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2 - CPR (pulmonary) > Peripheral Vascular Disease (PVD) > Flashcards

Peripheral Vascular Disease (PVD) Flashcards

1
Q

Who does Peripheral Arterial Disease affect?

A

Those with certain ethnicities and those with increasing age

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2
Q

What are some risk factors for Peripheral Arterial Disease?

A

Hypertension, Hyperlipidemia
Smoking
Diabetes, Chronic Kidney Disease

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3
Q

What is the underlying pathogenesis for Peripheral Arterial Disease?

A

ATHEROSCLEROSIS

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4
Q

Peripheral Arterial Disease can be Asymptomatic or Symptomatic. If Symptomatic, the symptoms will vary by?

A

Location

Acuity – Chronic (stenosis) or Acute (thrombus)

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5
Q

What are the symptoms of Chronic Ischemia with PAD?

A
  • Intermittent Claudication
  • Non-healing
  • Shiny skin, hair loss
  • Muscle Atrophy
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6
Q

What are the symptoms of Intermittent Claudication and when is that seen?

A
  • Seen with PAD

= Leg pain, cramping that is (+) by exercise and relieved by rest

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7
Q

With Chronic Ischemia due to PAD, what is something to be aware of with the symptoms?

A

50% have no symptoms or have abnormal symptoms

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8
Q

Intermittent claudication, shiny skin, hair loss, muscle atrophy can suggest?

A

PAD (peripheral arterial disease)

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9
Q

If PAD presents as an Acute Arterial Occlusion, what will the symptoms be?

A

6 P’s

= poikilothermia, pain, pallor, pulselessness, paralysis, paresthesias

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10
Q

If PAD presents as an Acute Arterial Occlusion, what will the symptoms be?

A

6 P’s

= poikilothermia, pain, pallor, pulselessness, paralysis, paresthesias

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11
Q

With an Acute Arterial Occlusion with PAD, what must you do quickly and why?

A

Revascularize

- Skeletal muscle can only handle ischemia for 4-6 hours

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12
Q

What is an initial way to diagnose PAD?

A

Ankle - Brachial Index

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13
Q

Describe the Ankle - Brachial Index

A
  • Ratio of highest systolic pressure in each leg
    VS.
  • Higher systolic pressure @ brachial artery
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14
Q

What are the fine and bad findings with the Ankle - Brachial Index for PAD?

A

Ratio > 0.9 = fine

Ratio < 0.9 = BAD

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15
Q

What is a bad finding with the Ankle - Brachial Index for PAD?

A

Ratio < 0.9

– highest systolic pressure in leg to higher systolic pressure at brachial artery

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16
Q

What are 3 other options for diagnosing PAD?

A
  • Arterial Ultrasound
  • CT Angiography
  • Angiography
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17
Q

Treatment for PAD first includes what lifestyle modification?

A

Exercise

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18
Q

What drugs can be offered for those with PAD?

A
  • Anti-platelets (aspirin, clopidogrel)
  • Statins, ACEi, ARB
  • Cilostazol for symptoms
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19
Q

What is Cilostazol, what does it help and what is its contraindication?

A
  • Vasodilator with anti-platelet activity
    • Helps symptoms of PAD, but has lots of side effects
    • Contraindication = Heart Failure
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20
Q

Pentoxifylline is NOT recommended for PAD because it does not help. What is its MOA?

A

Increases RBC deformity to increase blood flow

21
Q

What are the revascularization options for PAD?

A

Angioplasty
Stent
Endarterectomy
Bypass grafting

22
Q

What is a possible complication of Peripheral Arterial Disease (PAD)?

A

Critical Limb Ischemia

23
Q

What is Critical Limb Ischemia and what can it be a complication of?

A
  • Complication of PAD

= rest pain, wounds and gangrene of LE

24
Q

What is an action the patient may do to relieve symptoms of Critical Limb Ischemia?

A

Hang limb over side of bed to increase blood flow

25
What are strong risk factors for a DVT (deep venous thrombosis)?
- Surgery - Trauma - Cancer - Plaster cast
26
What are some moderate risk factors for a DVT?
- Prolonged inactivity, smoking, heart failure, IBD - Oral contraceptives/hormones - Genetic Conditions
27
What is the pathogenesis for a DVT?
Virchow's Triad - hyper-coagulability - endothelial dysfunction - changes in flow = stasis or turbulence
28
In what patients is prevention of DVTs VERY important?
Hospitalized patients!!
29
Possible symptoms of a DVT?
Unilateral leg pain, swelling, warmth, tenderness, erythema, vein dilation
30
If a DVT is asymptomatic, how may it present?
Pulmonary Embolism
31
To start a diagnosis of a DVT, first do what 2 things?
- Pretest likelihood | - D-Dimer
32
How is the D-dimer helpful for a DVT diagnosis?
If it is normal = NO DVT
33
What is the diagnostic test of choice for a DVT?
Ultrasound with compression
34
What is the initial treatment for a DVT?
Heparin/oral anticoagulants
35
What is a long term treatment for a DVT?
Warfarin/oral anticoagulants
36
What are 2 possible complications of a DVT?
- Pulmonary Embolism | - Post Thrombotic Syndrome
37
What are the symptoms of Post Thrombotic Syndrome and when is it seen?
- Complication of a DVT | = Leg pain/heaviness, edema, skin pigmentation, vein dilation and venous ulcers
38
What are the symptoms of Post Thrombotic Syndrome?
Leg pain/heaviness, edema, skin pigmentation, vein dilation and venous ulcers
39
What causes Chronic Venous Insufficiency?
Elevated Venous Blood Pressure
40
What causes Chronic Venous Insufficiency?
Elevated venous blood pressure
41
What are some risk factors for Chronic Venous Insufficiency?
- Prior DVT, prolonged standing, pregnancy | - increasing age, obesity, smoking
42
What are the symptoms of Chronic Venous Insufficiency?
Leg pain/heaviness, swelling, skin tightness/dryness and cramping
43
What are the signs of Chronic Venous Insufficiency?
Dilated veins, edema and skin changes with ulceration
44
What are the signs of Chronic Venous Insufficiency?
Dilated veins, edema, ulceration and skin changes
45
What is the lifestyle modification for Chronic Venous Insufficiency?
Exercise and elevate legs
46
If there is no ulcer present with Chronic Venous Insufficiency, what is the treatment?
Compression therapy and emollients
47
If there is an ulcer present with Chronic Venous Insufficiency, what is the treatment?
Wound management
48
If Chronic Venous Insufficiency is not responding to treatment, what should you do?
Refer for intervention

2 - CPR (pulmonary) (26 decks)

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