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Finals - CardioResp > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What is PAD?

A

Narrowing of the arteries supplying the limbs and periphery, reducing the blood supply to these areas

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2
Q

List 3 presentations of PAD

A
  1. intermittent claudication
  2. critical limb ischaemia
  3. acute limb-threatening ischaemia
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3
Q

List 3 consequences of artheroscerotic plaque formation in arteries

A
  1. Stiffening, leading to hypertension and strain on the heart
  2. Stenosis, leading to reduced blood flow (ie. in angina)
  3. Rupture, resulting in a thrombus that can block a vessel and cause ischaemia (ie. ACS)
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4
Q

List 2 non-modifiable risk factors for Atherosclerosis

A
  1. Older age
  2. Family history
  3. Male
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5
Q

List 4 modifiable risk factors for Atherosclerosis

A
  1. Smoking
  2. Alcohol consumption
  3. Poor diet
  4. Low exercise / sedentary lifestyle
  5. Obesity
  6. Poor sleep
  7. Stress
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6
Q

List 2 Medical Co-Morbidities which increase risk of atherosclerosis

A
  1. Diabetes
  2. Hypertension
  3. Chronic kidney disease
  4. RA
  5. Atypical antipsychotic medications
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7
Q

What is Leriche Syndrome?

What is the classic triad?

A

Occlusion in the distal aorta or proximal common iliac artery

  1. Thigh/buttock claudication
  2. Absent femoral pulses
  3. Male impotence
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8
Q

What is Buerger’s Test?

A

First part

  1. Patient lying on back, leg lifted to 45 degrees at the hip for 1-2 minutes
  2. Pallor indicates PAD
  3. Buerger’s angle is the angle at which the leg becomes pale

Second part

  1. Patient sat up with legs hanging over side of the bed, blood flows back
  2. Normally legs will remain a pink colour
  3. In PAD they will go: Blue initially then Dark red after a short time
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9
Q

List 4 features of an arterial ulcer

A
  1. Smaller and Deeper than venous ulcers
  2. Well defined borders
  3. “punched-out” appearance
  4. Peripherally located (ie. on the toes)
  5. Reduced bleeding
  6. Painful
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10
Q

List 4 features of an venous ulcer

A
  1. Hx minor injury to leg
  2. Larger and more superficial than arterial ulcers
  3. Irregular, gently sloping borders
  4. Affect gaiter area (mid-calf down to the ankle)
  5. Less painful than arterial ulcers
  6. Occur with other signs of chronic venous insufficiency (eg. haemosiderin staining and venous eczema)
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11
Q

List 3 investigations for PAD

A
  1. Duplex ultrasound
  2. Ankle-brachial pressure index (ABPI)
  3. Angiography (CT or MRI)
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12
Q

Features of intermittent claudication?

A
  1. Aching or burning in leg muscles following walking
  2. Can typically walk for a predictable distance before symptom onset
  3. Relieved within minutes of stopping
  4. Not present at rest
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13
Q

Assessment of Intermittent Claudication

A
  1. Check femoral, popliteal, posterior tibialis and dorsalis pedis pulses
  2. Check ABPI
  3. Duplex ultrasound (first line investigation)
  4. Magnetic resonance angiography (MRA) prior to any intervention
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14
Q

Interpret the various values of a duplex ultrasound

A
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15
Q

Management of intermittent claudication?

A
  1. Lifestyle changes and exercise training
  2. Atorvastatin, Clopidogrel, Naftidrofuryl oxalate
  3. Surgical: angioplasty, stenting, bypass surgery
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16
Q

What is acute limb ischaemia?

A

Rapid onset of ischaemia in a limb, typically due to a thrombus

17
Q

Features of acute limb ischemia

A

1 or more of the 6 P’s

  • pale
  • pulseless
  • painful
  • paralysed
  • paraesthetic
  • ‘perishing with cold’
18
Q

Initial investigations for acute limb-threatening ischaemia?

A
  1. handheld arterial Doppler examination
  2. If Doppler signals are present, an ABPI should also be obtained
19
Q

Initial management for acute limb-threatening ischaemia?

A
  • ABCE
  • analgesia: IV opioids
  • IV unfractionated heparin to prevent thrombus propagation
  • vascular review
20
Q

Definitive management for acute limb-threatening ischaemia?

A
  1. intra-arterial thrombolysis
  2. surgical embolectomy
  3. angioplasty
  4. bypass surgery
  5. amputation: for irreversible ischaemia
21
Q

What is Critical limb ischaemia?

A

End-stage of PAD which causes pain at rest, non-healing ulcers and gangrene

Typically causes a burning pain, worse at night when the leg is raised

22
Q

Features of Critical limb ischemia?

A

1 or more of:

  • rest pain in foot for more than 2 weeks
  • ulceration
  • gangrene

Patients often report hanging their legs out of bed at night to ease the pain

23
Q

Management of PAD

A
  1. Atorvastatin 80 mg
  2. Clopidogrel 75mg
  3. Exercise training
  4. Surgery for severe cases: angioplasty, stenting, bypass surgery
  5. Amputation for cirital limb ischemia who are not suitable for other interventions
24
Q

List another drug licensed for use in PAD

A

Naftidrofuryl oxalate: vasodilator

Finals - CardioResp (18 decks)

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