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PHTH 536 - Body Systems > Peripheral Artery Disease - PVD > Flashcards

Peripheral Artery Disease - PVD Flashcards

1
Q

What are the risk factors?

A
  • CAD/artheroscleorisis
  • advanced age
  • hypercholesterolemia
  • smoking
  • hypertension
  • diabetes
  • overweight
  • family hx
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2
Q

What are the characteristics of patients with increasd risk of PAD?

A
  • 65 years and over
  • 50-64 with risk factors of artherosclerosis or family hx of PAD
  • under 50 with DM and 1 risk factor for atherosclerosis
  • with known atherosclerotic disease
  • AAA - abdominal aortic aneurysm
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3
Q

Pathohysiology

What is the assumed cause?

A

mismatch of demands of the body’s organs and muscles with supply of O2
- this is because of atherosclerotic stenosis of peripheral arteries

reduced diameter of blood vessels = ischemia

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4
Q

Pathophsysiology

What occurs during exercise?

A

metabolism makes adenoside -> dilation of arterioles = increase blood flow to muscles

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5
Q

Pathophysiology

What is another factor that leads to ischemia?

A

obstructed arteries which can’t act well to vasodilation stimulus and blood flow
- dramatic reduction to exercise tolerance

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6
Q

Pathophysiology

Local adaptations to chronic ischemia will lead to changes in what?

A

Muscle fiber metabolism and skeletal muslce degeneration

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7
Q

Pathophysiology

What can lead to lower extremity weakness?

A

Physical and biomechanical changes

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8
Q

Pathophysiology

What does ischemic changes in multiple arteries lead to?

A

ischemic sx at rest (very similar to angina)

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9
Q

Clinical Presentation

What are the vessels most commonly affected?

A
  • aorta
  • iliac femoral
  • popliteal
  • tibialperoneal arteries
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10
Q

Clinical presentation

What vessels are affected if there is arm pain?

A

brachiocephalic or subclavian

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11
Q

Clinical Presentation

Where is intermittent claudication affected?

A
  • buttock
  • hip
  • thigh
  • calf pain
  • sometimes feet and toes
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12
Q

Clinical presentation

What is the prevalence of intermitted claudication?

A
  • only about 1/3 experience it
  • about 1/3 experience atypical sx
  • about 1/3 are asx
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13
Q

Clinical presentation

What are the atypical sx?

A

leg pain/carry on - able to keep exercising through the pain or pain that starts at rest w/o critical limb ischemia

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14
Q

Clinical Presentation

Where is the location of sx?

A

Distal to the stenotic artery

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15
Q

Chronic Presentation

Chronic ischemia leads to?

A

Ulceration, infection and skin necrosis

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16
Q

Clinical Presentation

What are the clinical presentation?

A
  • dimished or absent pulses distal to stenosis
  • muscle atrophy
  • pallor or reduced temp when elevated (rubor of dependency)
  • shiny, taut skin - typically with hair loss and brittle, thick, dry toenails (trophic changes)
  • wounds
  • gangrene
  • necrosis of foot and digits
  • reduced sensation
  • associated with diabetes
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17
Q

ACSM Intermittent Claudication Scale

Grade 1

A

Definite discomfort or pain
- but only initial or modest levels

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18
Q

ACSM Intermittent Claudication Scale

Grade 2

A

Mod discomfort or pain from which the patient attention can be diverted

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19
Q

ACSM Intermittent Claudication Scale

Grade 3

A

Intense pain from which the patient’s attention can’t be diverted

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20
Q

ACSM Intermittent Claudication Scale

Grade 4

A

Excuciating and unbearble pain

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21
Q

Ankle Brachial Index

What is considered normal measurement?

A

greater than 1.10

22
Q

Ankle Brachial Index

0.5 - 1.0

A

sx: claudications

clinical presentation: pain in calf with ambulation

23
Q

Ankle Brachial Index

0.2-0.5

A

sx: critical limb ischemia

clinical presentation: atrophic changes, pain at rest, wounds

24
Q

Ankle Brachial Index

less than 0.2

A

sx: severe ischemia

clinical presentation: gangrene, severe necrosis

25
Q

What is critical limb ischemia?

