Lecture 7: PAD, Carotid, Vasospastic Flashcards
ABI > 1:40
next step
non-compressible
toe-brachial
ABI 1-1.4
normal
ABI 0.91-0.99
borderline
ABI < 0.90
abnormal
indications for exercize aBI
if exertional symptoms
borderline ABI 0.91-0.99
positive result excerize ABI
20% decrease in excerize or > 30 mmHg drop in ankle pressure
positive TOE
PAD is diagnosed if
1. < 0.70
OR
SBP < 40
definition of critical limb ischemia
ABI < 0.4 with flat waveform
how to differ from lumbar spinal stensosi
- LBS - relieved by flexing spine, walking while leaning.
- worse with especially dowhill
(AUGUSTE)
Dx of lumbar stenosis
MRI of lumbar spine
BP goal in PAD
< 130/80
medication RX for risk manangmeent
- ASA or clopidrogel monotherapy
- high intensity statin
tx PAD, 1st line
supervisized excercize program
tx PAD, 2nd line
cilastozol, PDE inhibitor only in normal LV function
main contraindication of cilastazol
needs to have normal LV function
6 P of critical ischemia
Pain Pallor Pulsenessess Parasthesia Poikothermia Paralysis
TX critical ischemia
< 3 hours- catheter directed thrombolysis with angioplasty (muscle strength normal)
> 3 hours (or gangrene, paralysis) - limb amputation
post intervention on PAD to look for
cholesterol emboli and compartment syndrome
screening for PAD may be reasonable –>
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).
how to calculate ABI
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
Buerger’s disease pathophysiology
inflammation distal extremity small/medium arteries which causes digital ischemia/ulcers
who gets buerger’s
male, < 45, smokers
tx Buerger’s
stop smoking or amputation
Takayau disease pathophysiology
medium/large upper extremity/heart arteries off the aorta –< thrombosis/inflammation
tx Takayau
high dose prednisone + immunosuppresants
PE Takayasu
SBP > 10 mmHg difference between arms
subclavian bruit.
who gets Takayasu
Asian women below 40
who gets Primary Raynaud Syndrome
women < 40 y.o,
pathophysiology for Raynaud
Mnemonic of PE
vasospasm of distal extremity to changes in temperatue or mood.
White–> blue–< red (reactive hyperemia)
tx Raynaud
CCB, Nitroglycerin
features of Prinzmetal angina
younger person, vaso-occlusion with transient ST elevations.
tx Prinzmetal
CCB
if carotid ultrasound is positive for stenosis, then next step
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
Class I indication for end carotid arterectomy
ipsilateral carotid 70% on ultrasound or 50% by catheter angiography with previous history of stroke or TIA within the last 6 months
medications to put the patient on if stent carotid
ASA + clopidogrel x 1 month
if stroke and no other cause is found, which test will help prove etiology
30 day holter monitor to look for intermittent atrial fibrillation
1st line indication for CEA
within 6 months TIA/Stroke and ipsilateral stroke > 70% non-invase and > 50% by cathter angio
