PVD

Question 1

A slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel.
May involve disease in any of the blood vessels outside of the heart including arteries and veins and lymphatic vessels

Answer 1

Peripheral vascular disease

Question 2

PAD findings

Answer 2

Intermittent claudication (most common symptom)
Pallor on elevation
Dependent rubor
Impaired capillary refill
Impaired peripheral pulses
Affected limb may show cyanosis
Feel cool to the touch
Numbness or tingling reported in affected area
Skin may be shiny, thin, pale, and hairless
Nails become thickened and brittle

Question 3

Ankle-Brachial index (ABI)

Answer 3

1. Pt in supine
2. Measure brachial artery pressure
3. Apply same BP cuff to the ankle on the same side of the body
4. Palpate for the posterior tibial artery and take SBP reading
5. Palpate dorsal pedis artery and take pressure there
6. Apply BP cuff to the opposite ankle and obtain posterior tibial and dorsalis pedis pressures
7. Repeat on other arm

Question 4

Typical ABI findings in pts with PAD

Answer 4

ABI should be > or equal to 1
ABI < 0.9 is diagnostic of PAD
ABI 0.5-0.8 are fond in pts with claudication
ABI > 0.5 indicates critical ischemia

Question 5

Sound made by turbulent flow vibrating against arterial wall
Causes the arterial wall to vibrate during systole
Indicates the presence of an arterial lesion/plaque

Answer 5

Carotid bruit

Question 6

clinical Implications for PAD

Answer 6

High risk individuals for PAD and AAA
hemodynamics during exercise 
Intermittent claudication usually have some sort of walking impairment 
Exercise training 
Proper foot care, footwear, and hygiene 
Elevating head at night

Question 7

Most effective exercise treatment for claudication relief

Answer 7

Interval training with short rest periods

Work up until claudication onset (usually 3-5 min), then rest and allow symptoms to resolve. Repeat exercise-rest-exercise cycle with goal of 30-35 minutes of exercise

Question 8

Raynaud’s syndrome

Answer 8

Vasospasm causing reduced blood flow
Primary- more common in women, onset 15-30, more typical in cold climates, Family hx, no underlying disease
Secondary- less common, but more serious. Sxs usually appear later than primary (40).
Scleroderma, lupus, RA, repetitive trauma, smoking, atherosclerosis
Severe- rare, should result in permanent hypoperfusion of digits

Question 9

Aneurysm

Answer 9

Localized abnormal dilation by at least 50% compared to normal
Classified according to cause, size, shape
Causes: atherosclerosis, congenital infections, marfans
Risk factors:
CVD risk factors especially smoking
Male
Genetics
40-60 y/o
Hypertension prevalent

Question 10

Types of aneurysms

Answer 10

Saccular Aka Berry: small, spherical, most common in brain tissue
Fusiform: gradual more progressive
Dissecting: blood filled channel within aortic wall

Question 11

Abdominal aortic aneurysms

Answer 11

Dull, tearing ache/pain in low back, groin or mid abdominal left flank
Chest pain
Weakness or transient paralysis of legs
Palpable pulsating abdominal mass
Inter-arm systolic BP difference >20
Absent or decreased peripheral pulses aka pulse deficit
Tachycardia