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
