PVD Flashcards
Pathophysiology of PVD
r/t atherosclerosis processes in the extremities.
Risk Factors for PVD
SMOKING
Diabetes
High cholesterol
Heart disease
Stroke
Increased age >50
Etiology of PVD
ATHEROSCLEROSIS – most common cause.
A thrombus.
Inflammation: Thromboangitis obliterans which is an inflammatory condition of the arteries.
Vasospasm: Raynaud’s disease or phenomenon an autoimmune disease.
PAD: Clinical Manifestations
d/t local tissue ischemia and appear in the extremities.
Pain – calf pain, “buttock pain”, Numbness/Burning, Heaviness, Intermittent claudication.
Wounds that don’t heal.
Diminished sensation in extremities.
Trophic skin changes: Skin – shiny, thick toenails, Loss of leg hair, Diminished pulses, Elevation pallor, cyanosis, Reactive hyperemia (dependent rubor), Erectile dysfunction.
What is intermittent claudication?
Consistent pain precipitated by consistent level of exercise.
CEASES WITH REST.
Caused by ischemic tissue.
Pain depends on: Site of plaque build up, Collateral circulation.
Common site for PAD: Femoral artery
Atherosclerosis of femoral artery.
Lack of circulation: Pain (intermittent claudication), Decreased pulse, Coolness/Pallor of leg, Loss of sensation in foot.
Ischemia of muscle in lower leg, cellular hypoxia
The 5 Ps of PVD
Pain (intermittent claudication)
Pulselessness
Palpable coolness
Paresthesias
Paresis (weakness of extremity)
specific to PAD.
Diagnosis of PVD: Ankle-Brachial Index
Comparison of the blood pressure in the leg vs. the arm.
Normal ratio is >1
Normal: ankle pressure is greater than brachial pressure
Severe PAD ankle-brachial index ABI = 0.5
What is Chronic Venous Insufficiency?
A condition that occurs when theVENOUSwall and/or VALVES in the leg veins are not working effectively.
CVI causes blood to “pool” or collect in these veins = venous stasis.
Chronic.
Symptoms of VENOUS Insufficiency
Lower extremity edema
Achiness or tiredness in legs
Leathery looking skin
Stasis ulcers
Flaking or itching skin
New varicose veins
Nonpharmacological Treatment of PVD
Smoking cessation
Increase physical activity
Weight reduction
Stress reduction
Diabetes management
Hypertension control
Pharmacological Treatment of PVD
Antiplatelet agents
Anticoagulants
Thrombolytics
Lipid lowering agents
cilostazol (Pletal)
MOA: Platelet inhibitor, Vasodilation.
indication:intermittent claudication
SE: Headache, dizziness, Diarrhea, abnormal stools, Palpitations, peripheral edema.
NC: Drug interactions
Metabolized by Cytochrome P450
pentoxifylline/Trental
Class: Vasoactive agent
Indication: intermittent claudication caused by PVD
MOA: relieves leg pain by increasing blood flow and oxygen through the blood vessels. Helps to increase walking distance & duration
SE: N/V, dizziness
Route: po TID
