Peripheral Arterial Disease Flashcards
Risk factors
Diabetic Hypertension Hyperlipidemia CAD Previous hx of CVA or MI Smoking Age FHx Male Obesity Sedentary lifestyle Elevated levels of homocysteine Excessive levels of C-reactive protein Hx of radiation
What are the physical signs
Skin changes
Palpitations
Auscultation
Limb pressures
What are the different skin changes that can occur
Pallor Rubor Dependant rubor Cyanosis Temperature Ulcers Gangrene Trophic changes Capillary refill time
What is pallor
Pale colour secondary to deficient blood supply
What is rubor
Dark reddish colour or discolouration from dilated or damaged vessels
What is dependant rubor
When limbs take on pallor when elevated but becomes abnormally red when hanging dependant
What is cyanosis
Bluish colour of the skin and mucous membranes that results from a concentration of deoxygenated hemoglobin
What will the temperature of the skin feel like when there is skin changes
Cool to the touch
What are arterial ulcers
Deep,irregular shaped areas over the tibial area and are very painful
What does gangrene result from
Death of tissue from absent blood supply
What are trophic changes due to
The lack of nourishment
What does trick changes include
Shiny, scaly skin
Thick toenails
Loss of hair
What is capillary refill time
When pressure is applied to an area of the skin and released, colour return should be immediate
What does an increase in capillary refill time mean
Indication of poor arterial supply
Pulses are graded how
From 0-4+
What is a grade of 0 for a pulse
No pulse
What is a grade of 4+ for a pulse
Bounding pulse
For pulses what should always be done
Compare the sides
Diminished or absent pulses suggest what
Arterial insufficiency
Aneurysms have what
Bounding pulses
Bruits are
Abnormal low frequency sounds that can be caused by a significant stenosis
How are bruits graded
1+ - 3+ (mild to severe)
In a stenosis >90% is a bruit heard
No, it is not
Difference in limb pressures side to side may indicate what
Disease
What is the difference of limb pressure in the upper and lower extremity that is considered abnormal
20mmHg
Claudication (intermittent) is what
A symptom from the patient
What is intermittent claudication
Muscle pain that occurs during excessive but subsides at rest
What is intermittent claudication caused by
A lack of blood supply to a group of muscles
Is intermittent claudication reproducible
Yes
What are the common sites of intermittent claudication
Hip
Thigh
Buttock
Calf
The site of disease is always what
Proximal to the muscle group
What does buttock claudication suggest
Distal aortoiliac disease
Thigh claudication suggest what
Distal external iliac/CFA disease
Calf claudication suggests what
Femoral/popliteal disease
What are common symptoms that the patient presents with
Claudication (intermittent)
Ischemic rest pain
Necrosis
Pseudo claudication
Ischemic rest pain is always an indicator of what
Advanced multi-segment disease
What is ischemic rest pain a precursor to
Limb loss unless medically or surgically treated
What does the pain feel like in cases of ischemic rest pain
Severe and constant
Where does ischemic rest pain usually affect
The dorsum of the foot and toes
Early onset of ischemic rest pain usually occurs when
Only at night when the limb is not in a dependant position
How can early onset of ischemic rest pain be relieved
By lowering the foot to mildly excerising
Does rest relieve the pain caused by ischemic rest pain
No
Necrosis is
Tissue death at the end stage of absent blood supply and is the most severe symptom
Pseudoclaudication is what
Pain caused by other factors
What are the common factors that can cause pseudoclaudication
Joint disease
Spinal stenosis
Herniated discs
Is pseudoclaudication pain reproducible with exercise testing
No
What is a common patient hx
Excerise related claudication Rest pain Paralysis Paresthesia Poikilothermia Previous ulceration/gangrene of feet/toes Previous therapeutic vascular procedure
What are the mechanisms of disease
Atherosclerosis
Embolism
Aneurysm
