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Cardiology > PAD #1 > Flashcards

PAD #1 Flashcards

1
Q

Common PE finding of renal artery stenosis

A

Bruits

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2
Q

Peripheral ischemia is ____ threatening

A

Limb threatening

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3
Q

What is the pathophys of PAD

A

Segmental lesions typically localized to large or medium-size vessels
Pathology →
Atherosclerotic plaques with calcium deposits
Thinning of the media
Patchy destruction of muscle and elastic fibers
Fragmentation of internal elastic lamina
Thrombus development

same as atherosclerosis

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4
Q

Why sized vessels are occluded by PAD?

A

medium or large - which is why it is important to treat, might lose a limb

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5
Q

Where do you typically see a blockage at a bifurcation?

A

More traffic, strain, pressure

more turbulent blood flow

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6
Q

What does renal insufficiency let us know?

A

Order BNP

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7
Q

Smoking makes you at the same risk of arterial disease as someone ____ years older

A

20

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8
Q

Who should you screen for PAD

A

≥70 y/o
50-69 y/o with h/o smoking or DM
40-49 with DM and ≥ 1 other risk factor for atherosclerosis
Known atherosclerosis at other sites (coronary, carotid, renal, mesenteric or AAA)

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9
Q

What is the MC location for PAD

A

Femoral-popliteal disease (80-90% of patients)

white male smokers often have aorta proximal iliac disease

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10
Q

goal of PAD management

A

stop limb

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11
Q

mortatlity of PAD

A

15-25%

even if we treated them :(

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12
Q

presentation of PAD

A

20-50% have no symptoms :(

atypical leg pain - are not an athlete (cramping, aching, gnawing)

intermittent claudication (calf pain is severe after walking, so they need to stop)

Pain related to where the clot is

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13
Q

intermittent claudication

A

the more you work, the more your limbs hurt (like stable angina for your legs)

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14
Q

critical limb ischemia

A

No blood flow to the lower extremity

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15
Q

When does pain resolve after exertion with PAD?

A

typically after rest for 10 minutes

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16
Q

how to tell the difference between arterial blockage and psedoclaudiation

A

Pseudoclaudication will have NORMAL pulses because it is d/t nerve pain, not a clot

arterial blockage will have decrased pulses

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17
Q

How long does it take pain to resolve after exertion for pseudoclaudication?

A

30 minutes (much longer than arterial blockage!)

18
Q

Why does hanging a limb relieve pain in PAD?

A

Gravity pulls blood to the extremities

19
Q

Where are ulcers for PAD?

A

Typically at pressure points

20
Q

critical limb ischemia

A

no BF to lower extremity
wet gangrene (turns to sepsis)
dry gangrene (eschars)

21
Q

what are the three classifications we use for ulcers of foot?

A

Wound
Ischemia
and foot infection

WIFI

22
Q

what is a bruit?

A

turbulent bloodflow heard over thrombis or plaque

23
Q

PE for PAD

A

bruits
lungs
heart
pulses (should be very specific)
less hair growth
thicker
calf atrophy (less oxygen)
charcoot foot, look like a rocker foot (d/t poor blood flow to plantar aspect of the foot)
arterial ulcer
no distal hair on legs

24
Q

what is a bedside doppler used for?

A

listen for sound

handheld

helps identify where a lesion is

25
Q

burger’s test positive

A

Go against gravity by lifting the foot in the air, and it will turn white

hanging leg back down, it becomes red and shiny (the longer it takes to go back the worst)

Good positive

26
Q

arterial ulcer look

A

thick, scab-looking, black

different area and appearance then bed sores!

27
Q

different procedures for PAD

A

stress test
nuclear imaging
CT/angiogram

28
Q

first line test of PAD

A

ankle brachial index (ABI) FIRST LINE

if false negative (presents with PE of PAD but normal ABI)

often can diagnose them with this alone!

29
Q

ABI

A

get BP in all the extremeties and calculate the differences

30
Q

When do you need to order an ABI?

A

risk factors
PE

31
Q

Positive ABI for PAD

A

<0.9 is diagnostic

32
Q

Calculating ABI

A

Highest brachial
Highest of the LE (Posterior tibial or dorsalis pedis)

33
Q

Most sensitive and specific screening for PAD

A

ABI test

34
Q

What is a toe branchial index

A

TBI

test brachail reading in both extremeties and then the two big toes

35
Q

What is a positive TBI?

A

<75

36
Q

is an arterial duplex used for screening?

A

NO

used for planning surgery

37
Q

when do you do an MRA

A

screening for surgical planning

38
Q

first line vs gold standard of PAD

A

First line = ABI
Gold standard = distal subtraction angiography

39
Q

goal of PAD

A

improve functionality

gradual exercise improvement

40
Q

risk factor modification of PAD

A

Antiplatelet therapy
Smoking Cessation
Lipid-lowering therapy
Glycemic control
Blood pressure control
Diet and exercise
Obesity

41
Q
A

Cardiology (22 decks)

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