PVD Flashcards
What is Raynuads?
paroxysmal digital vasoconstrction resulting in bilateral symmetrical pallor or cyanosis, occurs women commonly 15-45
what are triggers for raynauds?
cold, emotional upset,
relieved by warmth
what is raynaud diagnosed?
symptomology for 3 + years
secondary raynaud is caused by?
underlying condition such as athersclerosis, collogen vascular disease, autoimmune disease (scleroderma), vibrating tools, sharp digit movement activiies. forst bite. tobacco, ergotamine use, BB use.
tx for raynauds?
ACE, dihyropyridine CCB (“pine”), warm water, smoking cessation
what are varicose veins?
tortuous dilated superficial veins that have inherited defect or valvular incompetence. commonly affects saphenous vein
signs of varicose veins?
leg aching, usually not extreme pain. discomfort not correlate with amt etc. mild edema at end of day around ankles. plalpable and compressible.
complication of varicose veins?
superficial thrombophlebitis
what med increases anticoag effect if given with warfarin?
clarithromycin
what med decrases anticoag effect if given warfarin?
cholestyramine
what is homans sign?
it is a test that includes pushing the foot toward the head and pain in calf. checks for DVT, VTE. etc. seen in 33% of patients with DVT
what med reverses heparin?
protamine sulfate
how long does warfrin therapy take to have effect?
1-2 days.
RF for PVD?
aterial occlusive disease, htn, hyperlipidemia, tobacco.
symptoms of PVD that are most common?
reproducible ischemic muscle pain. worse with exertion and response promptly to cessation of triggr.
how diagnose PVD when suspect LE occlusive disease?
doppler US first line . Magnetic resonance angiography gold standard.
careful with CT because can cause renal impairment.
Treatment for lower extremity occlusive disorder?
pentoxifylline (trental) - reduce blood viscosity and imprve blod flow
cilostazol (pletal) - impairs platelet aggregation and increases vasodilation. CI in HF.
ASA and statins
BB used to not be recommended but now are ok.
clopidogrel.
warfarin with INR 2-3. occassionally for high risk.
what are the acute limb ischemia manifestations if caused by embolic thrombolic or traumatic event
6 P’s: pain, paresthesia, pallor, pulselessness, poikilothermy, paralysis.
if the acute limb ischemia is caused by arterial embolism what is usually the origin of the clot?
heart w/underlying a fib.
if the acute limb ischemia is caused by arterial thrombosis what is usually the origin of the clot
chronic arteriosclerotic occlusive disease
what is chronic venous insufficiency?
common sequela of DVT and leg trauma. decreases venous return b.c vessel damage
earliest sign and other signs of chronic venous insufficiency?
edema earliest sign. leg aching and itchiness seen
later - thin, shiny, atrophic skin, brown pigmentation.
TX for venous stasis ulcer
compression therapy, rigid compression.
high dose pentoxifylline in combination
ulcer debridement, hyperbaric oxygen. slow release antispetic bandages. moisture retaining dressings. prtein diet.
signs of LE vascular occlusive disease?
burning, aching with walking.
pain in calf relieved by rest
numbness, coldness. absent pulse and nail thickening can also be seen. blanking foot with elevation poor capillary return sexual dysfcuntion ache in foot and arch