Peripheral vascular disease

Question 1

Peripheral artery disease

Answer 1

Narrowing of the arteries supplying the limbs and peripheries

Reduced blood supply to these areas

Question 2

Claudication

Answer 2

Symptom of limb ischaemia

Occurs during exertion and relieved by rest

Crampy, achy pain in the calf, thigh or buttock myuscle

Question 3

Critical limb ischaemia

Answer 3

End-stage of PAD

Inadequate supply f blood to a limb to allow it to function normally

Pain at rest, non-healing ulcers, gangrene

Question 4

Acute limb ischaemia

Answer 4

Rapid onset of limb ischaemia

Typically due to thrombus in arterial supply of distal limb

Question 5

Atherosclerosis risk factors

Answer 5

Older age

FH

Male

Smoking

Alcohol

Poor diet (high sugar and trans fats)

Low exercise/ sedentary lifestyle

Obesity

Poor sleep

Stress

Question 6

Comborbidities increases risk of atheroscleroris

Answer 6

Diabetes

HTN

CKD

Inflammatory conditions (RA)

Atypical antipsychotics

Question 7

Signs of CVD in PAD exam

Answer 7

Missing limbs/ digits

Midline sternotomy scar (CABG)

Inner calf scar (saphenous vein harvesting)

Focal weakness suggestive of a previous stroke

Question 8

Signs of PAD on inspection

Answer 8

Skin pallor

Cyanosis

Dependent rubor

Muscle wasting

Hair loss

Ulcers

Poor wound healing

Gangrene (breakdown of skin and red/black colour)

Question 9

Investigations

Answer 9

ABPI
- 0.9-13 normal
- 0.6-0.9 mild PAD
- 0.3-0.6 moderate/ severe PAD
- <0.3 severe disease to critical ischaemia