PVD/ Cardiovasc Flashcards
vascular system pathway- right v left side of heart
right- pulmonary- pumps blood through lungs to the pulmonary circ
left- systemic- pumps blood to all other tissues through systemic circulation
function- arteries, veins, cap
arteries- carry oxygenated blood (except pulm artery)
veins- deoxygenated blood
cap- filter and absorb
function of the vasc system
circulatory needs of tissues blood flow blood pressure cap filtration/reabsorption hemodynamic resis periph vascular regulating mech
factors that affect bp
pain, amnt body fluid, protein deficiency (cirrhosis), cap perm, resistance (length and radius of vessel, ex. thickening basemnt mem in diabetic pt inc blood viscosity= inc resistance) inc viscosity presents as inc hct/hgb and clotting/dehydration
conditions where inc metab is present (bp)
malignant hyperthermia, febrile states, exercise and infection
all inc metab state= inc o2 demand= inc risk for ischemia (not adeq o2 to tissue d/t dec blood supply)
vascular- age realted changes
Physical deconditioning
Result in atrophy of the left ventricle
Decreased elasticity of the aorta
Rigidity of the valves
Changes cause vessels to stiffen
Increased peripheral resistance (inc afterload)
Impaired blood flow
Increased LV workload= hypertrophy of ventricle (cardiomyopathy)
assessment of vasc system- health history
Intermittent claudication (cramping pain w/ exercise- stops w rest)
Arterial disorder (ischemia to tissues, dec o2 d/t dec perfusion)- chronic
Not able vasodilate
“Rest pain”
s/s progression
Location of the pain
Calf, throbbing/ sharp
assessment of vasc system- physical assessment
Physical assessment
Skin (cool, pale, pallor, rubor, loss of hair, brittle nails, dry or scaling skin, atrophy, and ulcerations)
Pulses
Thready/decreased
assessment of venous system- health hx
Dull aching pain- not assoc w/ activity
Swelling/edema
Relieved w/ elevation of feet
assessment of venous system- physical
edema, hyperpigmentation bilaterally, ulcers
Rough/scaly skin (elephantitis)
Pulses- present (can be dec d/t edema)
vascular system- diag eval
Doppler ultrasound flow studies Ankle brachial index (ABI) ratio systolic bp in ankle compared to arm Exercise testing ABI- walking- test b/a Duplex ultrasonography Angiography and magnetic resonance angiography Presence occlusive disease Labs: LDL, Triglycerides, A1C
arterial disorders
Arteriosclerosis and atherosclerosis Peripheral arterial occlusive disease Aortoiliac disease Aneurysms (thoracic, abdominal, other) Dissecting aorta Arterial embolism and arterial thrombosis Raynaud phenomenon Hypertension
arteriosclerosis- def
(wall thickening)
hardening of arteries
musc fibers and endothelial lining of walls of sm arteries and arterioles become thickened
arteriosclerosis- risk factors
non-mod- age, gender, genetics
mod- diab, smoking, obesity, htn, hyperlipidemia
arteriosclerosis- managemnt
weight loss, inc exercise, diet, dec na intake, control htn, anti-lipidemia meds (statins)
atherosclerosis
accum lipids, Ca, blood components, carbs, and fibrous tissue on intimal layer of the artery
initiates inflamm response that makes plaques unstable, turning them into complicated plaques
(usually happens after arterioscl)(plaque build-up)
common sites of artherosclerotic obstruction
*blockage happens after plaques become unstable and travel down vessels
entire span of aorta
left common iliac
femoral and tibial
all carotids, cerebrals, b/ left and right subclavians
atherosclerosis and PVD- risk factors-non mod
Age (inc risk after menopause)
Gender
Familial predisposition and genetics
atherosclerosis and PVD- risk factors-modifiable
Nicotine, diet Stim sympathy ns (inc hr/bp) not accommodate changes w/ stiff arteries, binds o2 to Co2 Hypertension Continuous damage endothelial tissues (dec elasticity, favorable area for lipid accum) Diabetes Work improve A1C, plaque build-up Obesity Stress Sedentary lifestyle C-reactive protein Marker of inflamm Inc= higher risk for CV disease Not always specific to CV All above factors lead to high c-reactive protein levels
peripheral arterial occlusive disease (PAD)- characteristics
Hallmark symptom is intermittent claudication described as aching, cramping, or inducing fatigue or weakness
Occurs with some degree of exercise or activity
Relieved with rest
Pain is associated with critical ischemia of the distal extremity and is described as persistent, aching, or boring (rest pain)
Ischemic rest pain is usually worse at night and often wakes the patient (inc urgency)
peripheral arterial occlusive disease (PAD)- interventions
DO NOT elevate, keep legs heart level/ neutral position
Heat can inc o2 metab demand (sometimes used bc vasodilates)
Meds- vasodil.
PAD complications
Critical limb ischemia***
Acute limb ischemia – thrombus (plaque) forms a narrowed artery progressing to occlusion= emergent situation
Embolism – plaque ruptures and creates a traveling clot
Treat with anticoagulation, thrombolytics, embolectomy
s/s of acute limb ischemia
Pain Pallor Pulselessness Paresthesias (numbness/tingling) Paralysis (unable dorsi/plantar flex) Poikilothermia (cool)
PAD- interventions
if critical
Angioplasty (clean arteries), atherectomy (remove clots)., surgical revascularization, (graft to bypass thrombus area)