Peripheral Vascular Disease Flashcards
what is peripheral artery disease
umbrella disease the describes circulatory diseases
- arterial and venous
what is the pathophysiology of PVD
atherosclerosis of the peripheral system
- formation of plaques which leads to dec perfusion
risk factors for PVD
SMOKING
DM
high cholesterol
heart disease
stroke
inc age over 50
causes of PVD
atherosclerosis
thrombus
inflammation (thromboangitis obliterans)
vasospasms
what is thromboangitis obliterans
inflammatory conditions of the arteries that typically leads to permanent occlusion
what are clinical manifestations of PVD
calf or buttock pain
numb, burning, heaviness, intermittent claudication
wounds that dont heal
diminished sensations in extremities
trophic skin changes
what are trophic skin changes
shiny skin, thick toenails
loss of leg hair
diminished pulses
elevation pallor, cyanosis
reactive hyperemia (dependent rubor)
ED
what is intermittent claudication
consistent pain precipitated by consistent levels of pain
- ceases with rest
- caused by ischemic tissue, arterial flow obstruction
- “angina” of the lower extremity
- pain usually occurs after walking a certain distance
what is pain of PVD dependent on
the site of plaque build up
collateral circulation (how long has it been developing)
what is the common site for PVD
femoral artery
what does PVD in femoral artery cause
lack of circulation resulting in
pain ( intermittent claudification)
dec pulse
coolness of leg bc dec in warm blood
pallor of legs
loss of sensation in foot
ischemia of lower leg –> cellular hypoxia
what are the 5 Ps of PAD
pain
pulselessness
palpable coolness
paresthesia
paresis (weakness of extremity)
how is PVD diagnosed
ankle brachial index
- ratio should be around 1
- Normal: ankle pressure should be greater than arm
- PVD: 0.8 and below indicates some to severe arterial disease (0.5 = severe)
what is an ankle brachial index
comparison of the BP in the leg vs the arm
what are the difference between arterial and venous vascular disease
arterial: intermittent claudification, no edema, no/weak pulse, no drainage, round smooth sores (toes and feet), black eschar
venous: dull/achy pain, lower leg edema, pulse present, drainage, sores w irregular borders (ankles), yellow slough or ruddy skin
what is chronic venous insufficiency
chronic condition that occurs when venous walls and or valves in the legs are not working effectively
- causes blood to pull/ collect = venous stasis
what are the symptoms of venous insufficiency
lower extremity edema
achiness or tiredness in legs
leathery looking skin (dark and hard)
stasis ulcers
flaking or itching skin
new varicose veins
what are the non pharm treatments of PVD
reduction of contribution factors like
-smoking cessation
-inc physical activity
-wt reduction
-stress reduction
-DM management
-HTN control
what are interventions that are aimed at preventing/treating occlusion of PVD
medication
bypass
balloon
stent
broad pharm treatments for PVD
antiplatelets
anticoags
thrombolytics
lipid lowering agents antilipemics
agents that inc blood supply to extremities
what is cilostazol
treatment for intermittent claudification
what is the moa for cilostazol
platelet inhibitor
vasodilation
what are the adverse effects of cilostazol
headache
dizziness
D
abnormal stools
palpitations
peripheral edema
what are the drug interactions of cilostazol
metabolized by the CYP 450 system
