Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio= Clin Med > Peripheral Artery Disease > Flashcards

Peripheral Artery Disease Flashcards

1
Q

Arterial Blood Vessel Disorders (10)

A 
Peripheral Artery Disease
Atherosclerotic Vascular Disease
Nonatherosclerotic Vascular Disease
Acute Arterial Occlusion of a Limb
Thoracic Outlet Compression Syndrome
Peripheral Artery Aneurysms
Raynaud’s Phenomenon
Acrocyanosis
Livedo Reticularis
Chilbain’s Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Peripheral Artery Disease (4)

A

A clinical disorder in which there is a stenosis or occlusion in the aorta or the arteries of the limbs.
Leading cause of PAD in patients >40yrs old:
Atherosclerosis
Highest prevalence occurs in the 6th/7th decades of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other Causes of PAD (6)

A 
Thrombosis
Embolism
Vasculitis (Giant Cell and Takayasu’s arteritis)
Fibromuscular dysplasia
Entrapment
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Increase risk of PAD if : (6)

A

Cigarette smoker (most modifiable risk factor)
DM: prevalence in Diabetics is around 24%, in contrast to 8% in non-diabetics
Hypercholesterolemia (low HDL, high TC, high LDL, etc)
HTN- tx of HTN alone will not decrease risk of PAD
Hyperhomocysteinemia- leads to atherosclerosis and PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary Sites of Atherosclerotic PAD (3)

A

Abdominal aorta and iliac arteries
Femoral and popliteal arteries-most common
More distal vessels (tibial and peroneal arteries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atherosclerotic PAD Clinical evaluation (3)

A

<50% are symptomatic
Most common symptom is Claudication
Pain, ache, cramp, numbness or a sense of fatigue in the muscles that occurs during exercise and is relieved w/ rest.
Site of claudication is always distal to the site of the lesion
Ex. Calf claudication (femoral/popliteal dz)
Develops at different distances depending on the degree of occlusion and stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Atherosclerotic PAD- PE Findings (7)

A

Decreased or absent pulses distal to the obstruction
Presence of a bruit over the narrowed artery
Muscle atrophy distal from the site of the lesion
Severe disease:
Hair loss
Thickened nails
Smooth and shiny skin
Reduced skin temp
Pallor or cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Noninvasive Diagnostic testing for PAD Ankle: brachial index (ABI)

A

Ankle: brachial index (ABI)-
Measure the SBP in the legs and compare it to the arms (ABI)
Arms and legs should be either equal or ankle>brachial, therefore ABI should be ≥ 1.0 in normal individuals
In the presence of stenosis, SBP in the legs is decreased
<0.5 in pts w/ severe PAD
Performed w/ Doppler U/S to look at the waveform analysis following a low ABI: shows blunting of the waveform in the presence of PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sites of Disease for PAD

A

Aortoiliac
Femoral/Popliteal
Lower leg/foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Noninvasive Diagnostic Testing for PAD

A

Treadmill testing: objective assessment of functional limitations
Decline of ABI immediately after exercise provides further support for the diagnosis of PAD
Duplex Doppler Ultrasound
Produces an image of the vessel (anatomy) & the surrounding tissue
Able to assess the speed and direction of blood flow through a vessel
Mostly useful in medium sized and superficial arteries, not for distal small ones.
MRA, CTA and conventional contrast angiography are not used for routine diagnostic testing. Reserved only if symptoms require revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Aortoiliac Artery Disease

Atherosclerotic PAD

A

Claudication occurs in the calves, thighs and/or buttocks
Femoral pulses and distal pulses are absent or weak
Bruit may be heard over the aorta, iliac or femoral arteries, or all 3
ABI will be decreased throughout the entire lower extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aortoiliac Artery Disease Treatment

Atherosclerotic PAD

A

Conservative
Endovascular surgery- angioplasty/stenting (when segmental or single stenosis)
Surgery (bypass grafting)
When to Refer to a vascular surgeon:
Progressive reduction in walking distance
Limiting ADL’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Femoral/Popliteal Artery Disease

Atherosclerotic PAD

A

Superficial femoral artery is the most common artery occluded by atherosclerosis
Symptoms will be confined to calf
May see atrophic changes in the lower leg and foot
Femoral pulse is normal, decreased pulses in popliteal and pedal pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Femoral/Popliteal Arteries Treatment

Atherosclerotic PAD

A

Tx:
Conservative
Surgery (Bypass-most common)- mandatory if rest pain or threatened tissue
Angioplasty +/- stenting
Thromboendarterectomy- limited to common femoral artery dz
When to Refer:
Progressive symptoms, short distance claudication, rest pain or if any ulcerations are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lower leg/Foot Arterial Disease

