Peripheral vascular Disease Flashcards
What is atherosclerosis?
Hardening of the arteries?
What is atherosclerosis caused by?
Plaque in the artery
What other diseases are often associated with patients with atherosclerosis?
Diabetes and kidney disease
What is PAD?
Periperal arterial disease
List 3 PADs?
Claudication
Critical ischaemia
Acute Ischaemia
What is claudication?
Pain in the leg on walking due to blocked or narrowed arteries
What causes pain in calf muscles whilst walking in claudication?
Blocked or narrowed arteries in the leg mean that blood flow cannot be increased during exercise so less oxygen is delivered = anaerobic respiration = build up of lactic acid
Answer these key points about claudication?
Does pain ever occur standing still or sitting?
Is it worse if you walk uphill or hurry?
What happens if you stand still?
Where do you get the pain or discomfort?
no
Yes
Goes away quickly (as lactic acid ‘ washed away’)
Typically in calf, sometime in buttock or thigh, not in foot or toes
List vascular risk factors for claudication?
Mi/angina/heart failure Stroke Diabetes Smoking status Quality of life exercise Medications
How can claudication be treated?
Blood pressure control
Anti-platelets
Identify and control diabetes
What life-style modifications can treat claudication?
Stop smoking
Exercise
Weight reduction
Improved diet
What is critical ischaemia?
Ischaemia which is bad enough to threaten loss of limb - pain when not walking
How does critical ischaemia and claudication differ?
CI - pain at rest, not just when walking Greater risk of gangrene Lower blood pressure in foot Pain can be felt in toes/foot Worse at night Helps to hang foot out of bed or sleep in chair (gravity helps ischaemia)
What is the priority of critical ischamia treatment?
Revascularisation to unblock or bypass the disease vessel
What are the names of the balloons that can expand the blood vessel?
Balloon angioplasty
If balloon angioplasty cannot be carried out, what surgery occurs?
Bypass surgery
What is acute ischameia?
Sudden onset pain in leg
What causes acute ischamia?
Thrombosis or embolus
What are the sources of emboli that can cause acute ischameia?
Heart - MI, valve disease, atrial fibrillation Arteries - aneurysms, stenoses Veins Tumours Forgein bodes
What processes are associated with acute ischaemia? (pathophysiology)
Nerves/muscles are more sensitive to ischaemia, skin less sensitive
Why is time critical in acute ischamia?
irreversible changes after -6 hours - limb cant be saved
List the 5 Ps that describe the clinical features of acute ischaemia?
Pain Pale/cold leg Pulseless Paralysis - cant stand/walk Paraestheiae/numbess
Management of acute ischaemia?
Herapin - stop thrombus formation resuscitate Catheter Surgery Amputation if late
What is aortic aneurysm?
Widening of the aorta
Risk factors of aortic aneurysm?
Men
Age
Smoking
Hypertension
Aortic aneurysms slowly grow, what happens after this?
Rupture when they get big enough - often fatal
How is aortic aneurysm treated?
Open surgery or stenting
Why is aortic aneurysm ultrasound screening the chosen method to screen med over 65 years?
Simple and safe no radiation Sensitivity and specificity nearly 100% Cost-effective Reduced ruptured aortic aneurysms
How does carotid disease cause stroke?
Embolisation
Restriction of flow
How is carotid artery stenosis treated?
Stenting
Atherosclerosis is a single systemic disorder with different clincial presentation where in the body?
heart, Brain, Legs
What is the priority for treating atherosclerosis?
Modifiable risk factors - smoking, exercise, weight
What is the function of carotid endarterectomy?
Prevents stroke
