Quiz 6 Flashcards
what is PAD?
peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs
what happens to the extremeties when one develops PAD?
extremeties do not recieve enough blood flow to keep up with demand
what causes intermittent claudication?
not enough blood flow is getting to the leg and the muscle cells are not getting the required oxygen when exercising
what is PAD also likely to be a sign of?
a more widespread accumulation of fatty deposits in other arteries as well as heart and carotids
what does PAD reduce?
blood flow to the heart and brain as well as the legs
what may be the cause of PAD?
- blood vessel inflammation
- injury to limbs
- unusual anatomy of ligaments or muscles
- radiation exposure
PAD with atherosclerosis has a risk of developing what?
critical limb ischemia
how does critical limb ischemia begin?
begins as open sores that dont heal, an injury, or an infection of your feet and legs
what may happen in the end with critical limb ischemia?
such injuries or infections progress and can cause tissue dealth (gangrene) and can cause amputation of the affected limb
fat deposits that build up in arteries supplying the heart and brain can cause what?
stroke or heart attack
what symptoms do most people with PAD have?
mild or no symptoms
what are intermittent claudication symtoms?
Muscle pain or cramping in the legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest
where is the location if claudication?
pain depends on the location of the clogged or narrowed artery
where is the most common location of cluaducation pain?
calf pain indication obstruction above this level in the popliteal or femoral artery
what are PAD symtoms?
- Claudication/altered gait
- Leg numbness or weakness
- Coldness in the lower leg or foot, especially when compared with the other limb
- Sores on the toes, feet or legs that won’t heal
- A change in the color of the legs
- Hair loss or slower hair growth on the feet and legs
- Slower growth of the toenails
- Shiny skin on the legs
- No pulse or a weak pulse in the legs or feet
- Erectile dysfunction in men
what does the physician look for signs of on a physical exam?
- trauma
- previous surgery
- muscle wasting (asymmetry)
- edema
- erythema
- hair abscent in PVD
- skiny skin
- haemosiderin deposits(brown pigment stain)
- lipodermatosclerosis
where are arterial ulcers located?
arterial ulcers tend to be on the borders/sides of the foot
where are neuropathic ulcers located?
plantar surface of the foot
where are venous ulcers located?
venous ulcers tend to be on the medial aspect of the leg superior to the medial malleolus
what do doctors look for in palpation?
- temperature (cool is poor circulation)
- pitting edema
ausculation
for femoral artery bruits, listening with a stethoscope in the groin area for wooshing sounds
where is the dorsalis pedis artery pulse?
on dorsal surface of the foot, running lateral to the tendon of the first toe
where is the posterior tibial artery pulse?
posterior and inferior to the medial malleolus
where is the popliteal artery pulse?
behind the knee, typically done with both hands
where is the femoral artery pulse?
in the femoral triangle/halfway between the ASIS and pubic tubercle
what do you ask your patient before starting the exam?
- have you had any surgeries to your blood vessels
- how far can you walk before pain starts (measure in blocks)
- does the pain subside when you stop to rest
- does it return when you resume walking
what does the sonographer visually assess for?
1-shiny skin
2-hairless especialy on toes
3-ulcers on the foot (diabetics)
4-asymmetry of limbs
what assesses peripheral vascular disease?
ankle-brachial pressure index (ABPI)
when may ABI be unreliable?
in patients with calcified arteries in the calf (often diabetic patients) or those with extensive edema
when ABI is unreliable, what should be used?
toe brachial pressure index (TBPI)
what is ischemic rest pain?
if peripheral artery disease progresses, pain may even occur when at rest or when lying down
rest pain may be intense enough to ___________
disrupt sleep
what may temporarily relieve rest pain?
hanging legs over the edge of the bed or walking around the room
what are risk factors for PAD and rest pain?
- smoking
- diabetes
- obesity (BMI over 30)
- high blood pressure (140/90)
- high cholesterol (over 240)
- increasing age (over 50)
- family historyn PAD, heart disease or stroke
- high levels of homocysteine
what is homocysteine?
a protein component that helps build and maintain tissue
who has the greatest risk of developing periheral artery disease due to reduced blood flow?
people who smoke or have diabetes
what are signs of PAD?