Atherosclerotic PAD

A

Primarily involves tibial vessels
DM is a major risk factor
Rest pain is confined to dorsum of foot and relieved w/ dependency
Pain is severe, burning and may awaken pt from sleep
Skin is cool, atrophic and hairless
Pedal pulses are absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lower leg/Foot Arterial Disease Treatment

Atherosclerotic PAD

A

Treatment (goal is to prevent tissue loss):
Conservative- good foot care
Surgery- required if rest pain at night w/ low ABI/monophasic wave forms to prevent tissue loss
Bypass- primary technique for revascularization to preserve limb
Amputation (necrotic or severely infected tissue):
When to Refer to a Vascular Surgeon:
If pedal pulses are even slightly weak/reduced and if any ulcers are present (regardless of size)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Goals of Treatment in all PAD

A

Management Goals:
Improve ability to walk
Prevent the Progression to Limb Ischemia and Amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Conservative Treatment for all patients w/ PAD

A

SMOKING CESSATION!!!
Risk factor reduction
Control BP in hypertensive pts (ACEI recommended)
Lower cholesterol w/ a statin (goal LDL <100)
Weight loss
Treat DM aggressively
Platelet inhibitors (ASA/Clopidogrel) reduces the risk of adverse CV events in pts w/ PAD (Stroke/MI) but does not tx symptoms
Consistent/moderate exercise (improves walking distance)- minimum of 30 minutes a day
Foot Care
Keep clean and protected against excessive drying
Well-fitted and protective shoes to reduce trauma
Avoid support hose/compressive stockings- reduces blood flow to the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prognosis for Atherosclerotic PAD

A

Depends on the patients medical hx (the extent of coexisting coronary and cerebrovascular disease)
Pts w/ PAD have a 15-30% 5 year mortality rate and a 2 to 6-fold increased risk of death from coronary heart disease
25-30% of pts w/ critical limb ischemia undergo amputation w/in 1 year
Prognosis is worse in pts who continue to smoke or have DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fibromuscular Dysplasia

A

Hyperplastic disorder
Results in stenosis and aneurysms of medium and small sized arteries—> HTN, dissections, claudication and rest pain if limb vessels are involved
Usually involves the renal and carotid arteries but can affect blood vessels in extremities
Predominantly in females, early 50’s
Increased risk in smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Fibromuscular Dysplasia Diagnosis and Treatment

A

Diagnosed angiographically by a “string of beads” appearance
S&S are similar to those for atherosclerosis when limb vessels are involved (claudication and rest pain)
Treatment is similar to PAD in pts w/ severe symptoms and/or threatened tissue loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Thromboangiitis Obliterans

A

Aka “Buerger’s disease”
Inflammatory occlusive vascular d/o involving small and medium sized arteries and veins in the distal upper and lower extremities only
Most frequently occurs in men >40yrs
Prevalence higher in Asians and pts of Eastern European descent
Cause is unknown, but cigarette smoking may play a role

23
Q

Triad for Thromboangiitis Obliterans

A

claudication of affected extremity
Raynaud’s phenomenon and
migratory superficial vein thrombophlebitis

24
Q

Thromboangiitis Obliterans Diagnosis and Treatment

A

Claudication confined to calves/feet and forearms/hands
If severe digital ischemia is present:
Trophic nail changes, painful ulcerations and gangrene may develop to tips of digits
Normal brachial and popliteal pulses but reduced or absent radial, ulnar and/or tibial pulses
Diagnosis confirmed by bx of involved vessel
No specific tx except smoking cessation
Arterial bypass of the larger vessels if possible, local debridement and amputation if required

25
Q

Takayasu’s Arteritis

A

Inflammatory and stenotic dz of medium and large sized arteries
Strong predilection for the aortic arch and its branches (“aortic arch syndrome”)
Can affect the iliac artery resulting in leg claudication symptoms
Uncommon (incidence rate of 1.2-1.6 cases/million)
Most prevalent in adolescent girls and young women
Most common in Asia but can occur anywhere

26
Q

Takayasu’s Arteritis Diagnosis and Treatment

A

Diagnosis:
Arteriography-confirms the diagnosis (characteristic pattern)
Irregular vessel walls, stenosis, poststenotic dilatation, aneurysm formation, occlusion and evidence of increased collateral circulation

Treatment
Glucocorticoid therapy may relieve acute symptoms, but does not treat the condition
Surgical: to decrease the mortality rate