A

Progression of PAD
- circulation can’t meet resting metabolic demands
- in early stages - collateral circulation will compensate

26
Q

Critical Limb Ischemia

1st critical phase

A

When collateral circulation can’t meet the needs of metabolic demand
- limited blood supply will affect muscles and skin = wound will be compromised

27
Q

Critical Limb Ischemia

2nd critical phase

A

Pain is experienced with exercise
- increasing muscle O2 demand

28
Q

Critical Limb Ischemia

3rd critical phase

A

Seen with resting pain
- non-healing wounds
- risk to infections
- risk for gangrene

29
Q

What is acute cold leg?

A

When there is an acute arterial occlusion
- a vascular emergency = longer delay will lead to amputation

30
Q

Acute Cold Leg

What is the cause of acute cold leg?

A

in situ thrombic occlusion - most often in femoral artery or embolism

31
Q

Acute Cold Leg

What are the sx?

A

sudden onset of:
- cold
- pale
- pulseless
- painful
- parasthetic
- paralytic leg

32
Q

Acute Cold Leg

How is it treated medically?

A

with revascularization

33
Q

Acute Cold Leg

What is the indication for an amputation?

A
  • mottled
  • non-blanching with hardened, woody muscle
34
Q

Clinical Categories of Acute Limb Ischemia

What is the prognosis of IIA (marginally threatened)?

A

salvageable
- if promptly treated

35
Q

Clinical Categories of Acute Limb Ischemia

IIA - sensory loss

A

minimal (at toes) or none

36
Q

Clinical Categories of Acute Limb Ischemia

IIA - possible doppler

A

arterial - inaudible
venous - audible

37
Q

Clinical Categories of Acute Limb Ischemia

IIB (immediately threatened) - prognosis

A

salvageable if immediately revascularized

38
Q

Clinical Categories of Acute Limb Ischemia

IIB - prognosis

A

Salvageable if immediately revascularized

39
Q

Clinical Categories of Acute Limb Ischemia

IIB - sensory loss

A

more than toes, pain at rest

40
Q

Clinical Categories of Acute Limb Ischemia

IIB - motor deficit

A

mild to moderate

41
Q

Clinical Categories of Acute Limb Ischemia

IIB - possible dobler

A

arterial - inaudible
venous - audible

42
Q

Clinical Categories of Acute Limb Ischemia

III (irreversible) - prognosis

A

Major tissue loss
permanent nerve damage
nerve damage inevitable

43
Q

Clinical Categories of Acute Limb Ischemia

III - sensory loss

A

profound loss

44
Q

Clinical Categories of Acute Limb Ischemia

III - motor deficits

A

profound, paralysis

45
Q

Clinical Categories of Acute Limb Ischemia

III - possible dopplers

A

both inaudible dopplers for arterial and venous

46
Q

ACSM Guidelines

What is the guideline for aerobic activity?

A

3-5x per week @ RPE 12-16 for 20-60 min per session
- walking speed should be at a pace to elicit caludations in 3-5 mins

47
Q

ACSM Guidelines

What is the guideline for resistance activity?

A

2x per week
- focusing on larger muscle
- emphasis on lower limbs

48
Q

ACSM Guidelines

What is the guidelines for flexibility?

A

2-3x per week

49
Q

What are the surgical interventions for PAD?

A
  • angioplasty with/or without stent
  • bypass surgery
  • femoral popliteal bypass
50
Q

When is exercise resumed after an angioplasty?

A

generally improved right away and helps with healing of distal wounds
- exercise can resume 72 hrs post

51
Q

When is exercise resumed after bypass surgery?

A

sx should resolve and out of bed after 1 day
- encourage activity once the wounds heal
- limit lifting for 6 weeks

52
Q

When is exercise resumed after femoral-popliteal bypass surgery?

A

used for critical limb ischemia
- OOB walking after day 1 post op
- go back to activity once wounds heal
- monitor limb tthrough healing

PHTH 536 - Body Systems (28 decks)

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