Peripheral vascular disease ppt Flashcards
What is PVD?
Circulatory problems in vascular structures that are peripheral to the heart
Vascular structures involved in PVD
Arteries
Veins
Lymphatic structures
Components of Tunica media
concentric ring of elastic membrane surrounded by smooth muscle
arteries: where is there more/less elasticity?
closer to the heart, more elastic (aorta)
farther from the heart, more muscular, less elastic (arterioles)
final branching of arteries
capillary beds gas exchange
How do veins compare to arteries?
- walls less distinct
- walls of veins are thinner
- less smooth muscle and elastic tissue
- lower pressure
- valves
capillary beds and lymph
intertwined
Why do lymph nodes enlarge when you’re sick?
They’re having to work harder
Where do capillaries and peripheral plexuses begin?
blindly in intercellular spaces
plexuses
joining of capillaries
collecting ducts
follow veins to lymph nodes
multiple layers
thin walls
What do lymph nodes do?
filter lymph of unwanted waste products
lymph is returned to the circulatory system through the vena cava
What is arteriosclerosis obliterans?
chronic arterial insufficiency associated with atherosclerosis
progression of arteriosclerosis obliterans
- acute occlusion
- chronic occlusion
Series of events that leads to vascular pathology
- endothelial damage
- entry of irritants into subendothelium
- inflammatory response
- plaque formation
What types of irritants make their way into the subendothelium after the endothelium is damaged?
oxidized LDL
monocytes
cytokines
chemicals involved in the inflammatory response
What is involved in the inflammatory response in the vessel?
cytokines
smooth muscle cells from tunica media
What does -oma stand for?
anything with -oma at the end is a tumor could be benign or malignant
atheroma formation
macrophage → foam cells → atheroma in the vessel
outcomes of endothelial dysfunction
- stable atherosclerotic narrowing lesions
- acute plaque rupture
Fatty Streaks aka _______
stable atherosclerotic narrowing lesions
What are fatty streaks?
chronic condition - inability to vasodilate
~gradual symptoms: angina, decreased activity tolerance
~symptoms untreated: MI
acute plaque rupture
- plaque destabilization
- acute condition → thrombus formation
acute plaque rupture How is the plaque destabilized?
MMPs disrupt fibrous cap
acute plaque rupture thrombus formation →
rapid onset of symptoms
MI
stable vs unstable angina
- stable: predictable
- unstable: chest pain that doesn’t resolve with rest = medical emergency
rupture of fibrous cap
- embolic fragment into the blood stream
- coagulation, hemmorhage, and thrombus at lesion site
- weakening of the vessel resulting in an aneurysm
aneurysm
out pouching of the vessel wall
acute occlusion
S/S
Sudden onset
- Severe pain, coldness, numbness and pallor
- Absent pulses distal to obstruction
- Possible sensory and motor loss (lack of O2 to the neurons long enough)
Acute occlusion pain
rarely occurs on both sides at the same time
chronic occlusion early asymptomatic stage
- collateral circulation develops
- anastamoses
anastamoses
adjacent blood vessels share blood supply rather than growing new vasculature around the area
chronic occlusion intermittent claudication Where does tissue ischemia occur?
- Femoro-popliteal junction = calf pain
- Aorto-iliac block = hip, buttock pain
- Tibial block = foot pain
chronic occlusion in upper extremities
rare except in the case of paraplegics
chronic occlusion rest pain (during sleep)
During sleep- vasodilatation systemically however occlusion prevents flow to area
Pain wakes patient, dangling foot relieves pain
chronic occlusion signs of advancing disease
- Skin changes-rubor
- Swelling
- Decreased nail growth
chronic occlusion gangrene: definition and causes
necrobiosis: tissue death and rotting
1. full vessel occlusion
2. infection
3. trauma (burns, frostbite, electrocution)
4. drop in distal arterial pressure
chronic occlusion and ABI clinical significance
≥ 1.0 = normal 0.8 – 1.0 = mild PVD, compression therapy with caution 0.5 – 0.8 = PVD, refer to MD, compression therapy contraindicated
chronic occlusion and compression
Can wrap wounds with minimal compression. Compromise healing process if you cut off blood supply to the wound.
Buerger’s disease Who is susceptible?
- heavy smokers
- young males 20-40
Buerger’s disease
- Occlusion of small and medium vessels
- Proximal vessels normal distal occlusion
- Defined point of occlusion -Both UE’s and LE’s can be affected
- Rest pain, distal limbs red, nails deformed, skin is thin, toes may be blue
