PAD Medical Flashcards
- Define PAD from an anatomical standpoint.
structural atherosclerotic narrowing of any non-coronary vessel which limits blood flow to the limbs
- Define PAD from the functional standpoint.
arterial narrowing causing a mismatch between organ supply and demand causing intermittent symptoms of claudication and/or tissue ischemia
- Discuss the prevalence of PAD and associated risk of coronary artery disease.
In a primary care population defined by age and common risk factors, the prevalence of PAD was approximately one in three patients
prevalence increases with age
- Name the single most important, modifiable cause of PAD.
tobacco use (dose dependent) causes a 10x increase in relative risk
- What factors besides smoking put a patient at risk for PAD?
DM (increases 2-4x due to inflammation of endothelial), dyslipidemia (elevated total cholesterol and increased TG) HTN (esp. regarding stroke) inflammatory mediators age, gender and ethnicity obesity and physical inactivity
- What is the stratification for individuals “at risk” for lower extremity PAD?
less than 50, with DM and one additional factor
50-60 yo with smoking or DM
70 yo or older
known atherosclerotic coronary, carotid or renal artery disease
What is claudication and what causes it?
dull aching muscular discomfort induced by exercise and relived by rest caused by muscle ischemia
atypical presentation include fatigue, heaviness, dysesthesia or cold sensation
- Discuss the elements of a vascular focused hx. and PE.
bilateral arm BP cardiac exam palpation for abdominal aneurysm auscultation for bruits exam of legs and feet pulse exam (carotid, radial/ulnar, femoral, pop., dorsalis pedis and posterior tibial)
Describe the scale used to describe pulse (0-3).
0- absent
1-diminished
2-normal
3-bounding
- What is the standard test used to assess PAD?
resting ankle-brachial index measurement
What is the procedure for preforming an ABI?
performed with patient supine
all pressures measured with an arterial doppler and appropriately sized blood pressure cuff
systolic pressures will be measured in the R/L brachial arteries followed by R/L ankle
What is an ABI?
ratio of higher brachial systolic pressure and the higher ankle systolic pressure for each leg (give an ABI score for each leg)
- What ABI is diagnostic for PAD?
greater or equal to 0.9
.91-.99 borderline
.41-.9 mild/moderate
less than .4 severe disease
- What are important characteristics of a ultrasonogoraphy read-out that are important?
the shape can help you ID turbulent flow and velocity can also be important with obstruction
this modality can diagnosis anatomic location and degree of stenosis
- What is MRA and what are its benefits?
magnetic resonance angiography (has replaced contrast arteriography for PAD diagnosis)
benefits: no ionizing radiation, no iodine contrast
(some limitations with claustrophobia, pacemaker or obesity)
- Name one other imaging technology beyond MRA that can be used in PAD and what are its downsides?
CTA- Computed tomographic angiography
requires iodinated contrast and ionizing radiation
Name two different causes of renal artery stenosis.
atherosclerotic etiology (risk factors similar for atherosclerosis) fibromuscular dysplasia (congenital)
How could location of plaque help you differentiate between athersclerotic plaques v. fibromuscular dysplasia?
atherosclerotic: proximal segment
fibromuscular dysplasia: mid to distal segment
What is the size of an abdominal aortic aneurysms relative to normal diameter? What is the danger of this disease?
diameter +50%, dilation greater than 2x the size of a more proximal artery
with risk of dissection, mortality is high (once rupture happens, 75-90% death)
Where would you most likely find an aortic aneurysm? (abdominal v. thoracic)
abdominal are more common then thoracic aneurysms, especially in men
screening should be considered for those with a family history or smoking history
- Discuss the prevalence and significance of carotid disease.
third leading cause of death in the US, 50% of patients with a stroke will have a second stroke within 5 years if untreated
What are the two different kinds of stroke and what is their mutual outcome.
ischemic (clot) 85%
hemorrhagic (bleeding)
both result in brain cell damage
- What are the two major goals in treating patients with PAD?
limiting poor limb outcomes (improve walking, prevent progression of disease/amputation)
reducing CV morbidity and mortality (decrease non-fatal stroke and decrease fatal MI and stroke.
Why is walking so important with CAD.
getting the patient walking will encourage collateral arteries and activity level can help to decrease overall risk
- What are major parts of treating the underlying PAD?
smoking cessation anti platelet therapy address hyperlipidemia and HTN control diabetes get active, lose weight
- What are indications for angioplasty/ stent in PAD?
persistent limiting claudication, preventing work or ADL
rest pain
tissue loss/non healing ulcers
abdominal aorta or renal artery severe disease
carotid artery severe disease
not in lower exterminates, bypass or vein/synthetic graft may be indicated
