Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Peripheral vascular disease (CV) > Flashcards

Peripheral vascular disease (CV) Flashcards

1
Q

Define peripheral artery disease.

A

Disease characterised by narrowing and occlusion of the peripheral arteries due to atherosclerotic plaques

Includes a range of arterial syndromes caused by atherosclerotic obstruction of lower-extremity arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is peripheral artery disease most commonly caused by?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What classification system is used for peripheral artery disease?

A

Fontaine classification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the stages of the Fontaine classification of peripheral artery disease?

A
  • stage I - asymptomatic PAD
  • stage II - pain (intermittent claudication) on exertion:
    • IIa - claudication at walking distance >200m
    • IIb - claudication at walking distance <200m
  • stage III - ischaemic pain at rest
  • stage IV - necrosis, ulcers or gangrene (dry or wet)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is claudication (peripheral artery disease)?

A

Pain on exertion due to inadequate flow during exercise, causing fatigue, discomfort or pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is acute limb ischaemia (PAD)?

A

Sudden decrease in limb perfusion that threatens limb viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 6Ps of acute limb ischaemia (PAD)?

A
  • Pain
  • Paralysis
  • Paraesthesia
  • Pulseless
  • Pallor
  • Perishingly cold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a major risk factor for acute limb ischaemia (PAD)?

A

Atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two key causes of acute limb ischaemia (PAD)?

A
  • atrial fibrillation
  • atherosclerotic plaque
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What two types of causes can acute limb ischaemia (PAD) have?

A
  • thrombotic causes (pre-existing claudication with sudden deterioration, reduced/absent pulses in contralateral limb)
  • embolic causes (sudden onset painful leg, Hx shows obvious cause of embolus e.g. AF, recent MI, no evidence of PVD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is acute limb ischaemia (PAD) treated?

A

IV heparin (medical emergency requiring revascularisation within 4-6h to save limb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some examples of chronic limb ischaemia (PAD)? (4)

A
  • intermittent claudication
  • Buerger’s disease
  • Leriche syndrome
  • critical limb ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is intermittent claudication (PAD)?

A
  • calf pain on exercise
  • exercise increases muscle demand = cannot be met by supply
  • improvement occurs by maintaining exercise –> stimulate angiogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Buerger’s disease (thromboangiitis obliterans) - PAD?

A
  • happens in young male smokers with symptoms similar to limb ischaemia
  • paraesthesia/cold sensation in fingers or limbs
  • Raynaud’s phenomenon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Leriche syndrome (PAD)?

A

Aortoiliac occlusive disease

Symptoms:

  • buttock claudication
  • impotence
  • absent/weak distal pulses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most severe manifestation of peripheral vascular disease?

A

Critical limb ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is critical limb ischaemia (PAD)?

A
  • compromise of blood flow to an extremity, causing chronic limb pain at rest (worse at night) for 2+ weeks
  • pain at rest
  • can lead to tissue loss: gangrene, arterial ulcers
  • most severe form of PAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the general clinical features of PAD? (4)

A
  • most patients are asymptomatic
  • diminished/absent pulse
  • erectile dysfunction (impotence)
  • thigh or buttock pain (claudication) when walking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What artery is affected in calf pain (PAD)?

A

Femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What artery is affected in buttock pain (PAD)?

A

Iliac artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the clinical features of intermittent claudication (PAD)?

A
  • cramping pain of leg (calf, thigh or buttock) which is worse on exertion/walking a given distance (claudication distance)
  • relieved by rest
  • calf claudication = FEMORAL disease
  • buttock claudication = ILIAC disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the red flag signs of PAD that are indicative of critical limb ischaemia? (2)

A
  • resting pain
  • skin changes - ulcers or gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the clinical features of critical limb ischaemia (PAD)? (5)

A
  • pain at rest
  • ulcers
  • gangrene
  • night pain (relieved by dangling leg over edge of bed)
  • muscular atrophy
24
Q

What are the clinical features of Buerger’s disease (PAD)? (2)

A
  • paraesthesia/cold sensation in fingers or limbs
  • Raynaud’s phenomenon
25
Q

What are the clinical features of Leriche syndrome (aortoiliac occlusive disease)? (3)

A
  • buttock claudication
  • impotence (erectile dysfunction)
  • absent/weak distal pulses
26
Q

What might you find on examination in acute limb ischaemia (PAD)? (6 + 5)

A
  • Pain
  • Paralysis
  • Paraesthesia
  • Pulseless
  • Pallor
  • Perishingly cold
  • other symptoms:
    • atrophic skin (shiny/scaly)
    • hairless
    • punched-out ulcers (painful)
    • thickened toenails
    • colour change when raising leg (to Buerger’s angle) - dependent rubor
27
Q

What are the risk factors for PAD? (8)

A
  • smoking
  • diabetes
  • hypertension
  • hyperlipidaemia
  • age>40
  • Hx CAD/cerebrovascular disease
  • physical inactivity
  • renal failure
28
Q

What is the first-line investigation for PAD?

A

Ankle-brachial index (ABPI)

29
Q

What is ABPI (PAD)?

A

Ratio of systolic ankle BP to systolic brachial BP (marker of cardiovascular disease)

Ankle SBP / Brachial SBP

30
Q

What ABPI indicates PAD?

A

<0.8 (0.5-0.9)

31
Q

What is important to remember if ABPI<0.8 in PAD?

A

Do NOT apply a pressure bandage as this will worsen ischaemia

32
Q

What ABPI indicates critical limb ischaemia?

