peripheral arterial disease and chronic venous insufficiency Flashcards
risk factors for PAD
Atherosclerosis
Smoking
Diabetes
Age > 70
Male gender
Hypertension
Hyperlipidemia
Family history
History of MI, heart failure, TIA or stroke
clinical manifestations of PAD
- pain (intermittent claudication)
- pulselessness
- pallor
- paresthesia
- paralysis
describe intermittent claudication
Early
- Cramping, burning, or aching pain in the legs or buttocks, with activity that is relieved with rest.
Late
- Pain at rest is a warning sign of an anoxic limb
describe skin and pallor with PAD
- Lower extremity skin
Cool, thin, atrophic with shiny appearance
Alopecia
Reddened skin color, more when dependent
Pale skin upon elevation of extremities
Thick, brittle nails with ridges
Ulcers or lesions that are not healing - Delayed capillary refill
describe paralysis and paresthesia with PAD
Suggest limb threatening ischemia and mandate emergent evaluation and consultation.
bedside diagnostic evaluation of PAD
Ankle Brachial Index (ABI)
Apply blood pressure cuffs to the upper arm and above the ankle to obtain blood pressure readings.
The systolic ankle pressure is divided by the systolic brachial pressure.
Normal ABI is 0.91 to 1
management of PAD
Modifying or eliminating risk factors
Medications such as pentoxifylline (Trental), Cilostazol (Pletal), and Clopidogrel (Plavix), or Aspirin
Lipid lowering drugs
Peripheral interventional procedures such as balloon angioplasty (PTCA) and stenting
Surgical vascular bypass for severe or diffuse arterial obstruction
signs of chronic insufficiency
Brown pigmentation of skin
Edema
Thick, flaky skin
Ulcerations
Which of the following medications is indicated for a patient with peripheral arterial disease?
A. Clopidogrel
B. Tenecteplase (TNK)
C. Norepinephrine
D. Nitroprusside
A. Clopidogrel
Rational: Patients should be on an anti-platelet medication to prevent further thrombus formation in peripheral arterial disease
