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Cardiopulmonary > Peripheral Vascular Disease (2) > Flashcards

Peripheral Vascular Disease (2) Flashcards

1
Q

What is peripheral vascular disease?

A

Slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel

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2
Q

Where is PVD involved?

A

In any blood vessels outside of the heart (arteries and veins)

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3
Q

What is peripheral arterial disease caused from?

A

Structural changes in the vessel wall

Narrowing of vascular lumen

Spasm of vascular SMC

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4
Q

What can structural changes in the vessel wall in peripheral arterial disease be due to?

A

Degeneration secondary to inflammation or infection and lead to dilation, aneurysms, dissection, or rupture

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5
Q

What is a common symptom in peripheral arterial disease?

A

Intermittent claudication

Pallor on elevation

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6
Q

Why does pallor on elevation occur in peripheral arterial disease?

A

Insufficient arterial pressure to perfuse when leg is elevated above the heart

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7
Q

What test is used for intermittent claudication?

A

Walking test

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8
Q

How is the walking test performed?

A

Have a patient walk at cadence to keep intensity consistent until they notice symptoms then have them rest and resume when symptoms go away (compare times)

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9
Q

How does claudication pain occur if intensity is kept consistent?

A

At predictable and reproducible durations

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10
Q

What are findings in peripheral arterial disease?

A

Blood pooling in maximally dilated capillary bed (dependent rubor)

Impaired capillary refill

Impaired peripheral pulses

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11
Q

What may happen to the limbs in peripheral arterial disease?

A

May show signs of cyanosis

May feel cool to the touch

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12
Q

Is there numbness and tingling in affected area with peripheral arterial disease?

A

Yes

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13
Q

How does the skin appear in peripheral arterial disease?

A

Shiny, thin, pale, and hairless

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14
Q

What happens to the nails in peripheral arterial disease?

A

They become thick and brittle

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15
Q

How do you do the ankle brachial index?

A

Patient is in supine and use posterior Tibialis and Dorsalis pedis arteries

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16
Q

What is the cutoff in the ankle brachial index for PAD?

A

<0.9

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17
Q

What does an ankle brachial index of 0.5-0.8 indicate?

A

Claudication

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18
Q

What does an ankle brachial index of <0.5 indicate?

A

Critical ischemia

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19
Q

What are individuals with PAD at a high risk for?

A

AAA

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20
Q

What do patients with intermittent claudication tend to have?

A

Walking impairment that improves significantly with exercise training

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21
Q

What has exercise training been show to be as effective as in intermittent claudication?

A

Surgical interventions

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22
Q

Why should patients with PAD be instructed on proper foot wear, foot care, and hygiene?

A

Possible foot ulcer

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23
Q

How can you improve pain while sleeping with PAD?

A

Elevate head of bed

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24
Q

What is most effective for exercise training in claudication?

A

Interval training with short rest periods for relief of claudication

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25
Q

How should exercise be conducted in patients with PAD?

A

3x a week

Intensity should cause claudication pain in 3-5 min and continue until pain of 5/10 and then rest

Repeat this for 30 minutes

26
Q

What is Raynaud’s syndrome?

A

Vasospasm causing reduced blood flow

27
Q

What is primary Raynaud’s syndrome?

A

More common in women lasting 15-30 seconds often in cold climates

28
Q

What is secondary Raynaud’s syndrome?

A

Less common but more serious usually around age 40 (due to repetitive trauma, smoking, or atherosclerosis)

29
Q

What is severe Raynaud’s syndrome?

A

Rare but could result in permanent hypoperfusion of digits

30
Q

What is an aneurysm?

A

Localized abnormal dilation by at least 50%

31
Q

What are causes of aneurysms?

A

Atherosclerosis or congenital defects

32
Q

What are risk factors for aneurysms?

A

CVD (smoking)

Male

Genetics

40-60 y/o

Hypertension

33
Q

What are the types of aneurysms?

A

Saccular (berry)

Fusiform

Dissecting

34
Q

What is a secular (berry) aneurysm?

A

Small and spherical (most common in brain tissue)

35
Q

What is a fusiform aneurysm?

A

Gradual and more progressive

36
Q

What is a dissecting aneurysm?

A

Blood filled channel within vessel wall

37
Q

Where does pain occur with an AAA?

A

Low back, groin, mid abdominal left flank, or chest

38
Q

What is an AAA?

A

Palpable pulsating abdominal mass > 3 cm

39
Q

What is an independent predictor of AAA?

A

Inter arm systolic BP difference > 20 mmHg

40
Q

What is chronic venous insufficiency?

A

Vein wall or valves in the leg veins do not work effectively which impairs the ability for blood to return to the heart from the legs (results in venous stasis)

41
Q

What 3 systems is the venous network for chronic venous insufficiency divided into?

A

Superficial

Deep

Perforating or communicating veins

42
Q

What makes up the superficial venous system?

A

Lesser and greater saphenous

43
Q

What makes up the deep venous system?

A

Anterior and posterior Tibial

Peroneal

Popliteal

Deep and superficial femoral

Iliac veins

44
Q

What may cause chronic venous insufficiency?

A

Vein wall degeneration, post thrombotic valvular damage, chronic venous obstruction, or dysfunction of muscular pumps

45
Q

What is edema?

A

Apparent increase interstitial fluid volume

46
Q

When does edema develop?

A

When starling forces are altered so there is increased flow of fluid from vascular system into interstitium

47
Q

What is generalized edema?

A

Heart failure, hypo-albumenia, nephrotic syndrome, cirrhosis, and sepsis

48
Q

What is localized edema?

A

MSK injury or DVT

49
Q

What is a 1+ for pitting edema?

A

Barely detectable impression when finger is pressed into skin

50
Q

What is a 2+ for pitting edema?

A

15 seconds to rebound

51
Q

What is a 3+ for pitting edema?

A

30 seconds to rebound

52
Q

What is a 4+ for pitting edema?

A

> 30 seconds to rebound

53
Q

What are some things PTs can do to help with chronic venous insufficiency?

A

Exercise to increase muscle pump

Short walks

Pressure stockings or pump

Unna boot

54
Q

What is an ulcer?

A

Persistent discontinuity in integrity of skin despite given time to heal

55
Q

What are the 3 types of ulcers?

A

Venous

Arterial

Neuropathic

56
Q

What is a venous ulcer?

A

Usually medial

Browning

Varicose veins and pitting edema

57
Q

What is an arterial ulcer?

A

Distal to toes

Painful

Pallor, loss of hair, nail dystrophy

58
Q

What is a neuropathic ulcer?

A

Plantar (usually due to pressure points)

59
Q

What does a patient with a venous ulcer usually have?

A

Chronic venous insufficiency

60
Q

What does a patient with an arterial ulcer have?

A

Peripheral artery disease

61
Q

What does a patient with a neuropathic ulcer have?

A

Diabetic neuropathy

Cardiopulmonary (20 decks)

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