Peripheral Vascular Dz Flashcards
Most important risk factors for peripheral artery disease? Other risk factors?
Cigarette smoking and diabetes mellitus
Hypertension, dyslipidemia, elevated homocysteine
Ankle brachial index? Determined by?
Ratio of ankle brachial systolic blood-pressure. determined using Doppler ultrasound
Peripheral artery disease confers the same risk of cardiovascular death as?
Prior myocardial infarction or stroke
Patient with aortoiliac disease may complain of exertional pain where?
Thighs or butt
Rest pain in peripheral arterial disease indicates?
Severe occlusion
Bruits on physical exam indicate?
Accelerated blood flow velocity and turbulence at the sites of stenosis
In a patient with a peripheral artery disease, elevation of the feet will induce? If feet are then placed in dependent position?
Pallor in the soles. Redness as a result of reactive hyperemia
Chronic arterial insufficiency may cause what findings? In severe cases?
Hair loss on legs and feet, thickened toenails, atrophic shiny skin
Ulcers or gangrene
Normal ankle brachial index? In patients with claudication? In patients with critical leg ischemia?
1+
.41 - .90
Less than .40
Mortality rate in patients with symptomatic peripheral artery disease
50% in 10 years
Intervention that reduces the risk of fatal or nonfatal MIs by as much as 50%?
Smoking cessation
Drug approved for the treatment of claudication? Mechanism of action?
Cilostazol. Phosphodiesterase inhibitor with vasodilatory and antiplatelet properties
Treatment of PAD includes?
- Treat cardiovascular risk factors (smoking cessation, hyperlipidemia, hypertension, aspirin, ACE inhibitor)
- Assess severity of claudication with treadmill test or maximal walking distance
- Angioplasty or bypass grafting
Who should be evaluated for revascularization?
patients with ankle brachial index less than .4, severe claudication, rest pain, or nonhealing ulcers should be evaluated for?
An ideal candidate for revascularization?
Ideal candidates have discrete stenosis of large vessels (Diffuse or small-vessel disease patients respond poorly)
Buerger’s disease: Size of vessels? Typical patient?
Inflammatory condition of small and medium-sized arteries found exclusively in smokers, especially males younger than 40
Fibromuscular dysplasia? Size of vessels? Sex? Arteries generally affected?
Hyperplastic disorder affecting medium and small arteries and usually occurs in women. Generally affects renal and carotid arteries
Takayasu arteritis: Typical patient? Vessels affected? Presentation?
Young women. Affects branches of the aorta, most commonly subclavian. Causes arm claudication, Raynaud’s phenomenon, fever, weight loss
Patients with chronic peripheral artery insufficiency who present with sudden unremitting pain may have?
Acute arterial occlusion, most commonly from embolism or in situ thrombosis
In acute arterial occlusion, most common source of emboli?
The heart
Heart conditions that may cause cardiogenic emboli?
Atrial fibrillation, dilated cardiomyopathy, endocarditis
Patients with acute arterial occlusion present with what signs?
6 p’s
Pain, pallor, pulselessness paresthesias, paralysis, poikilothermia (coolness)
Management of patients with acute arterial occlusion?
- Anticoagulation with heparin
- Keep limb below horizontal plane without any pressure
- Surgical removal or balloon catheter
31-year-old male smoker with resting pain in his legs and a nonhealing foot ulcer. Diagnosis?
Buerger disease
62-year-old male with livedo reticulatus and three toes, including one with gangrene following cardiac catheterization. Dx?
Cholesterol embolus
