Peripheral Vascular Disease Flashcards
1
Q
Peripheral vascular disease
A
- a slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel
- may involve disease in any of the blood vessels outside of the heart
2
Q
Peripheral Arterial disease findings
A
- Intermittent claudication most common symptom but many patients are asymptomatic or have atypical symptoms
- Predictable time and intensity, reproducible, doesn’t change with posture,
- Location of the diseased artery determines location of claudication.
- Walking test
- Pallor on Elevation
- Insufficient arterial pressure to perfuse when leg elevated above level of heart.
- Limb drains of blood turns pale (palor)
- Dependent Rubor
- Blood pooling in maximally dilated capillary bed
- Impaired capillary refill
- Impaired Peripheral Pulses
- Affected limb may show sings of cyanosis
- Feel cool to the touch
- Numbness or tingling reported in affected area
- Skin may appear shiny, thin, pale, and hairless.
- Nails become thickened and brittle.
3
Q
Ankle-Brachial Index Steps
A
- Pt in supine position
- Measure brachial artery pressure using a Dopplar US
- Apply same BP cuff to the ankle on the same side of the body
- Palpate for the posterior tibial(PT) artery and take SBP reading.
- Palpate for the dorsalis pedis(DP) artery and take pressure there.
- Apply BP cuff to the opposite ankle and obtain Post Tib & DorPed pressures.
- Repeat on the other arm.
4
Q
Ankle- Brachial Index Results
A
- Normally ankle BP is as high as brachial, and thus ABI ≥ 1
- ABI ≤ 0.9 is diagnostic of PAD
- ABI 0.5 –0.8 are found in patients with claudication
- ABI < 0.5 indicates critical ischemia
- An ABI of 0.9 or lower has a specificity of 83% to 99% and a sensitivity of 69% to 73% in detecting stenoses greater than 50%
- The sensitivity of an ABI less than 1.0 approaches 100%
5
Q
Capillary Refill
A
- Pressure is applied to the nail bed until it turns white. This indicates that the blood has been forced from the tissue.
- This is called blanching.
- Once the tissue has blanched, pressure is removed. The clinician then counts the time until the normal pink color returns.
- Normal refill is >2 seconds
- Fingers
- Toes
6
Q
Carotid Bruit
A
- Sound made by turbulent flow vibrating against arterial wall
- Causes the arterial wall vibrate during systole
- Indicates the presence of an arterial lesion/plaque
7
Q
Turgor
A
Normally, skin springs back to it’s “resting position” right away after being pulled.
•In dehydrated patients this return to the resting position is delayed.
•May also observe hypotension, tachycardia, orthostasis, irregular heart rate and ECG
8
Q
Clinical Implications for PAD
A
- High risk individuals should be examined for PAD and AAA.
- Important to monitor hemodynamics during exercise.
- Patients with intermittent claudication usually have some sort of walking impairment that has shown to significantly improve with exercise training.
- Exercise training has shown to be as effective as surgical interventions in reducing symptoms and improving walking distances.
- Patients should be instructed in proper foot care, footwear, and hygiene
- Might improve nocturnal pain by elevating head of bed slightly
9
Q
Exercise Implications for PAD
A
- Exercise for claudication different than exercise advised for many other conditions since exertion to the point of leg pain is required for maximum benefits
- The transient impairments in perfusion that causes claudication during walking is also the stimulus for many of the favorable changes
- For this reason, exercises that use muscles that do not result in claudication pain may not be beneficial for improving claudication symptoms
- For more severe cases: Arm ergometryalso improves walking performance.
- Leg strength training improves walking time, although not as much as treadmill exercise training does.
- Interval training with short rest periods for relief of claudication is most effective.
- Exercise at least 3 x/week
- Initial workload/intensity should induce claudication within 3-5 min
- Continues at this workload until the pain is of mod severity (5/10)
- Rest to allow the symptoms to resolve
- Repeat exercise-rest-exercise cycle several with a goal of 30-35minutes for maximum benefits
10
Q
Raynaud’s Syndrome
A
Vasospasm causing reduced blood flow
11
Q
Primary raynaud’s syndrome
A
More common in women, onset usually 15-30, more typical in cold climates, family Hx, no underlying disease
12
Q
Secondary raynaud’s syndrome
A
- Less common but more serious. S&S usually appear later than primary, around age 40
- Sceleroderma, Lupus, RA, repetitive trauma, smoking, atherosclerosis
13
Q
Severe Raynaud’s Syndrome
A
rare, could result in permanent hypoperfusion of digits
14
Q
Aneurysms
A
- Localized abnormal dilation by at least 50% compared to normal.
- Classified according to cause, size and shape
- Causes: athreosclerosis, congenital infections, Marfans
15
Q
Aneurysms Risk Factors
A
- Cardiovascular disease and Risk factors for CVD - Especially smoking
- Male
- Genetics (marfans)
- 40-60 yr old
- Hypertension prevalent
