Peripheral Vascular Disease Flashcards
What are the characteristics of intermittent claudication?
Muscular aching or cramping
Located In major muscle masses (buttocks, thighs, calves)
Produced by walking, relieved by rest (never happens DURING rest)
Reproducible
What are the six Ps that represent the classic presentations of acute arterial insufficiency?
Pulselessness
Pallor
Poikilothermia
Pain
Paresthesia Highest
Paralysis - most indicative Severity
What is the pathophysiology of intermittent claudication?
Blood flow adequate to meet resting metabolic needs
Cannot increase blood flow during exercise due to occlusive disease
Inadequate blood flow during exercise, anaerobic glycolysis –> H+, lactate
What are the characteristics of ischemic rest pain?
Numb, aching, constant pain
Forefoot, toes, metatarsal heads = distal circulation
Relieved by dependency, aggravated by elevation
What is the pathophysiology of ischemic rest pain being improved with dependency?
Gravity causes slight increase in blood flow
Increase in venous pressure
Prolongs red cell residence time
Maximal O2 extraction
What are the signs and symptoms of chronic arterial insufficiency?
Absent pulses Decreased hair growth - foot, toes Skin atrophy (thin, shiny) Muscular atrophy (disuse) Thickened nails Blanch on elevation Dependent rubor (chronic dilation skin capillaries) Slow venous refill (>10-15 sec)
How do you record pulses in a patients chart?
+ indicates normal, palpable pulse
W indicates a weak pulse
- indicates pulse not palpable
D indicates nonpalpable is audible by Doppler
0 indicates not palpable OR detectable by Doppler - urgent intervention
How can you feel the femoral pulse?
fingertips in depths of groin crease and palpate upwards towards inguinal ligament
Pulse found at midpoint of line between ASIS and pubic tubercle
How can you feel the popliteal pulse?
Flex knee and make sure extremity relaxed
Meet fingertips behind knee and press deeply
Counter pressure with thumbs
How can you feel the dorsalis pedis pulse?
Just lateral to extensor tendon of big toe
Absent in 10-15% of people
How can you feel the posterior tibial pulse?
Halfway between most prominent portions of medial malleolus and calcaneus
Use pads of first three fingers
Gentle counter pressure with thumb
What are some conditions confused with rest pain and how can you differentiate them?
Neuropathy - stocking distribution, sensation, burning
Gout - inflammation, increased uric acid
Metatarsalgia - pain on joint motion
Trauma - history, pain on squeezing
What is the rupture triad of AAA?
Pain (back, flank, and/or abdominal)
Pulsatile mass
Shock (hypotension)
How can you feel and determine the size of the aorta on physical exam?
Patient has knees up, arms at side
Stand to right and use finger pads
Deep palpation at or just above umbilicus - where bifurcation is
Obese individual - use line drawn between iliac crests
Normal aorta is about 2 cm
What are transient ischemic attacks?
Focal neurologic deficit in carotid or vertebral-basilar distribution
Key distinction from stroke - lasts less than 24 hours (most 1 or 2)
Complete recovery
Diagnosed by history
What we signs and symptoms of TIAs in right carotid, left carotid, or vertebral-basilar arteries?
Right - left body motor and sensory deficits, upper body more affected
Left - right body motor and sensory, expressive aphasia
Vertebral basilar - bilateral motor and sensory, diplopia, cerebellar symptoms
What is amaurosis fugax?
Transient, monocular visual disturbance
Lasts seconds to minutes, full recovery
May be total blindness, but usually ascending or descending curtain
What is the pathophysiologic basis of ischemia with carotid bifurcation plaque?
Atheroembolism
Platelet fibrin emboli
Carotid thrombosis
Severe stenosis –> reduced flows
What is abnormal when feeling bilateral upper extremity blood pressures?
Greater than 15-20 mm Hg difference
What finding on neck pulses is indicative of obstruction of common carotids or innominate?
Asymmetry of neck pulses
What findings in a bruit can differentiate between bifurcation occlusive disease and other causes?
Bruit becomes loser as one progresses down scm - most likely from chest
Bruit lessens in intensity as one progresses down scm - most likely from carotid bifurcation
Why is listening for bruits not the best indication?
Poor correlation between intensity and severity of stenosis Very advanced (>80%) stenosis wouldn't produce bruit
What is the risk for amputation with claudication, rest pain, and tissue loss?
Claudication - 5% at 5 yrs
Rest pain - 50% at 1 yr
Tissue loss - 75% at 1 yr
What size generally denotes the classification of “aneurysm”?
1.5x the normal vessel size
