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Clinical Pop > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Peripheral Arterial Disease

A

obstruction of arteries of legs

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2
Q

PAD results in:

A

claudification: pain, weakness, numbness or cramping in muscles due to decreased blood flow

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3
Q

PAD impact

A

PREVALENCE

  • ~8-12 million people in United States
  • increases with age
  • lower in women
  • higher for blacks vs. whites
  • higher among diabetics
  • –1 to 3
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4
Q

Direct Medical Costs of PAD in 2001

A

$4.37 billion

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5
Q

Atherosclerosis Etiology and Pathophysiology

A

-likely begins with endothelial dysfunction due to oxidative stress

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6
Q

Arterial Stenosis Etiology and Pathophysiology

A
  • lowers blood flow to musculature
  • ischemia and low oxygenation
  • –during activity
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7
Q

Metabolic and Neural Effects

A
  • impaired energy utilization
  • impaired re-synthesis of ATP and CP
  • low concentration of ATP and CP
  • loss of muscle fibers
  • lower metabolic efficiency of muscle
  • mitochondrial damage
  • damage to peripheral nerves
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8
Q

Risk factors

A
  • older age
  • smoking
  • diabetes
  • dyslipidemia
  • hypertension
  • high C-reactive protein
  • high homocysteine
  • high fibrinogen
  • high blood viscosity
  • family history for cardiovascular diseases
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9
Q

Prevention

A
  • early evaluation of risk factors
  • modification of risk factor profile
  • –medication
  • —–hypertension
  • —–dyslipidemia
  • -lifestyle modification
  • —-smoking cessation
  • —-physical activity
  • —-diet
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10
Q

Symptoms are progressive

A

Mild PAD may asymptomatic

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11
Q

Intermittent Claudication

A
  • 35-40% of PAD Patients

- progressively occurs during shorter activity bouts

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12
Q

Critical Limb Ischemia

A
  • presence of ischemic rest pain; foot ulcers; gangrene

- 1-2% of PAD patients

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13
Q

Gangrene

A

Amputation

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14
Q

Other symptoms of Arthersclerosis

A

MI, Stroke

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15
Q

Common Morbidities

A
  • heart disease
  • cerebrovascular disease
  • diabetes
  • pulmonary disease
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16
Q

Classification

A

Fontaine Stages

Rutherford

17
Q

Fontaine Stages

A 
I. asymptomatic
IIa. mild claudication
IIb. moderate to server claudication
III. ischemic rest pain
IV. ulceration or gangrene
18
Q

Rutherford

A

0: asymptomatic
1: mild claudication
2: moderate claudication
3: severe claudication
4: ischemic rest pain
5: minor tissue loss
6: major tissue loss

19
Q

Specialists

A

primary care physician, cardiologist, vascular specialist vascular surgeon

20
Q

Components of Medical Evaluation

A

-physical exam and risk factor assessment

diagnostic tests

  • blood test for risk factors
  • ankle-bracial index
  • exercise test
  • doppler ultrasound
  • reactive hperemia
  • CT or MR Angiogram
21
Q

Ankle-Brachial Index

A

Ratio: SBP in ankle/SBP in arm

22
Q

Post Exercise ABI

A

May help identify severe ischemia

23
Q

Prognosis

A
  • worse when intermittent claudication is present
  • poor with clinical limb ischemia
  • lower with low functional capacity
  • high risk for cardiovascular and cererbovascular events
  • –5-7% per year
24
Q

Treatment

A

LIFE-STYLE MODIFCATION
smoking cessation, diet, physical activity

MEDICATION
cholestrol, hypertension, diabetes, anti-coagulants (blood thinners), pain

REVASCULARIZATION

  • bypass grafting
  • angioplasty

AMPUTATION

25
Q

Exercise as Treatment

A

IMPORTANT COMPONENT OF MANAGEMENT
more effective than meals
-for improving walk time

IMPROVES

  • pain free walking time and distance
  • —claudication does not disappear
  • risk factor profile
  • functional capacity
  • quality of life
26
Q

Adaptations

A
  • improved oxidative metabolism in muscles
  • improved walking biomechanics
  • –better efficency and economy
  • reduced blood viscosity
  • greater collateral circulation
  • better endothelial function
  • greater pain tolerance
  • higher pain-free walking distance and time
  • –115% in distance after 6 months increase
27
Q

Exercise Testing: Diagnostic

A
  • with ABI helps identify severe ischemia in legs

- diagnosing heart problems

28
Q

Exercise Testing: Functional

A
  • may be true peak GXT
  • should record
  • –time and distance prior to onset of pain
  • –time and distance prior to onset go max pain
29
Q

Exercise Testing: Prognostic

A
  • worse prognosis with

- –low FC, early onset of claudication

30
Q

Protocols

A
  • constant speed 2mph
  • ramping protocols common
  • discontinuous protocols may be used
  • relative indication for termination: 3+ to 4 point pain scale
31
Q

Aerobic Exercise Prescription

A

MODE

  • large muscle activities
  • –waiting most important but should included other activities
  • intermittent training commonly used
  • —especially during initial phase

FREQUENCY

  • intially:2-3times a week
  • progress daily

INTENSITY
moderate
-40-60% VO2R or HER
-until 3+ on 4 point scale

DURATION

  • start with intermittent
  • –2-5 min exercise. 1-2 minute recovery
  • progress to longer bouts. as tolerated
32
Q

Training for Strength and Flexibility

A

-follow general guidelines

Clinical Pop (6 decks)

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