Peripheral Vascular Flashcards
What can peripheral vascular system involve?
arteries, veins, lymphatics
Who gets PAD?
men >50 yo or high risk
What are high risk for PAD?
Diabetes CAD HTN Smoking Abnormal cholesterol Strokes Kidney dz requiring hemodialysis
What are the two most important PAD?
atherosclerosis of large arteries and microvascular disease
What do you see with exercise in PAD?
ischemia
What can PAD also be the results of?
vascular trauma, radiation therapy, vasculitis
What are the symptoms of PAD?
Pain, fatigue, discomfort, heaviness, burning
Where does PAD usually occur?
muscles of feet, claves, thighs
How do the legs feel in PAD?
cool, skin is pale, numb
What do you get with severe PAD?
Erectile dysfunction
Pain and cramps at night
Pain/tingling so severe, bedsheets or clothes are painful
Pain worse when leg is raised, improved when leg is down
Skin that looks dark blue
Sores that do not heal
What does PAD atherosclerosis cause?
AAA
Where does AAA occur?
below renal arteris, extends to external iliac
What AAA size has 20% risk of rupture?
> 5 cm in 1 year, 50% in 5 yr
Who is AAA more common in?
men and whites
Who gets PAD microvasculature disease?
diabetics
What does microvascular disease cause?
peripheral neuropathy - sensory, motor or autonomic
What is the rule of 15 in diabetics?
15% get foot ulcer –> 15% osteomylitis or 15% amputation
What is the rule of 50 in diabetics?
50% amputation above knee
50% get second amputation in 5 yrs
50% die in 5 years or less
What holds 70% of blood?
venous system
What controls veins?
neural and hormonal stimuli, valves, less sturdy and more distensible
What two things does PVD go to?
venous stasis or thrombotic disorders
What is a severe complication of thrombotic disorder?
PE
When is venous pressure the highest?
upright posture
What are complications of chronic venous insufficiency?
pigment changes, dermatitis, celluiltits, ulcerations, thrombus
What does PVD cause?
Pain: UEs, LEs, abdominal, flank or back Intermittent claudication Changes in skin color and temp, numbness, hair loss Ulceration Edema Emboli Neurologic symptoms
pain in the LE during exc and relieved by rest. Site of pain is always distal to the occlusive dz.
intermittent claudication
pain with DVT. Combo of venous valvular incompetence, outflow obstruction, and muscle pump function derangement.
venous claudication
What is pain at rest, worse with cool temps or elevation (IC or VC)?
Intermittent claudication
What is motionless standing painful, walking less (VC, IC)?
Venous claudication
common in lumbar spinal stenosis, or spinal neuritis, often related to posture.
Neurogenic claudication
chronic aortoiliac obstruction severe atherosclerosis at the aortic bifurcation IC and ED
leriche’s syndrome
bilateral LE pain or numbness while walking and resting MSK dz in the lumbar area
Pseudoclaudication
What are the features of IC?
pain - dull, cramp, fatigue onset - gradual, consistent relief - stop walking, rest location - muscles legs - one
What are features of VC?
pain - aching, heavy, tight onset - gradual relief - activity location - whole leg legs - one
What are features of neurogenic claudication?
pain - pins and needles, going down onset - immediate relief - sitting, stop, flex hip location - poor localized leg - both
What are the skin chanages in chronic arterial insufficiency?
cool and pale, hairless, shiny, superficial ulcers
What are the changes in chronic venous?
warm, red, edema
What are the changes in acute arterial insufficency?
embolus –> mottled
What is necrobiosis lipoidica diabeticorum?
skin disorder in DM, severity not related to severity of DM, occurs prior to frank DM
What is the hallmark of NLD?
waxy yellow reddish brown sharply demarcated plaquelike lesions
What causes ulcerations?
persistent ischemia
What are the ulcers like in artieral insufficency?
trauma caused
painful, discrete, punched out, crusted, rapid, red
What are ulcers like in venous insufficency?
light trauma cause, painless, ankles, brawny changes, cobblestone, slow developing
usally indicates insufficiency from prolonged dependent positions, or right sided heart failure
orthostatic pitting edema
What causes edema without pitting?
arterial insufficiency
What causes unilateral edema?
occlusion of major vein
What does lymphadema look like?
nonpitting edema, painless, rough skin
What are symptoms of an emboli?
SOB from PE
abdominal pain from renal or intestinal
neurologic from basilar artery
pain and paresthesia from peripheral artery emboli
Where do you check pitting edema?
prominence of tibia or medial malleolus
What is contour and whats normal?
waveform - smooth, round, dome shape
What is amplitude?
force
bounding, aneurysmal
4
full, increased
3
normal
2
diminished
1
absent, not palpable
0
What arteries do you palpate?
Carotid Brachial Radial Femoral Popliteal Dorsalis pedis (DP) Posterior tibial (PT)
PAD in butt and hip =
aortoiliac = leriche’s syndrome
PAD in thigh =
femoral or external iliac
PAD in upper calf =
superficial femoral
PAD in lower calf =
popliteal
What are the 5 p of acute arterial occlusion?
pain, pallor, paresthesia, paralysis, pulselessness
How do you check UE PAD?
allens test
How do you test LE PAD?
elevation/dependency test or ankle brachial
How do you check LE and UE PAD?
cap refill
What areas do you ausculatate?
carotid, renal, AA, iliac, femoral
Where does head of bed need to be for JVD?
45
What can you do to help assess JVD?
hepatojugular reflux
When comparing calf what is the significant sign?
2 cm larger
What is the sign where you dorsiflex the foot and causes pain and means DVT?
homan’s sign
What is the gold standard for looking at DVT?
doppler US
An exaggerated spasm of the digital arterioles (occas in nose and ears) usually in response to cold exposure
Raynaud Phenomenon and syndrome
An inflammatory dz of the branches of the aortic arch, including the temporal arteries
temporal arteritis
A pathologic communication between an artery and a vein.
arteriovenous fistula
jvd =
INCREASE right atrial pressure
What is the first wave in JVD?
a wave
When does BP decrease?
preg first trimester