27
Q

Giant Cell Arteritis

A

AKA “temporal arteritis”
Inflammation of medium and large sized arteries
Characteristically involves one or more branches of the carotid artery, particularly the temporal artery
Systemic disease; therefore can affect involve arteries in multiple locations
Strongly associated w/ Polymyalgia Rheumatica (PMR)
Seen in 40-50% of patients w/ giant cell arteritis
Occurs exclusively in patients >50yrs old
More common in women than men

28
Q

Clinical Signs/ Symptoms of Giant Cell Arteritis

A

Complex of fever, anemia, high ESR and HA’s in a pt over 50y
Systemic symptoms: malaise/fatigue, anorexia, wt loss, sweats, arthralgias, PMR or large vessel dz
If involving cranial arteries- HA is most common w/ a tender, thickened, or nodular artery, scalp pain, claudication of the jaw/tongue, ischemic optic neuropathy (could lead to blindness)
If involving large vessels- subclavian artery stenosis arm claudication; aortic aneurysms (risk of rupture and dissection); leg claudication w/ diminished pulses or bruits

29
Q

Labs/Diagnosis/Treatment of Giant Cell Arteritis

A 
Labs
Elevated ESR (non-specific)

Diagnosis:
Confirmed by biopsy of the temporal artery
Should be obtained as quickly as possible and therapy should not be delayed pending the bx results
If large vessel disease, confirm by vascular imaging (MRA, CTA)

Treatment:
Goal- reduce symptoms and prevent visual loss
Glucocorticoid treatment is the gold standard tx
High dose Prednisone for 1 month followed by gradual tapering

30
Q

Acute Arterial Occlusion of a Limb

A

Results in the sudden loss of blood flow to an extremity
The size/extent of the occlusion and development of collateral blood flow determines the signs/symptoms, the degree of ischemia and the viability of the extremity

31
Q

2 causes: of Embolism and Primary Thrombosis

A

Embolism
Most common sources of arterial emboli are : heart, aorta and large arteries
A. fib is the most common cause
Primary Thrombosis:
Pts usually have a hx of claudication and now have an acute occlusion

32
Q

Clinical Features of Acute Arterial Occlusion of a Limb (6)

A 
6 P’s:
Sudden onset of pain
Pallor
Pulselessness
Paresthesias
Poikilothermia (coolness)
Paralysis
If occurs in the presence of an adequate collateral circulation
Symptoms will be less impressive 
Sudden decrease in the distance walked before claudication occurs or of pain and paresthesia
33
Q

Diagnosis of Acute Arterial Occlusion of a Limb

A

Clinical diagnosis
Doppler U/S to assess blood flow- little or none
Imaging (MRA, CTA or catheter-based arteriography)- abrupt cutoff of contrast

34
Q

Treatment of Acute Arterial Occlusion of a Limb

A

If limb is in jeopardy: Immediate revascularization w/in 3 hours along w/ Heparin IV to prevent clot propagation
If limb is not in jeopardy: Conservative tx
Observation and anticoagulants (prevents recurrent embolism and reduce the likelihood of clot propagation)
Heparin IV followed by oral warfarin
Endovascular Surgery (catheter directed chemical thrombolysis into the clot)

35
Q

Prognosis of Acute Arterial Occlusion of a Limb

A

10-25% risk of amputation w/ acute arterial occlusion from emboli
Prognosis for acute thrombotic occlusion is better d/t collateral flow

36
Q

Thoracic Outlet Compression Syndrome Etiology

A

Compression of the neurovascular bundle (artery, vein or nerves) at the thoracic outlet as it courses through the neck/shoulder
Causes:
Cervical ribs
Abnormalities of muscles or their insertion
Proximity of clavicle to the first rib

37
Q

Thoracic Outlet Compression Syndrome

A

Combination of 4 symptoms in the upper extremity
Pain, numbness, weakness and swelling
Depends on what structures are being compressed
Vascular symptoms:
Arterial ischemia- pallor of fingers on elevation of the extremity, sensitivity to cold and rarely gangrene of the digits
Venous obstruction- edema, cyanosis and engorgement
Symptoms can be provoked w/in 60sec >90% of the time by having the patient elevate the arms
Wright’s Maneuver
Adson’s Test

38
Q

Wright’s Maneuver (hyperabduction test)

A

The radial pulse weakens or disappears when the arm is abducted and externally rotated on the affected side

39
Q

Adson’s Test

A

Radial pulse weakens or disappears when the patient rotates their head to the affected side with extended neck following deep inspiration.

