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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
Q

What are strong risk factors for a DVT (deep venous thrombosis)?

A
  • Surgery
  • Trauma
  • Cancer
  • Plaster cast
26
Q

What are some moderate risk factors for a DVT?

A
  • Prolonged inactivity, smoking, heart failure, IBD
  • Oral contraceptives/hormones
  • Genetic Conditions
27
Q

What is the pathogenesis for a DVT?

A

Virchow’s Triad

  • hyper-coagulability
  • endothelial dysfunction
  • changes in flow = stasis or turbulence
28
Q

In what patients is prevention of DVTs VERY important?

A

Hospitalized patients!!

29
Q

Possible symptoms of a DVT?

A

Unilateral leg pain, swelling, warmth, tenderness, erythema, vein dilation

30
Q

If a DVT is asymptomatic, how may it present?

A

Pulmonary Embolism

31
Q

To start a diagnosis of a DVT, first do what 2 things?

A
  • Pretest likelihood

- D-Dimer

32
Q

How is the D-dimer helpful for a DVT diagnosis?

A

If it is normal = NO DVT

33
Q

What is the diagnostic test of choice for a DVT?

A

Ultrasound with compression

34
Q

What is the initial treatment for a DVT?

A

Heparin/oral anticoagulants

35
Q

What is a long term treatment for a DVT?

A

Warfarin/oral anticoagulants

36
Q

What are 2 possible complications of a DVT?

A
  • Pulmonary Embolism

- Post Thrombotic Syndrome

37
Q

What are the symptoms of Post Thrombotic Syndrome and when is it seen?

A
  • Complication of a DVT

= Leg pain/heaviness, edema, skin pigmentation, vein dilation and venous ulcers

38
Q

What are the symptoms of Post Thrombotic Syndrome?

A

Leg pain/heaviness, edema, skin pigmentation, vein dilation and venous ulcers

39
Q

What causes Chronic Venous Insufficiency?

A

Elevated Venous Blood Pressure

40
Q

What causes Chronic Venous Insufficiency?

A

Elevated venous blood pressure

41
Q

What are some risk factors for Chronic Venous Insufficiency?

A
  • Prior DVT, prolonged standing, pregnancy

- increasing age, obesity, smoking

42
Q

What are the symptoms of Chronic Venous Insufficiency?

A

Leg pain/heaviness, swelling, skin tightness/dryness and cramping

43
Q

What are the signs of Chronic Venous Insufficiency?

A

Dilated veins, edema and skin changes with ulceration

44
Q

What are the signs of Chronic Venous Insufficiency?

A

Dilated veins, edema, ulceration and skin changes

45
Q

What is the lifestyle modification for Chronic Venous Insufficiency?

A

Exercise and elevate legs

46
Q

If there is no ulcer present with Chronic Venous Insufficiency, what is the treatment?

A

Compression therapy and emollients

47
Q

If there is an ulcer present with Chronic Venous Insufficiency, what is the treatment?

A

Wound management

48
Q

If Chronic Venous Insufficiency is not responding to treatment, what should you do?

A

Refer for intervention

2 - CPR (pulmonary) (26 decks)

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