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Cardiovascular > Peripheral Arterial Disease > Flashcards

Peripheral Arterial Disease Flashcards

1
Q

How does peripheal arterial disease present?

A

Can be asymptomatic

Claudication

  • Due to mismatch between O2 demand and supply

Rest pain

  • Continuous pain in feet when elevated
  • Relieved when lowered

6 P’s

  • Pallor
  • Pulseless
  • Perishing cold
  • Paralysis
  • Pain
  • Paraesthesia

Ulcers

Elevation pallor/dependent rubor

Iliac artery bruit (whoosh)

Gangrene/necrosis

Hair loss

Decreased capillary refill

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2
Q

Give the three main patterns of presentation of arterial limb disease

A

(From mild to emergency)

Intermittent claudication

Critical limb ischaemia

Acute limb-threatening ischaemia

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3
Q

Give specific features of critical limb ischaemia

A

Triad of rest pain, arterial ulcers and gangrene

Rest pain in foot for more than 2 week

  • Patients often report hanging their legs out of bed at night to ease the pain

Ulceration

Gangrene

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4
Q

Give specific features of intermittent claudication

A

Intermittent claudication

  • Aching or burning in the leg muscles following walking
  • Patients can typically walk for a predictable distance before the symptoms start
  • Usually relieved within minutes of stopping
  • Does not present at rest
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5
Q

Give specific features of acute limb threatening ischaemia present

A

1 or more of the 6 P’s

Pale

Pulseless

Painful

Paralysed

Paraesthetic

Perishing cold

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6
Q

What risk factor has the strongest association with peripheral arterial disease?

A

Smoking

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7
Q

What classification is used in peripheral arterial disease?

A

Fontaine classification

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8
Q

Describe Fontaine classification 1

A

Asymptomatic

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9
Q

Describe Fontaine classification 2A

A

Mild claudication, >200m before pain

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10
Q

Describe Fontaine classification 3

A

Rest pain

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11
Q

Describe Fontaine classification 2B

A

Walk <200m

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12
Q

Describe Fontaine classification 4

A

Ulcers, gangrene, necrosis

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13
Q

What investigations are used in peripheral arterial disease diagnosis?

A

Duplex US

  • First line

Ankle-Brachial Pressure Index (ABPI)

Magnetic Resonance Angiography

  • Performed prior to any intervention

Buerger’s Angle

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14
Q

What is the first line investigation in peripheral arterial disease?

A

Duplex US

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15
Q

What is the ankle-brachial pressure index (ABPI)?

A

Ratio of the systolic blood pressure in the lower leg to that in the arms

Lower blood pressure in the legs (result in a ABPI < 1) is an indicator of peripheral arterial disease

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16
Q

An ankle-brachial pressure index (ABPI) of what is normal?

A

1-1.2

17
Q

An ankle-brachial pressure index (ABPI) of what is suggestive of claudication?

A

0.6-0.9

18
Q

An ankle-brachial pressure index (ABPI) of what is suggestive of critical limb ischaemia

A

<0.5

19
Q

An ankle-brachial pressure index (ABPI) of what is suggestive of vessel calcification common in diabetes?

A

>1.2

20
Q

What is Buerger’s angle?

A

Pallor <20 degrees

21
Q

What is the management for peripheral arterial disease?

A

Smoking cessation

Manage comorbidities

  • DTM
  • Obesity
  • HTN

Exercise training

Statin/Atorvastatin 80mg

Antiplatelets/Clopidogrel 75mg

Heparin and urgent vascular review for acute limb ischaemia

Severe/Acute

  • Angioplasty, in single segment disease
  • Stenting
  • Bypass surgery

Limb amputation

  • Reserved for patients with critical limb ischaemia not suitable for other interventions
22
Q

What is first line management of peripheral arterial disease?

A

Exercise training

23
Q

What is cervical rib?

A

Supernumery fibrous band arising from seventh cervical vertebra, which may cause thoracic outlet syndrome

24
Q

How is cervical rib managed?

A

Surgical division of rib

25
Q

What is subclavian steal syndrome?

A

Proximal stenotic lesion of the subclavian artery, resulting in retrograte flow through vertebral or internal thoracic arteries, causing a decrease in cerebral blood flow and syncopal symptoms

26
Q

What is Buergers disease/thromboangiitis obliterans?

A

Small and medium vessel vasculitis that is strongly associated with smoking and raynauds phenomenon

Cardiovascular (12 decks)

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