40
Q

Ddx and Diagnosis for Thoracic Outlet Compression Syndrome

A

DDx:
OA of the spine
Tumors of the lung, spinal cord or nerve roots
Periarthritis of the shoulder

Diagnosis:
CXR: identifies cervical rib
MRI: w/ arm held in a certain position
Angiography (arterial/venous obstruction)

41
Q

Treatment of Thoracic Outlet Compression Syndrome

A 
95% treated successfully w/ conservative tx
PT and avoiding aggravating positions/activities
Operative tx (<5%)
42
Q

Peripheral Artery Aneurysm

A

Popliteal artery aneurysms are the most common (70%)
50% are b/l
Tend to embolize repetitively over time and occlude arteries
Most common presentation is limb ischemia secondary to thrombosis or embolism
1/3 of patients require amputation
To prevent limb loss, repair should be performed if the aneurysm is >2cm in diameter or if they are symptomatic

43
Q

Clinical Findings for Peripheral Artery Aneurysm

A

If in groin, may feel a pulsatile mass
Popliteal aneurysms are often undetected
First symptoms may be d/t ischemia
Range from sudden onset pain and paralysis to short distance claudication that slowly lessens as collateral flow develops
Recurrent pain in the foot w/ cyanosis suggests embolization and requires a thorough work up

44
Q

Imaging and Treatment for Peripheral Artery Aneurysm

A 
Imaging:
Duplex U/S- gold standard
MRA/CTA is required for reconstruction
Treatment:
Surgery if symptomatic, if aneurysm measures >2cm in diameter or if a thrombus is present w/in the aneurysm
45
Q

Raynaud’s Phenomenon

A

Syndrome of paroxysmal digital ischemia
Most commonly caused by an exaggerated digital arteriole vasoconstriction to cold or emotional stress
Initial phase: excessive vasoconstriction resulting in digital pallor or cyanosis
Recovery phase: vasodilation resulting in intense hyperemia (increased blood flow) and rubor
Primarily affects the fingers, but can affect toes
Thumbs are rarely affected

46
Q

Signs/ Symptoms of Raynaud’s Phenomenon

A

One or more digits appear white when exposed to cold (pallor/cyanosis)
During recovery phase, may get intense rubor, throbbing, paresthesias, pain and slight swelling
Attacks usually resolve spontaneously or upon rewarming

47
Q

Primary Type of Raynaud’s Phenomenon

A 
2-6% of adults
More common in young women
Appears first b/w ages 15-30yr
Mildly progressive
Symmetric involvement is the rule
48
Q

Secondary Type of Raynaud’s Phenomenon

A

Less common
Associated w/ rheumatic disease
Nailfold capillary abnormalities may be 1st clue
Causes digital pitting, ulceration and/or gangrene

49
Q

Treatments for Raynaud’s Phenomenon

A

Treatment of Primary RP

General:
Keep body warm (prevent reflex vasospasms)
Wear gloves/mittens in cold weather
Protect hands from injury at all times
Treat dry skin
Smoking cessation
Avoid sympathomimetic drugs (decong, diet pills, etc)
Medications (severe cases):
Calcium Channel Blocker (CCB)- first line
Α-adrenergic antagonists

Treatment of Secondary RP
General measures above
Treat the underlying illness (rheumatology consult)

50
Q

Acrocyanosis

A

Arterial vasoconstriction and secondary dilation of the capillaries and venules resulting in persistent (not episodic) cyanosis of the hands and occasionally the feet
Cyanosis is worse when exposed to the cold

51
Q

Primary Acrocyanosis

A

Women >men, age of onset <30yrs
Asymptomatic, but seek tx d/t cosmetic reasons
Pain, ulcers and gangrene do not occur
Exam- normal pulses, cyanosis and moist palms, blanching does not occur
Tx- reassurance, dress warmly and avoid cold exposure

52
Q

Primary and Secondary Livedo Reticularis

A

Localized areas of the extremities develop a mottled (net-like) appearance of reddish/blue discoloration that is more prominent after cold exposure

Primary (idiopathic):
Benign, but may be associated w/ ulcerations
Women>men
Age of onset, 3rd decade of life
Asymptomatic (seek eval d/t cosmetic reasons)
Tx: Reassure and avoid cold environments

Secondary:
d/t underlying d/o
Ulcerations do not occur
Tx underlying d/o

53
Q

Pernio (Chilbains)

A

Vasculitis d/o associated w/ exposure to cold
Most commonly occurs in young women, but may occur in adults and children
Raised erythematous lesions develop on the distal lower extremities in cold weather
Usually self-limiting but may lead to recurrent disease
Associated w/ pruritis, burning sensation and/or pain
May ulcerate and blister

54
Q

Pernio (Chilbains) Treatment

A

Avoid exposure to cold
Wound care over ulcers
Sympatholytic agents and dihydropyridine CCB may be effective (ex. Nifedipine which produces vasodilation)

Cardio= Clin Med (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions