Lecture 7: PAD, Carotid, Vasospastic

Question 1

ABI > 1:40

next step

Answer 1

non-compressible

toe-brachial

Question 2

ABI 1-1.4

Answer 2

normal

Question 3

ABI 0.91-0.99

Answer 3

borderline

Question 4

ABI < 0.90

Answer 4

abnormal

Question 5

indications for exercize aBI

Answer 5

if exertional symptoms

borderline ABI 0.91-0.99

Question 6

positive result excerize ABI

Answer 6

20% decrease in excerize or > 30 mmHg drop in ankle pressure

Question 7

positive TOE

Answer 7

PAD is diagnosed if
1. < 0.70
OR
SBP < 40

Question 8

definition of critical limb ischemia

Answer 8

ABI < 0.4 with flat waveform

Question 9

how to differ from lumbar spinal stensosi

Answer 9

• LBS - relieved by flexing spine, walking while leaning.
• worse with especially dowhill
  (AUGUSTE)

Question 10

Dx of lumbar stenosis

Answer 10

MRI of lumbar spine

Question 11

BP goal in PAD

Answer 11

< 130/80

Question 12

medication RX for risk manangmeent

Answer 12

• ASA or clopidrogel monotherapy

- high intensity statin

Question 13

tx PAD, 1st line

Answer 13

supervisized excercize program

Question 14

tx PAD, 2nd line

Answer 14

cilastozol, PDE inhibitor only in normal LV function

Question 15

main contraindication of cilastazol

Answer 15

needs to have normal LV function

Question 16

6 P of critical ischemia

Answer 16

Pain
Pallor
Pulsenessess
Parasthesia
Poikothermia
Paralysis

Question 17

TX critical ischemia

Answer 17

< 3 hours- catheter directed thrombolysis with angioplasty (muscle strength normal)
> 3 hours (or gangrene, paralysis) - limb amputation

Question 18

post intervention on PAD to look for

Answer 18

cholesterol emboli and compartment syndrome

Question 19

screening for PAD may be reasonable –>

Answer 19

screening may be reasonable in persons with one of the following characteristics that signify increased risk: (1) age 65 years and older, (2) age 50 to 64 years with risk factors for atherosclerosis or family history of PAD, (3) age younger than 50 years with diabetes mellitus and one additional risk factor for atherosclerosis, or (4) known atherosclerotic disease in another vascular bed (coronary, carotid, subclavian, renal, or mesenteric artery stenosis, or abdominal aortic aneurysm).

Question 20

how to calculate ABI

Answer 20

the ABI is calculated by dividing the ankle pressure (dorsalis pedis (DP) and the posterior tibial (PT) arteries, and the higher of the two is used as the ankle pressure for that leg) by the higher of the two brachial pressures

Question 21

Buerger’s disease pathophysiology

Answer 21

inflammation distal extremity small/medium arteries which causes digital ischemia/ulcers

Question 22

who gets buerger’s

Answer 22

male, < 45, smokers

Question 23

tx Buerger’s

Answer 23

stop smoking or amputation

Question 24

Takayau disease pathophysiology

Answer 24

medium/large upper extremity/heart arteries off the aorta –< thrombosis/inflammation

Question 25

tx Takayau

Answer 25

high dose prednisone + immunosuppresants

Question 26

PE Takayasu

Answer 26

SBP > 10 mmHg difference between arms | subclavian bruit.

Question 27

who gets Takayasu

Answer 27

Asian women below 40

Question 28

who gets Primary Raynaud Syndrome

Answer 28

women < 40 y.o,

Question 29

pathophysiology for Raynaud | Mnemonic of PE

Answer 29

vasospasm of distal extremity to changes in temperatue or mood. White--> blue--< red (reactive hyperemia)

Question 30

tx Raynaud

Answer 30

CCB, Nitroglycerin

Question 31

features of Prinzmetal angina

Answer 31

younger person, vaso-occlusion with transient ST elevations.

Question 32

tx Prinzmetal

Answer 32

CCB

Question 33

if carotid ultrasound is positive for stenosis, then next step

Answer 33

If the carotid ultrasound shows significant stenosis, the percentage of narrowing and the anatomic location should be confirmed with either CT angiography or MRA without contrast before recommending stenting procedures or other surgery

Question 34

Class I indication for end carotid arterectomy

Answer 34

ipsilateral carotid 70% on ultrasound or 50% by catheter angiography with previous history of stroke or TIA within the last 6 months

Question 35

medications to put the patient on if stent carotid

Answer 35

ASA + clopidogrel x 1 month

Question 36

if stroke and no other cause is found, which test will help prove etiology

Answer 36

30 day holter monitor to look for intermittent atrial fibrillation

Question 37

1st line indication for CEA

Answer 37

within 6 months TIA/Stroke and ipsilateral stroke > 70% non-invase and > 50% by cathter angio