Peripheral Artery Disease Cases Flashcards
What to ask about pt history in interview for peripheral artery disease?
Describe the pain: Location, severity, exacerbating and alleviating factors Has it happened before? What is he/she doing? How long did it last? Does the patient have any other medical history? What medications do they take? Do they smoke tobacco? Family history?
What is intermittent claudication?
- pain caused by too little blood flow during exercise
- Cramping, tightness, fatigue
- Involves buttock, hip, thigh, calf, foot usually
- Exercised-induced - does not occur when standing
What relieves intermittent claudication?
Relieved by rest (Usually within 5 minutes)
What pt present with classic intermittent claudicaiton?
Only ~ 1/3 of the PAD patients experience classic IC and the remaining have either atypical symptoms or are asymptomatic
PAD is as serious as CAD, what are CAD pt almost always told to do that PAD pts are not?
EXERCISE!!!! it can help with PAD just as much as CAD
What is the mortality rate of PAD?
32% over a period of 10 years - which is pretty darn high
What should you look for in physical exam for a pt with PAD?
- Auscultate the abdomen, femoral arteries, for the presence of bruits
- Palpate for the presence of an abdominal aortic aneurysm
- Palpate the femoral, popliteal, posterior tibial, and dorsalis pedis pulses
- Inspect the feet for ulcers, fissures, calluses, tinea, tendinous xanthomas, and evaluate overall skin care
How do you grade pulses?
- normal: 2
- diminished: 1
- absent: 0
What should you visually inspect on a pt with PAD?
- Hair loss
- Thickened and brittle toenails
- Smooth and shiny skin
- Subcutaneous fat atrophy
- muscle atrophy
- Skin fissures
- Ulceration
- Gangrene
When would you find pallor in pt with PAD?
in the supine position or with elevation = not good
PAD can have dependent rubor what is that?
Filling of dilated skin capillaries with deoxygenated blood
What non-invasive evaluation should be done with PAD pts?
Ankle-Brachial Index**
Ankle-Toe Index**
Exercise treadmill testing
Segmental limb pressures
What is ankle brachial index?
ratio of ankle systolic pressure to brachial artery systolic pressure. the ratio correlates with severity of disease: the lower the ABI the higher the mortality
How can you treat a pt with PAD?
- Risk factor modification
- Exercise
- Antiplatelet therapy
- RBC rheology modifiers
- Phosphodiesterase inhibitors
- Percutaneous vs Surgical
Overall treatment goal for pt with PAD?
Decrease risk factors!!!!
- smoking
- lipid control
- BP control
- diabetes control
- exercise
- ideal body weight
How much does cigarette smoking increase your risk of PAD?
Two to fivefold increased risk of PAD: Approximately 84%-90% of patients with claudication are current or ex-smokers
Does smoking have a greater risk for PAD or CAD?
Smoking increases the risk of PAD»CAD
What happens to pt with PAD who continue to smoke?
More common progression to CLI and limb loss & Decreased the LE arterial bypass patency rates
How much does diabetes increase your risk of PAD?
Two to fourfold increased risk of PAD and more likely to have an amputation
Does reduction in HbA1c help PAD?
Risk reduction per 1% reduction in HgA1c:
- Risk for amputation 37%
- Death from PAD 43%
- Myocardial infarction 14%
- Stroke 12%
- Heart failure 16%
What kind of pham therapy is there for PAD?
Pentoxifylline, cilostazol clopidogrel, aspirin, warfarin
What does Pentoxifylline?
A methylxanthine derivative: hemorrheologic agent
weak antiplatelet activity
some vasodilation
What does cilostazol do?
A phosphodiesterase III inhibitor: platelet aggregation inhibitor vasodilator decrease TG inhibits SMC proliferation
What are the exercise recommendations for pt with PAD?
- Sessions of 30 min in duration
- At least 3 times a week
- At least 6 months
