PAD 1 Flashcards
What is Peripheral Arterial Disease?
Narrowing of the arteries supplying the limbs and periphery, reducing blood supply
Leads to symptoms of claudication
What are the symptoms of claudication?
Pain
Cramping
Parasthesia
What is intermittent claudication?
Symptom of ischaemia in a limb
When does intermittent claudication occur?
During exertion
Relieved by rest
What is experienced in intermittent claudication?
Crampy, achy pain in the calf, thigh or buttocks
Associated with muscle fatigue when walking
What is critical limb ischaemia?
End-stage of peripheral arterial disease
Inadequate supply of blood to a limb at rest
What are the features of critical limb ischaemia?
Pain at rest
Non-healing ulcers
Gangrene
SIGNIFICANT RISK OF LIMB LOSS
What is acute limb ischaemia?
Rapid onset of ischaemia in a limb
Why does acute limb ischaemia occur?
Thrombus blocks the arterial supply to the distal limb
What is ischaemia?
Inadequate oxygen supply to the tissues due to reduced blood supply
What is necrosis?
Death of tissue
What is gangrene?
Death of the tissue due to inadequate blood supply
What is atherosclerosis?
Atheromas (deposits in the artery walls) harden causing stiffening of the blood vessels
What vessels are affected by atherosclerosis?
Medium and large arteries
What causes atherosclerosis?
Caused by chronic inflammation and activation of the immune system in the artery walll
What happens in atherosclerosis?
Lipids deposited in the artery wall
Followed by development of atheromatous plaques
What can atheromatous plaques cause?
- Stiffening of artery walls leading to hypertension
- Stenosis leading to reduced blood flow
- Plaque rupture resulting in a thrombus that can block distal vessels causing ischaemia
What are 3 non-modifiable risk factors of atherosclerosis?
Old age
Family history
Male
What are some modifiable risk factors of atherosclerosis?
Smoking
Alcohol
Diet
Sedentary lifestyle
Obesity
Poor sleep
Stress
What co-morbidities increase the risk of atherosclerosis?
Diabetes
Hypertension
CKD
Inflammatory conditions
Atypical antipsychotic medications
What can atherosclerosis lead to?
Angina
MI
TIA
Stroke
Peripheral arterial disease
Chronic mesenteric ischaemia
What are the 6 Ps of critical limb ischaemia?
Pain
Pallor
Parasthesia
Pulseless
Paralysis
Perishingly cold
What type of pain does critical limb ischaemia typically cause?
Burning pain
When is crticial limb ischaemia worse?
Worse at night when leg is raised as gravity no longer pulls blood into foot
What is leriche syndrome?
Occlusion in the distal aorta or proximal iliac artery
What is the clinical triad of Leriche syndrome?
Thigh/buttock claudication
Absent femoral pulses
Male impotence
What is xanthomata?
Yellow cholesterol deposits on the skin
What can a hand-held doppler be used for?
Assessing pulses when difficult to palpate
What is Buerger’s test?
Used to assess peripheral arterial disease in the leg
- Lay patient supine
- Lift patient’s legs at 45 degress to hip
- Hold for 1-2 minutes looking for pallor
- Sit patient up with legs over side of the bed
What does pallor suggest in buerger’s test?
Arterial supply not adequate enough to overcome gravity suggesting peripheral arterial disease
What is Buerger’s angle?
Angle at which leg is pale
How do patients with peripheral arterial disease differ to normal patients in Buerger’s test?
Normal patient’s legs remain pink colour
in PAD, blue initially as the ischaemic tissue deoxygenates the blood
Dark red after a short time due to vasodilation in response to waste products of anaerobic respiration
(rubor)
