Peripheral Vascular disease Flashcards
PAD and PVD are…
Circulatory diseases
PAD
only the arteries are affected
PVD patho
- affects lower extremes (PVD)
- athero occurs, fills with lipid macrophages in venous walls - plaques - tissue ischemia
- dec mobility, pain, and dec perfusion
Risks for PVD
SMOKE, uncontrolled DM, inc chol, HD, stroke, age 50+
etiologies for PVD
- ATHERO
- thrombus
- thromboangiitis obliterans (inflam)
- permanent occlusion of peripheral arteries
- vasospasm–Raynaud’s or autoimmune
CM of PVD
- pain in calf or buttock
- numb/burn
- heaviness
- intermittent claudication
- trophic skin chx (shiny skin, thick nails, lose leg hair)
- dec pulse
- pallor, cyanosis
- reactive hyperemia when legs hang and dependent edema
- dec sensation in extremities
- erectile dysfunction
Intermittent claudication
consistent pain with exercise, stops at rest, depends on where plaque is built and collateral circ
PAD sx
- often femoral artery, athero, lack circ
- IC pain
- dec pulse
- cool leg
- leg pallor
- lose foot sensation
- ischemia of LL–cell hypoxia
5 Ps of PAD
- paresthesia
- pain (IC)
- pulselessness
- palpable coolness
- paresis
PVD dx
- ankle-brachial index
- compare BP in leg and arm
- ankle ratio is greater than brachial
- severe PAD index; ABI = 0.5
Chronic venous insufficiency
ventricular wall and/or valves no worky
- blood pools in veins - stasis
- 40 of the U.S.??
- chronic
CVI CM
- edema, achy and tired legs, leathery, stasis ulcers, flake/itch, varicose veins
nonpharm tx for peripheral vascular disease
- smoke cessation
- inc PA
- dec wt
- dec stress to dec inflam
- control DM and HTN
- if thrombus, balloon shunt
- if chronic, stent
Pharm tx for vascular diseases
- antiplt
- anticoag
- thrombolytics
- lipid decreasing agents
- agents that inc blood to extension
What are valves made of?
Leaflets; tri, pulm, and aortic have 3, bi have 2
AV nodes
bi and tri
Ventricular valves
atrial and pulmonic
Which valves open with systole and close with diastole if the atria
tri and bi
How can valves get damaged
- wear and tear
- calcium deposits (calcification)
- problem with the pannus (leaf not close/open well)
- endocarditis - valve infx
- clot formation (thrombus)
- AV valves –papillary muscle
What happens when leaflets are damaged?
Can’t close and open all the way
Aortic stenosis
Leaflets are too tight and hard to get blood thru
- most common
- no sx until severe
syncope, lightheaded, chest pain
- can also get SOB and pulm edema
- blood does not leave the heart so coronary vessels lack BF
Mitral regurg
- fatigue and SOB
- blood backs up to the left atrium so lack oxy blood supply
- valve is loose
aortic stenosis and mitral regurg are both probs of the…
Left side
dx and tx for valve diseases
- dx with ECHO (transthoracic or transeso)
- tx with valve replace often bc meds not great
Common cause of valve probs
genetics or childhood diseases - endothelial diseases
Infective endocarditis
Infx of the valves that cause vegetations on the valves that can become septic emboli if broken off
Which valve is most often affected by infective endocarditis?
Tricuspid bc it is the first valve blood goes thru and can lead to a PE
Where will a vegetation from the mitral valve go?
brain, coronary artery
Risks for infective endocarditis
prosthetic, pacemaker (wires with bac), IVDU with contaminated needle (esp tricuspid valve)
NC for prosthetic valves
Take prophylactic abx before a dental procedure to dec risk of infx
Sx of infective endocarditis
VERY SICK - fever, chills, anorexia, wt loss, myalgia, arthralgia, heart murmur (may not hear)
- many diff based on where vegetations are incl neuro meningitis, sz, enceph, brain abscesses
Often the first CM of infective endocarditis?
signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain based on where vegetations are
Septic emboli
microorgs to heart, adhere to damaged endothelial tissue and attracts WBCs and plts, release cytokines and coag factors
Septic emboli
- microorganisms trigger the coag cascade to make fibrin deposits that develop into vegetations
- veg often on leaflets and break into circ
- carried by blood and cause ischemia and infx in remote tissue
CM of septic emboli
petechiae, splinter hemorrhages, Janeway lesions, osler nodes, Roth spots
Tx for infective endocarditis
- replace valves
- often ppl with rheumatic HD need replacement
- if blood infx often 24h abx pre-surg
What brings ppl with heart failure to the hospital?
need for diuretics; heart can’t maintain oncotic pressure
First line rate control drugs
Beta blockers
