of vascular exam?

A

color
texture
appearance

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24
Q

what pulses should you take ?

A 
femoral
popliteal
posterior tibial
dorsalis pedis 
Perforating peroneal
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25
Q

Grading of pulses

A 
0-absent 
1-diminished 
2-normal 
3-accentuated
4-aneurysmal
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26
Q

What do you do if you are not sure about pulses ?

A

you Auscultate ( manual or doppler )

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27
Q

What artery is occuled in Allen’s test

A

Radial artery

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28
Q

What do you see in podiatric vascular exam in PVD?

A

pallor with elevation

Rubor with dependency

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29
Q

with elevation normal color should return in

A

10 s

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30
Q

In diseased feet with elevation normal color will return in

A

40-60 s

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31
Q

How is the skin texture in arteriosclerosis obliterans?

A

atrophic or thin skin

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32
Q

How is the skin texture in lymphedema?

A

Thick skin

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33
Q

How is the skin texture in scleroderma?

A

smooth and shiny

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34
Q

What is the normal CFT?

A

2-4 sec

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35
Q

What does delayed in CFT mean?

A

decrease in flow due to obstruction/spasm

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36
Q

What does Smith-Wick test measure?

A

Subpapillary venous plexus filling time

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37
Q

arterial system is directly connected to the venous system through

A

capillary network

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38
Q

Lymphatic system consist of what type of vessels ?

A

blind ended

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39
Q

vascular system is consisted of

A 
Endothelial cells
BM
Elastic tissue
Collagen
Smooth muscle
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40
Q

Arterial histology

A

mostly smooth muscle and endothelium

Largely tunica media

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41
Q

Veins histology

A

larger than aa
thiner walls
few smooth muscles for small amount of dilation and contraction

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42
Q

what is degenerative artheriopathies

A

interference of the flow of blood through the arteries

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43
Q

What are some diseases asoociated with degenerative artheriopathies ?

A 
Atherosclerosis
Arterioslerosis
Monckeberg's sclerosis
Fibromuscular dysplasia
Thromoangiitis onliterans
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44
Q

Atherosclerosis

A

Increased thickinening of the tunica intima layer
Accumulation of lipids, CHO deposits and blood products
increase in intra-arterial pressure

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45
Q

Atherosclerosis occurs in conjunction with

A

Arteriosclerosis

46
Q

plaques are unique to

A

arteries

47
Q

What appears first in atherosclerotic lesions ?

A

Fatty streak

48
Q

What replace the smooth muscle cells in atherosclerotic lesions ?

A

Complicated lesions

49
Q

What is the first sign of atherosclerosis ?

A

Fatty streak

50
Q

Where do you see fatty streak in atherosclerosis ?

A

arterial wall just beneath the endothelium

51
Q

What are fatty streak?

A

lipid containing foam cells

52
Q

Where do fatty streak occur?

A

in coronary aa

53
Q

What is the fate of fatty streak?

A

Can evolve into atherosclerotic plaques
can remain stable
can regress

54
Q

H-H theory

A

Thrombosis leads to plaque development

55
Q

lipoprotein oxidation theory?

A

lipid and protein oxidation products are responsible for lesion formation/ development

56
Q

what is the major target for oxidation ?

A

intimal low density lipoprotein

57
Q

What are some pro-atherogenic properties of in vitro oxidized lipoprotein ?

A

chemotaxis
Sterol accumulation in macrophages
Adhesion molecule expression on endothelial cells
Apoptosis of several cell types

58
Q

what happens in arteriosclerosis obliterans?

A 
Increased thickening of the intima
Increased calcium 
Increased diameter
Loss of elasticity
hardening of the arteries 
occurs throughout the arterial system
59
Q

What are some major risk factors for Arteriosclerosis obliterans (ASO)

A 
Stress
HTN
DM
Sicke cell 
Hyperlipidemia
obesity
hereditary
diet
tobacco use
60
Q

Pathology of ASO?

A

obstruction of blood flow through large arteries and therefore ischemia

Ischema causes collateral circulation to increase

Less pressure and less blood flow in small vessels since large arteries are occluded.–> ischemia to tissues

poiseuille’s law

61
Q

what is poiseuille’s law?

A

Flow is proportional to the 4th power of radius of the vessel

62
Q

What are some clinical findings of Arteriosclerosis?

A

pain due to build up of lactic Acid ( product of anaerobid glycolysis) and ischemic pain begins

63
Q

What are the symptoms of ASO?

A

Intermittent claudication
Exercise and pain begins
rest and there is relief of pain

64
Q

What is the first sypmtom in ASO

A

Intermittent claudication and pain

65
Q

ABI in ASO is uaually

A

< 0.7

66
Q

What are symptoms of PVD?