A

<0.5

33
Q

What are the ABPI cut-offs for normal/PAD? (4)

A
  • arterial calcification: >1.2
  • normal: 0.9-1.2
  • PAD: 0.5-0.9
  • critical limb ischaemia: <0.5
34
Q

What do you need to keep in mind when using ABPI to measure PAD?

A

Calcification of arteries can occur in diabetes and renal failure, which can alter results and cause high ankle pressures due to incompressible arteries

35
Q

When is ABPI not useful in PAD?

A

In an emergency when a patient presents with acute limb ischaemia, as it does not identify the site of arterial occlusion and would not guide acute management

36
Q

What is the first-line investigation for intermittent claudication?

A

Duplex ultrasound - can determine site, severity and length of stenosis

37
Q

What is the first-line investigation for patients with suspected acute limb ischaemia (PAD)?

A

Bedside handheld doppler scan - absent/reduced signal in acute limb ischaemia

Followed by lower limb CT angiography to quantify extent of occlusion

38
Q

What investigation is important to do in all patients presenting with suspected acute limb ischaemia (think 6Ps)?

A

Handheld doppler USS (absent/reduced signal) - as ABPI not helpful in acute setting

39
Q

What is the gold-standard investigation for PAD?

A

MRI/CT angiogram

40
Q

What is Buerger’s test (PAD)?

A
  • lie patient flat on bed and lift leg to 45 degrees
  • limb developing pallor indicates arterial insufficiency
  • angle <20 degrees indicates severe limb ischaemia
  • when patient swings leg over bed, reactive hyperaemia is seen
41
Q

What are some differential diagnoses for PAD? (7)

A
  • spinal stenosis (ABPI normal)
  • arthritis
  • venous claudication (ABPI normal)
  • chronic compartment syndrome (athletes, duplex USS shows no stenosis)
  • symptomatic Baker’s cyst (ABPI normal, cystic mass in popliteal fossa)
  • nerve root compression
  • Buerger’s disease (non-atherosclerotic vasculitis, paraesthesia/cold sensation in fingers or limbs, Raynaud’s, rest pain and ulceration/gangrene, young male smokers)
42
Q

What classification is used to stage peripheral vascular disease?

A

Fontaine classification:

  • I: asymptomatic
  • II: intermittent claudication
  • III: rest pain
  • IV: ulceration/gangrene/necrosis (tissue loss)
43
Q

What is the management plan for intermittent claudication?

A
  • antiplatelet therapy (clopidogrel/aspirin)
  • exercise
  • risk factor modification
    • hypertension with ACEi
    • dyslipidaemia with statin
    • beta-blockers
  • symptom relief (cilostazol or naftidrofuryl)
  • consider revascularisation
44
Q

What is the Rutherford classification for PAD?

A
  • 0: asymptomatic
  • 1: mild claudication
  • 2: moderate claudication
  • 3: severe claudication
  • 4: ischaemic rest pain
  • 5: minor tissue loss (non-healing ulcer, focal gangrene with diffuse pedal ischaemia)
  • 6: major tissue loss (extending above transmetatarsal level, frank gangrene)
45
Q

What doses of antiplatelet therapy & statins are given in PAD?

A
  • clopidogrel 75mg OD
  • atorvastatin 80mg OD (as secondary prevention, 20mg as primary prevention)
46
Q

What can we give for intermittent claudication if exercise is ineffective and patient does not want to be referred for angioplasty/bypass surgery?

A

Naftidrofuryl oxalate - vasodilator that can alleviate pain in PAD

47
Q

What do we do if risk factor modification and exercise have not improved symptoms in intermittent claudication?

A

Refer for surgical revascularisation

48
Q

What is the management plan for critical limb ischaemia (PAD)? (6)

A
  • urgent referral to vascular MDT for revascularisation (endovascular vs surgical)
  • antiplatelet therapy (aspirin/clopidogrel 75mg OD)
  • risk factor modification
  • spinal cord stimulation (if inoperable)
  • autologous bone marrow stem cell transplantation
  • consider amputation
49
Q

What is the difference between endovascular and surgical revascularisation in critical limb ischaemia?

A
  • endovascular revascularisation (angioplasty +/- stent, atherectomy): stenosis<10cm / chronic occlusions <5cm
  • surgical revascularisation (bypass with autologous vein/prosthetic material): stenosis>10cm / chronic occlusion >5cm
50
Q

What is the last resort for critical limb ischaemia?

A

Amputation in the event of a non-viable limb:

  • tissue loss (gangrene)
  • nerve damage
  • sensory loss
  • skin mottling
  • plantar fasciitis
51
Q

What is the management plan for acute limb ischaemia?

A
  • IV heparin initially (unless CI)
  • urgent assessment for revascularisation + thrombolysis (urokinase or alteplase) OR amputation (if non-viable limb)
  • antiplatelet therapy (aspirin/clopidogrel)
  • analgesia (paracetamol+opioid) + fluids + O2
52
Q

What surgical options are available for acute limb ischaemia? (3)

A
  • endovascular revascularisation + intra-arterial thrombolysis (urokinase or alteplase)
  • bypass (surgical revascularisation) - if stenosis>10cm or chronic occlusion>5cm
  • amputation
53
Q

What is the sole treatment for acute limb ischaemia with a viable limb / whilst awaiting transfer to vascular specialists?

A

IV heparin

54
Q

What are some complications of PAD? (3)

A
  • arterial ulcers
  • gangrene
  • permanent limb weakness/numbness/pain
55
Q

Describe the prognosis of claudication symptoms (PAD).

A

Remain stable and has good prognosis

56
Q

Describe the prognosis of critical limb ischaemia (PAD).

A

Poor prognosis

Year 3 (80 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions