Peripheral vascular exam Flashcards
JVD
Jugular venous distention. External jugular vein. The pressure built up in the jugular vein due to RT atrial problem
JVP
Jugular venous pressure. Internal jugular vein. Estimates Right atrial pressure
How do you test for JVP
lie pt at 30 degree. turn head to left, look for venous fluttering. measure from the sternal angle to top of venous fluttering
Measurement interpretation of JVP
Rt atrium is ~5cm deep to sternum. A total of 9+cms (5cm +external measurement) is indicative of increased CVP.
Hepatojugular reflux
exaggerated when RT heart failure present
How do you do hepatojugular reflux
- Use hand to apply pressure to and (mid epigastric region)
- Pt breathes normally
- Check neck for increase in JVP with pressure and decrease without pressure
If no change in JVP during hepatojugular reflux, what is indicated
pressure is either higher or lower
Artery structure
Thick, muscular, high pressure
Vein structure
Thin walls, accommodates a lot of blood, stretches, low pressure
What things would indicate poor blood flow in extremities
- Loss of hair at certain level on legs
- Brown, red, pale skin
- Ulcers, gangrene
- Edema
Brown staining around ankles indicates
Venous return problem
What is rubor mostly associated with
Arterial problems
Ulcers on the toes
arterial problem
Ulcers on the ankles
Venous problem
Edema is indicative of
venous return problems, and RT sided heart failure. This causes a traffic jam of venous return, which induces swelling
If both legs have edema
systemic problem
If one leg has edema
local problem
Pitting edema
collection of fluid in lower limbs (dependent) measured 1-4
Non-pitting edema
aka brawny edema. Pt has had edema for so long that the fluid becomes scarred and hard. Does not push out of the way
Orthostatic edema
usually occurs from sitting too long, pitting, always both legs
Lymphedema
Lymphatic obstruction, common in breast CA (no pitting)
Lipedema
Fat deposits. No edema in foot and no pitting
Chronic venous insufficiency
Chronic venous stasis, leg injury, phlebitis. Pitting and ulcerations seen
Variables affecting amplitude of arterial pulse
- SV
- Aorta stretchibility
- Obstruction/peripheral resistance
- Viscosity of blood
Which arteries to you auscultate for bruits
Aorta, carotids, renal, iliac, femoral
Pulsus alternans
Alternating strong and weak beats. Lt ventricular systolic problem
Pulsus bigeminus
Two heartbeats close together followed by a longer pause. 2nd pulse weaker. Hypertrophic obstructive disease
Pulsus bisferiens
Double peaked pulse (striking twice) aortic insufficiency
Pulse deficit
Difference between apical pulse and palpable (radial pulse) seen in atrial fibrillation
Venous insufficiency
Flow of blood through veins is impaired often times because of insufficient valve closure (chronic)
Causes of venous insufficiency
Varicose veins or poor function of the venous valves. Get chronic venous stasis
Signs of venous insufficiency
brown color on ankle ulcerations, brawny ankle
Venous obstruction
poor venous return due to clot or DVT
Signs of venous obstruction
swelling, pain in one leg, PE,
Arterial insufficiency
Poor blood flow to the extremities
Causes of arterial insufficiency
obstruction, plaque, trauma
Signs of chronic arterial insufficiency
Claudication, pain, diminished pulses, pallor, rubor, ulcers on toes, gangrene
Arterial obstruction
Lack of blood flow due to clot or stenosis
Signs of arterial obstruction
Pain, numbness, tingling, pale, mottled, pulses absent
Varicosities
Dilated, tortuous veins (saphenous)
Signs of varicosities
dull, aching pain, heaviness. Exacerbated by pregnancy and obesity
Claudication
Intermittent pain and cramping in leg due to arterial obstruction
Test for possible DVT in calf
Homans sign
Allen test
Checks collateral arterial circulation in hand
How do you test for chronic arterial insufficiency
Raise both legs 60 degrees, if pale on elevation, positive test. THEN have pt dangle feet, it it takes longer than 10 seconds