A

rest pain
Ulcerations
Gangerene
Disuse atrophy

67
Q

Differential diagnosis for pseudo-claudication?

A 
non vascular caudication 
neurologic 
herniated disc or spinal stenosis 
Arthriditis 
DJD
deformities
multiple hereditary exostoses
usually bilateral 
variable walking distances
68
Q

Caudication -onset

A

walking

69
Q

Caudication -character

A

cramp/pain

70
Q

Caudication bilateral

A

yes and no

71
Q

Caudication -distance

A

fairly consistent

72
Q

Caudication -cause

A

ASO

73
Q

Caudication -relief

A

rest

74
Q

Pseudo-claudication-onset

A

standing /walking

75
Q

Pseudo-claudication-character

A

paresthesias

76
Q

Pseudo-claudication-bilateral

A

yes

77
Q

Pseudo-claudication-distance

A

variable

78
Q

Pseudo-claudication-cause

A

spinal stenosis

79
Q

Pseudo-claudication-relief

A

sit

80
Q

Monckeberg sclerosis

A

senile medical calcinosis
scar tissue and fibrous tissue replaces muscle
mostly in middle age men
doesnt indicate arterial occlusive disease or arterial wall weakness
doesnt get into adventitia or lumen

81
Q

juvenile and presenile calcinosis

A

Rare
Extensive calcinosis
No evidence of lumen obstruction

82
Q

Fibromuscular dysplasia

A

non-atherosclerotic, non-inflammatory vascular disease that causes abnormal growth within the wall of an artery
intermediate sized arteries
leading cause for renal vascular HTN
strings of beads on arteriogram

83
Q

cystic degeneration of popliteal artery

A

sudden onset

distal pulses present at rest, absent on exercise

84
Q

doppler exam can be

A

audible

visual

85
Q

what is a doppler shift?

A

change in frequency and is proportional to blood flow velocity

86
Q

When plaques are present they are

A

bi or monophasic

87
Q

triphasic form is

A 
ventricular systole
Diastole ( deflection)
elastic recoil ( dichrotic notch )
88
Q

What is ABI

A

ankle brachial index

compare ankle pressure to arm pressure

89
Q

ABI is difficult to analyze in

A

calcified vessels

will be falsely elevated

90
Q

Normal ABI

A

1

91
Q

moderate ABI

A

0.8-1.0

92
Q

intermittent claudication

A

0.6-0.8

93
Q

Rest pain

A

0.4-0.6

94
Q

ulcerations

A

<0.4

95
Q

success for healing ABI for non DM

A

0.35

96
Q

Success for healing ABI for DM

A

0.45

97
Q

How to measure segmental pressue

A 
put 4 cuffs in 
high thigh
above the knee
below the knee
ankle
98
Q

how to read segmental pressure

A

a drop between segments of over 30mmHg shows disease in the vessel above

99
Q

what is the normal value for segmental pressure

A

70-120

100
Q

What is photoelectric plethysmography? PPG

A

indirect summation of blood in microcirculation of the toe

Intensity of light reflected by cutaneous microcirculation

101
Q

what is the normal value for PPG?

A

50mmHg

102
Q

What is transcutaneous oxygen pressure ?

A

quantifies skin oxygenation
useful in advanced stages of arteriopathy for evaluation of cutaneous ischemia
indicator of amputation level

103
Q

What does TCPO2 above 30mmhg mean

A

predictive of spontaneous healing

104
Q

What does TCPO2 below TCPO2 below 10mmHg mean?

A

it is unfavorable

105
Q

What is the treatment for PVD?

A

Walking program
D/C smoking
Decreased Bp
Lose weight

106
Q

Pharmacologic treatment for arteriosclerosis

A

Pentoxyfylline (Trental) 400 mg I tab PO TID

Ciostazol (Pletal) 100 mg 1 tab PO BID

107
Q

Pentoxyfylline (Trental)

A

increase erythrocyte flexibility
must take at least 1 month to see a result
inhibit platelet agregation
interferes with caffeine and theophylline

108
Q

Ciostazol (Pletal)

A

vasodilatory and antiplatelet acticity

inhibity type III phosphodiasterase activity

109
Q

What are some surgical treatment options for PVD?

A

Bypass
Thromectomy/Endarterectomy
Angioplasty

110
Q

what are some podiatric treatment options for PVD?

A

once blood flow is established
Amputatate at appropriate level
Flap
Graft

111
Q

Goals of therapy for critical limb ischemia

A

Restoration of continuous in-line flow to the foot
Pulsatile flow equals wound healing
Expert wound care/debridement /amputation at appropriate level

PVD (5 decks)

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