Peripheral Vascular Disease Flashcards
Peripheral Vascular Disease?
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
Atherosclerosis?
most common condition affecting the arterial system in the elderly
in the lower extremity is a disease of the elderly
Venous Disease Categories?
Deep
Superficial
Deep Vein Disease Risk factors?
Injury (Surgery) Stasis (immobility) Hypercoagulative state Obesity Age
Virchow’s Triad?
Injury, Stasis, Hypercoagulable State
DVT often presents with?
Classic symptoms of DVT
-pain, edema, warmth is variable, Positive Homan’s Sign
DVT (deep vein thrombosis) Diagnosis?
History and Physical
High Index of suspicion
Venous Doppler Study (ultrasound)
DVT treatment?
anticoagulant, warm moist packs, elevate, invasive-thrombectomy, thpmbolytics, inferior vena cava filter (especially with 2nd)
DVT sequale?
most important
PE- pulmonary embolism
life threatening, don’t want to miss
PE signs and symptoms?
Chest pain, shortness of breath, anxiety, tachycardia, respiratory distress, shock, death
Superficial Venous Disease?
Not so dramatic as DVT
Chronic
Can be a real mess:
-varicose veins, superficial phlebitis, stasis dematitis, venous ulcers
Superficial phlebitis?
bad varicose veins, feel warmth
Superficial Venous Disease Risk factors?
Sedentary, Obesity, Varicose veins, poor hygiene, age
Superficial Venous Disease Signs and Symptoms?
Ache, Edema, Rash, Inflammation, Ulcers(feet)
Peripheral Arterial Occlusive Disease?
Hardening of the arteries
most common arterial disease of the elderly
Peripheral Arterial Occlusive Disease Risk Factors?
Smoking, Hypertension, Hyperlipidemia, Diabetes, Sendentary Lifestyle, Age, Family History
Treatable risk factors of Peripheral Arterial Occlusive Disease?
Smoking, Hypertension, Hyperlipidemia, Diabetes, Sendentary Lifestyle
Peripheral Arterial Occlusive Disease Signs and Symptoms?
Ache/Pain, Claudication, Loss of hair, numbness, coolness, pallor and cyanosis, absent pulse
Claudication?
pain in legs on walking relieved by rest
Peripheral arterial disease?
reduced blood flow and oxygen delivery to tissues
this causes pain with walking (increase oxygen demand of skeletal muscle)
Pain in peripheral arterial disease vs DVT?
DVT pain never goes away
peripheral arterial pain gets better with rest
The anatomy of Claudication? (what arteries it affects in different locations)
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)
Treatment/ modify risk factors Peripheral arterial disease?
Stop smoking, control hypertension, lower lipids, control diabetes, exercise
Peripheral arterial disease medicines?
Anti-platelet agents
-Aspirin, Clopidogrel, Cilostazol, Pentoxyfylline
Lipid lowering agents
ACE inhibitors
Clopidogrel?
irrversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
Aspirin?
irreversible inhibits cyclooxygenase, reducing prostalgandin and thromboxane A2 synthesis, reducing platelet aggregation
Phentoxyifylline?
increase erythrocyte flexibility, decrease plasma fibrinogen (decrease blood viscosity), increase blood flow, tissue oxygenation
Cliostazol?
increase cAMP, decrease platelet aggregation and cause femoral vasodilation
platelets- decrease platelet aggegation, decrease claudication
vasculature- vasodilate, decrease claudication
First line?
Cilostazol
more effective than pentoxyifylline
Pentoxyifylline?
used as an alternative to cilostazol
mixed results in clinical trials
What are you treating with meds?
Claudication symtoms
Cilostazol adverse reactions?
Headache, diarrhea, palpitation, dizziness, contraindicated in heart failure
Pentoxyfylline adverse reactions?
nausea, vomiting, diarrhea, dizziness, headache
Arterial embolism?
medical emergency
acute and dangerous
fortunately far less common than chrome Peripheral Arterial disease
Acute arterial occlusion signs and symptoms?
pain, pallor, parathesis, paralysis, pulseless
Acute occlusion diagnosis?
History and physical
imaging studies
Acure occlusion treatment?
Thrombolytic/ anticoagulant
surgery (surgical bypass)
intravacular procedures
what happens with peripheral artery disease?
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
Chronic tissue ischemia and hypoxia causes?
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
