limb ischaemia Flashcards

1
Q

what is peripheral vascular disease commonly caused by

A

atherosclerosis

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2
Q

what are the patients most likely to die of

A

MI or stroke

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3
Q

what are the 2 types of limb ischaemia

A

acute or chronic

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4
Q

what are risk factors chronic limb ischaemia

A
  • smoking
  • diabetes
  • hypercholesterolaemia
  • hypertension
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5
Q

what do patients with intermittent claudication complain of

A

exertion discomfort most commonly in the calf that is relieved by rest

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6
Q

what do patients with aorta-iliac disease experience

A

pain in the buttock, hip or thigh also may have erectile dysfunction

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7
Q

what do patients with rest pain experience

A

unremitting pain in the foot which stops patient from sleeping

relieved by dangling the foot over the edge of the bed or standing on cold floor

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8
Q

signs

A
  • lower limbs are cold
  • dry skin
  • lack of hair
  • diminished pulses
  • ulceration may occur with dark discolouration of the toes
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9
Q

what is severity of disease indicated by

A

ankle/brachial pressure index

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10
Q

what options are there for imaging

A
  • angiography
  • duplex ultrasound using colour doppler
  • 3D MR angiography
  • CT angiography
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11
Q

what does digital subtraction angiography provide

A

an arterial map

use immediately prior to intervention

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12
Q

what can duplex ultrasound using colour doppler provide

A

an accurate anatomical map of the lower limbs

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13
Q

what does 3D MR angiography provide

A

imaging of both legs with single contrast injection

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14
Q

what should patients be encouraged to do for treatment

A

stop smoking

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15
Q

what do patients with diabetes need

A

regular chiropody and diabetic management

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16
Q

what lifestyle measures

A
  • weight loss

- increase exercise

17
Q

what drugs are given

A
  • cilostazol

- naftidrofuryl

18
Q

what is cilostazol

A

phosphodiesterase III inhibitor that increases levels of cAMP

19
Q

what does cilostazol produce

A

vasodilatation and inhibits platelet aggregation

20
Q

what is naftidrofuryl

A

vasodilator agent that inhibits vascular and platelet 5-HT2 receptors

reduce lactic acid

21
Q

what drugs are not recommended

A

Oxpentifylline, inositol nicotinate and cinnarizine

22
Q

what occurs in severe ischaemia

A

amputation

23
Q

symptom of acute limb ischaemia

A

the 5 P’s

  • pain
  • pallor legs (white)
  • paraesthesia
  • paralysis
  • perishingly cold
24
Q

signs of acute limb ischaemia

A
  • limb is cold
  • marbling of skin
  • pulses are diminished or absent
  • movement of leg are reduced
  • pain in calf on compression
25
Q

what are causes of acute limb ischaemia

A
  • embolic disease
  • rheumatic fever
  • cardiac arrhythmias
  • atrial myxoma
26
Q

what is given first

A

heparin

27
Q

what is given to patients with acute limb ischaemia after MI

A

long term warfarin

28
Q

what do patients with embolus benefit from

A

surgical removal = embolectomy