PAD Flashcards
What is intermittent claudication?
exertional discomfort, relieved w/rest in specific muscles at risk for ischemia during exercise
What does IC usually suggest?
atherosclerotic dz / PAD
What does IC in a young person suggest?
Popliteal entrapment
What does IC in a biker suggest?
external iliac artery kinking (endofibrosis of the iliac artery)
Sx of PAD
LEG CRAMPS Pain R/T activity Pain at rest Non healing wounds Gangrene Some are asymptomatic, need to screen them benefit from meds
How to screen for PAD
ABI. Use highest arm SBP as denominator and highest ankle in rt and left as numerator (2 calculations)
Claudication in buttock and hip suggests…
aortoiliac dz
Claudication in thigh suggests…
aortoiliac or femoral
Claudication in upper 2/3 of calf suggests…
superficial femoral artery
Claudication in lower 1/3 of calf suggests…
Popliteal artery
Claudication in foot suggests…
tibial or peroneal artery
PE for PAD includes:
BP, Pulse, Temp of extremities BL
Inspection for shiny skin, nail changes (thickened), ulcers/poor wound healing
Palpate for cool extremity
Auscultate for bruits
Where might you find diminished or absent pulses in relation to stenosis
below stenosis
Where might you find bruits in relation to stenosis
over stenosis
What is Buerger’s test?
Patient supine, raise leg above central venous line. Normal limb does not lose color.
Immediately place limb dependent to body - observe rub or of lower limb
*limb may remain red if cellulitis
What is Leriche’s syndrome?
aortoiliac dz
Buttock & hip pain, achy weak hip, look for muscle atrophy
•almost always have erectile dysfunction
Two classification systems for PAD
Fontaine and Rutherford
Tx for PAD and renal stenosis
Aggressive!
ASA, antiplt, pentoxifylline, cilostazol (avoid in CHF)
Stents, statins, BP control
Meds approved for tx of IC
pentoxifylline & cilostazol (C/I in HF!)
