Peripheral Vascular Disease

Question 1

Peripheral Vascular Disease?

Answer 1

diseases of arteries and veins except for the heart

any occlusive process that limits blood flow to or from the limbs or to vital organs other than the heart

Question 2

Atherosclerosis?

Answer 2

most common condition affecting the arterial system in the elderly
in the lower extremity is a disease of the elderly

Question 3

Venous Disease Categories?

Answer 3

Deep

Superficial

Question 4

Deep Vein Disease Risk factors?

Answer 4

Injury (Surgery)
Stasis (immobility)
Hypercoagulative state
Obesity
Age

Question 5

Virchow’s Triad?

Answer 5

Injury, Stasis, Hypercoagulable State

Question 6

DVT often presents with?

Answer 6

Classic symptoms of DVT

-pain, edema, warmth is variable, Positive Homan’s Sign

Question 7

DVT (deep vein thrombosis) Diagnosis?

Answer 7

History and Physical
High Index of suspicion
Venous Doppler Study (ultrasound)

Question 8

DVT treatment?

Answer 8

anticoagulant, warm moist packs, elevate, invasive-thrombectomy, thpmbolytics, inferior vena cava filter (especially with 2nd)

Question 9

DVT sequale?

Answer 9

most important
PE- pulmonary embolism
life threatening, don’t want to miss

Question 10

PE signs and symptoms?

Answer 10

Chest pain, shortness of breath, anxiety, tachycardia, respiratory distress, shock, death

Question 11

Superficial Venous Disease?

Answer 11

Not so dramatic as DVT
Chronic
Can be a real mess:
-varicose veins, superficial phlebitis, stasis dematitis, venous ulcers

Question 12

Superficial phlebitis?

Answer 12

bad varicose veins, feel warmth

Question 13

Superficial Venous Disease Risk factors?

Answer 13

Sedentary, Obesity, Varicose veins, poor hygiene, age

Question 14

Superficial Venous Disease Signs and Symptoms?

Answer 14

Ache, Edema, Rash, Inflammation, Ulcers(feet)

Question 15

Peripheral Arterial Occlusive Disease?

Answer 15

Hardening of the arteries

most common arterial disease of the elderly

Question 16

Peripheral Arterial Occlusive Disease Risk Factors?

Answer 16

Smoking, Hypertension, Hyperlipidemia, Diabetes, Sendentary Lifestyle, Age, Family History

Question 17

Treatable risk factors of Peripheral Arterial Occlusive Disease?

Answer 17

Smoking, Hypertension, Hyperlipidemia, Diabetes, Sendentary Lifestyle

Question 18

Peripheral Arterial Occlusive Disease Signs and Symptoms?

Answer 18

Ache/Pain, Claudication, Loss of hair, numbness, coolness, pallor and cyanosis, absent pulse

Question 19

Claudication?

Answer 19

pain in legs on walking relieved by rest

Question 20

Peripheral arterial disease?

Answer 20

reduced blood flow and oxygen delivery to tissues

this causes pain with walking (increase oxygen demand of skeletal muscle)

Question 21

Pain in peripheral arterial disease vs DVT?

Answer 21

DVT pain never goes away

peripheral arterial pain gets better with rest

Question 22

The anatomy of Claudication? (what arteries it affects in different locations)

Answer 22

Buttock and Hip= Aortoilliac arteries

Thigh= Common Femoral Artery

Calf(upper 2/3)= Superficial Femoral Artery

Calf (lower 1/3)= Poplitial artery

Foot- Tibial or Peroneal artery (fibular artery)

Question 23

Treatment/ modify risk factors Peripheral arterial disease?

Answer 23

Stop smoking, control hypertension, lower lipids, control diabetes, exercise

Question 24

Peripheral arterial disease medicines?

Answer 24

Anti-platelet agents
-Aspirin, Clopidogrel, Cilostazol, Pentoxyfylline
Lipid lowering agents
ACE inhibitors

Question 25

Clopidogrel?

Answer 25

irrversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation

Question 26

Aspirin?

Answer 26

irreversible inhibits cyclooxygenase, reducing prostalgandin and thromboxane A2 synthesis, reducing platelet aggregation

Question 27

Phentoxyifylline?

Answer 27

increase erythrocyte flexibility, decrease plasma fibrinogen (decrease blood viscosity), increase blood flow, tissue oxygenation

Question 28

Cliostazol?

Answer 28

increase cAMP, decrease platelet aggregation and cause femoral vasodilation

platelets- decrease platelet aggegation, decrease claudication

vasculature- vasodilate, decrease claudication

Question 29

First line?

Answer 29

Cilostazol

more effective than pentoxyifylline

Question 30

Pentoxyifylline?

Answer 30

used as an alternative to cilostazol

mixed results in clinical trials

Question 31

What are you treating with meds?

Answer 31

Claudication symtoms

Question 32

Cilostazol adverse reactions?

Answer 32

Headache, diarrhea, palpitation, dizziness, contraindicated in heart failure

Question 33

Pentoxyfylline adverse reactions?

Answer 33

nausea, vomiting, diarrhea, dizziness, headache

Question 34

Arterial embolism?

Answer 34

medical emergency
acute and dangerous
fortunately far less common than chrome Peripheral Arterial disease

Question 35

Acute arterial occlusion signs and symptoms?

Answer 35

pain, pallor, parathesis, paralysis, pulseless

Question 36

Acute occlusion diagnosis?

Answer 36

History and physical

imaging studies

Question 37

Acure occlusion treatment?

Answer 37

Thrombolytic/ anticoagulant
surgery (surgical bypass)
intravacular procedures

Question 38

what happens with peripheral artery disease?

Answer 38

plague buildup in artery
causes reduced pressure and flow of blood distal to the atheroma
endothelial dysfunction distal to the atheroma which causes reduced production of NO
RBCs deform when passing through capillaries and align themselves in planar manner
reduce viscosity and enables them to pass smoothly through capillaries

Question 39

Chronic tissue ischemia and hypoxia causes?

Answer 39

decreased ability of RBCs to deform
increased platelet aggregation and activation of clotting factors
these events increase blood viscosity and further inhibit blood flow and oxygen delivery to tissues