Peripheral Vascular Disease Flashcards
What is meant by peripheral arterial disease?
Progressive narrowing of the arteries supplying the limbs and periphery, reducing the blood supply to these areas.
Usually affects the lower limbs resulting in symptomatic manifestations such as claudication
What is meant by intermittent claudication?
Symptoms of ischaemia in alimb
Occuring during exertion and relieved by rest
Crampy, achy pain in calf, thigh or buttock muscles associated with muscle fatigue (aka when walking), when oxygen/blood supply is insufficient to reach demand
What is meant by critical limb ischemia?
End-stage, most severe form of peripheral arterial disease
Inadequate supply of blood to a limb at rest - unable to function at rest/low exertion - unable to meet metabolic demand
High risk of amputation
Presents with chronic rest pain, non-healing wounds or gangrene.
What are the key signs and symptoms of critical limb ischemia?
Pain in limb at rest
Non-healing ulcers
Gangrene
Pain worse at night when leg is raised - gravity no longer helps pull blood into the foot, pain relieved by hanging foot off the end of the bed.
What is acute limb ischemia?
Rapid onset ischemia of a limb
Norm caused by thrombus of a distal artery to a limb
Severe manifestation of PAD
Presents with the 6Ps, requires immediate restoration of blood to the affected limb through revascularization process.
Define ischemia
Inadequate oxygen supply to tissues due to reduced blood supply
Define gangrene
Death of tissue, specifically due to an inadequate blood supply.
What is meant by athersclerosis?
Atheroma formation (fatty deposits in artery walls) and sclerosis (harding or stiffening of the blood vessel walls)
Mainly affects the medium and large arteries.
Caused by chronic inflammation and activation of the immune system in the artery wall.
Lipids deposited in artery walls
What are the consequences of atheromatous plaque formation in arteries?
Mainly affects large and medium blood vessels
Stiffening of wall = hypertension and increased strain on heart as pump against more resistance
Stenosis - reduced blood flow aka angina
Plaque rupture - resulting in a thrombus causing ischemia
What are some risk factors for atherosclerosis?
Increased age (particularly over 50y)
Family history -(hypercholesterolemia /dyslipidaemia)
Smoking - poor vascular health
HTN - endothelial dysfunction
Diabetes Mellitus - chronic hyperglycemia leads to endothelial dysfunction inc atherosclerosis formation
Alcohol consumption
Male
Poor diet (high in sugar/trans fat, low in fruit, veg and omega 3s)
Low exercise/sedentary lifestyle
Obesity
Poor sleep
Stress
What medical co-morbidities tend to be associated with atherosclerosis?
Diabetes
Hypertension
Chronic Kideny Disease
Inflammatory conditions such as rheumatoid arthiritis
Atypical antipsychotic medications
What are some of the clinical ways that atherosclerosis can present?
Angina
Myocardial infarction
Transient Ischaemic attack
Stroke
Peripheral Arterial Disease
Chronic Mesenteric ischaemia
What is the key symptom of peripheral arterial disease?
Intermittent claudication
Crampy pain typically in calf (thigh or buttock) that occurs predictably when walking a certain distance then resolves on rest.
What are the key features of acute limb ischemia?
Pain
Pallor
Pulseless
Paralysis
Paraesthesia (pin and needles)
Perishinling cold
What is leriche syndrome?
Occlusion in the distal aorta or proximal common iliac artery
Presents with the clinical triad of:
Thigh/buttock claduciation
Absent femoral pulses
Male impotence
What signs on examination can indicate a peripheral vascular disease?
Tar staining on fingers
Xanthomata (yellow cholesterol deposits on the skin)
Signs of cardiovascular disease - amputation, midline sternotomy scar/ scan on inner calf (prev CABG), focal weakness from stroke
Weak pulses of (may assess further using a hand-held doppler)
Skin pallor
Cyanosis
Dependent rubor
Muscle wasting (atrophy)
Hair loss
Ulcers
Poor healing wound
Gangrene
Cold skin
Reduced sensation
Prolonged cap refill
Changes during burgers test.
How do you perform Buergers test?
Patient supine
Lift lefs to 45 degrees hip flexion
Hold for 1-2mins = looking for pallor
Pallor indicates artery not able to overcome gravity = PAD
Gradually lower the legs to identify angle when legs become pale = burgers angle
Sit patient over side of bed, legs handing down - blood flow now associated by gravity
health - normal pink
PAD - blue as ischemia tissue deoxygenated the blood, then dark red (rubor) due to vasodialtion in response to waste products of anerobic resporation
What is the main cause of arterial ulcers?
Damage caused by ischemia secondary to inadequate blood supply.
Skin/tissue struggles to heal due to impaired blood flow