PAD/ PVD / DVT / HF Flashcards
PAD what
oxygenated blood from heart to body ( narrowing of the arteries causes lack of blood supplies to limbs)
PAD signs 4, DX, PLan
- shiny/pale skin, hairless, dry, cold
- pedal and posterior tibial pulses decrease
- increased cap refill time
- intermittent claudication, painful, ( pain goes away with rest)
- DX : ankle-brachial index ABI < 0.9 duplex US
- Plan:
- decrease CV risk factors ( statins), smoking cessation, long term antiplatlet therapy (ASA)
- excerise by walking daily helps develop callateral circulation
- NO compression stockings, NO elevation of legs
- ASA for prevention of blood clots
- sugery to improve blood flow
- cilostazol and pentoxyifline to help reduce symptoms
Chronic Venous Insufficiency
Lower extremity chronic venous disease
From body to lungs w/ de-oxygenation blood cant make its way back
( there is a one way valve that isnt working and blood is pooling)
Venous insuffiency signs , dx, plan
brawny to brown color, thicker skin, lymphedema, itting edema, pigmentary changes ( hermosiderin)
varicose veins, spider veins
palpable pulses , venous lef ulcers on the medial malleolus delayed healing
aching sensation and lower extremeity heaviness that worsens as day progresses
DX: venous duplex US
Plan: - ASA 300 mg, pentoxifyline - horse chestnut extract compression hose therapy ( percription) - elevate legs above heart 3/4 times a day for 30 min
- sclerotherapy or ablation
b - leg excerises ( walking and ankle flexion)
What does the Ankle Branchial Index used for?
PAD
BP cuff measures systolic bp in ankle compred to upper arm
score < 0.9 abnormal ( norm is 1)
what is normal Cap Refill time
< 2 ( will see increased time in PAD)
DVT ( unprovoked, provoked, Proximal, Distal)
Unprovoked DVT w/ no known environmental event
Provoked DVT is secondary to even ( surgery, estrogen therapy, immobile for 3 or more hours )
Proximal DVT is located on popliteal, femoral or ilac vein,
Distal DVT : calf
DVT presentation
swelling in affected limb with erythema, may be painful. Lower leg calf is bigger by > cm.
+ Homan sign ( not reliable
refer to ED for anticoagulation therapy
How to measure calf circumference
measure 10 cm below tibial tuberosity and is there is a > cm difference = abnormal
Superficial Thrombophlebitis
Venous inflammation caused by a thrombosis of superficial vein.
red- cord like superficial vein ( indurated vein) painful and tender to touch
r/o if is is septic or not
if large and inflamed ( er)
mild/ localized : NSAIDS and ASA and compression stockings or ACE bandage
Primary Raynauds DX
Most females
recurrent episodes of cold, numb, painful fingertips triggered by cold weather, or stress
( white, blue, red) is order of color of extremeties
higher risk for autoimmune disorders
can use CBB
HF presentation
new onset of dyspnea , recent fast weight gain, peripheral edema , nocturnal wheezing or cough with frothy pink sputum
Left Heart failure presentation
L = Lungs
PE: S3, crackles, decreased breath sounds, wheezing
look for: orthopnea (SOB when lying down), paroxysmal nocturnal dyspnea, edema
right Heart failure presenation
R; GI
PE; JVD, enlarged liver, enlarged spleen
look for : anorexia, n/ RLQ pain, lower extremity edema
CXR: enlarged heart size, intersitital edema
Labs : BNP, electrolytes
CHF tx
intial : give diuretic - goal is to decrease symptoms of fluid overload
ACE - start lowest dose
Beta blocker - not during acute phase
can use spironoactone if class II of LVEF < 30
NYHA classes
- *II : ordinary physcial activity results in fatigue, dyspnea
- *III: marked limitation in normal physcial activity
Acute MI presenation (s)
complains of heavy pressure / tightness sensation on teh chest radiating to left shoulder or neck to the jaw
or
new onset angina that markedly limits physcial activity or rest angina that last more than 20 min
( not sharp pain)
Women have atypical symptoms such as new onset fatigue, back pain w/ cp. W more likely to have HF
Acute MI labs plan
serial EKG (STEMI ro NSTEMI), Trops, CKMD,
call 911
Anterior wall MI
elevated leads in V2 V3 will see tombstoning
also V1 V2 V3 V4
Inferior wall MI
II, III, AvF
What is the DASH diet
eat veggies, fruits, whole grains , low fat dairy, fish, polutry, limit sodium to 2400 mg/day
or 1500 mg/day
and increase Potassium consumption ( unless CKD)
what are sources of potassium
tomato juice
papaya, bannas
cantaloupe
Food sources of mg
almonds, cashews, halibut, soybeans, spinach, dried beans whole grain, nuts
food sources of ca
yogurt, sardines, cheddar cheese, non fat milk, fortified orange juice
food sources of NA +
canned or pickled goods, hot dogs, cold cuts, potato chips
men alcohol comsumption
2 drinks ( beer is 12 ounces, wine 5 ounces, shot , 1.5 oz)
what does isometric / dynamic resistance help
spare the joints
BMI
norm: 18,5 -24.9
over weight : 25-29
obese ( 30-32)
Hypercholesteremia
increased cholesterol
Total < 200
LDL < 100 (DM CAD goal <70) if no risk factors (<129 is okay
HDL > 40 m >50 w
Try < 150
when to tx triglycerides first
when triglycerides are > 500 , lower first to prevent pancreatitis then address high LDL
first and second line to decrease triglycerides
lifestyle
if over 800 >
fibrates or high dose statin, fish oils
Fibrates
Fenofribrate ( tricor) or gemfibrozil (lopid)
lowers try by 50 %
be careful w/ combining with statins or naicin increase risk for heptotoxicity or rhabdo
dont give to people with hepatic dysfuntion, gallbladder dx or severe renal dx
get Lipids, CBC, LFt;s, renal fucntion at baseline and periodically
Bile Acid Sequestrants
not first line but a choice for people who cant tolerate stains
Cholestyramine ( Questran)
s/e : flatulence, bloating, abdominal pain
which is the best drug to lower LDL
statins or HMG coA reductase
Rhabdomyolysis
concern for people on statins
breakdown of muscle tissue releases myoglobins which are toxic to kideys
new onset of severe muscle fatigue or weakness or local pain ( dark-colored urine)
Labs: creatinine kinase, creat, UA
look for signs of hepatitis - hold statin get LFT;s
Who should get a high intensity statin
Atorvastin 40-80
Rosuvastatin 20-40
ages younger than 75
- ASCVD high risk score or
- MI, CAD, Angina, PAD, stent surgery, Stroke, TIA
or VERY high LDL 190 or higher
who should get moderate intensity statins?
Atorvastatin 10-20 Rosuvastatin 5-10 Simvastatin 20-40 Pravastatin 40-80 Lovastatin 40
DM (40-75 yrs old)
w/ LDL 70-189
older than 75