- a weak or absent pulse below a narrowed area of the artery
- whooshing sounds over the arteries
- evidence of poor wound healing in the area where blood flow is restricted
- decreased blood pressre in the affected limb
what is a common test ti diagnose PAD?
ABI
what is ABI?
compares the blood pressure in the ankle with the blood pressure in the arm
how is an ABI done?
walking on a treadmill and have readings taken before and immediattely after exercising to capture the severity of the narrowed arteries during walking
how are blood tests done for diagnosis of PAD?
a sample of the blood can be used to measure cholesterol and triglycerides and to check for diabetis
what is angiography?
injecting a dye (contrast material) into the blood vessels, allows a specialoist to view blood flow through thr arteries as it happens
how to you examine flow with angiography?
X-ray imaging, magnetic resonance angiography (MRA), or computerized tomography angiography (CTA)
what is a more invasive angiography?
catherdar angiogrpahy involves guiding a cathedar through an artery in the groin to the affected area and injecting dye that way
what does cathedar angiography allow for?
simultaneous diagnosis and treatment
what does angiography do?
finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow
cholesterol - lowering medications?
a cholesterol lowering drug called a statin to reduce the risk factor of heart attack and stroke
high blood pressure medications?
the goal of this is to reduce the systolic blood pressure to 140 millimeters of mercury or lower the diastolic blood pressure to 90 mm Hg or lower
what is the target blood pressure for a diabetic patient?
under 130/80 mmHg
what is important to control in a diabetic patient?
control blood sugar (glucose) levels
why is it importnat to reduce risk of blood clots?
becuase peripheral artery disease is related to reduced blood flow to the limbs
what can cause tissue dealth?
a blood clot ca completely block an already narrowed blood vessel
what is a common drug to reduce risk of blood clots?
plavix
what may necessary to treat peripheral artery disease thats causing intermittent claudication?
angioplasty or surgury
how is an anioplasty preformed?
a small hollow tube (cathedar) is threaded through a blood vessel to the affected artery and a small balloon on the tip of the cathedar is inflated to reopen the artery and flatten the blockage to increase blood flow
what may also be done with angioplasty?
a doctor may also insert a mesh stent in the artery to keep it open
what is angioplasty the same procedure as?
same one doctors use to open heart surgeres
how may a doctoe allow blood to flow around or bypass the blocked or narrowed artery?
the doctor may create a graft using a vessel from another part of your body or a blood vessel made of synthetic fabric
what is thrombolytic therapy?
if there is a blood clot blocking an artery, the doctor may inject a clot dissolving drug into the artery at the point of the clot to break it up
what is step 1 for arterial testing protocol?
bilateral ABI measurements
ankle brachial indice
Ankle/Brachial systolic pressure
BRA pressure use what?
use the highest systolic measurement of the Lt or Rt arm
legs pressure use what?
highest of the PTA or dorsalis pedis A
what will the ABI indicate?
how much disease you may encounter
what ABI is indicative of little or no hemodynamically significant stenosis?
> 0.9
ABI mild disease
0.8-0.89
ABI moderate disease
0.5-0.79
ABI severe disease
<0.5
ABI ischemic rest pain
<0.3
what is always preformed in step 2 of arterial testing protocol?
bilateral exam is always preformed
how do we image the arteries in step 2?
image the arteries from the groin to the proximal PTA/PER A and ATA
what do we sagital scan through?
- CFA
- PFA origon
- FA prox, mid and distal through adductor (hunters) canal
- pop artery form prox to distal
- trifurcation-each branch
why is color analyzed?
for aliasing
where are ratio measurement taken?
sites of narrowing/aliasing
how do we obtain the ratios?
PSV prox to stenotic zone and highest attainable PSV in the stenotic zone
what must be used when obatining ratios?
angle correct of 60 degrees
what may be history to a person with arterial diseae?
- HBP
- high cholesterol
- smoking
- heart disease
- claudication
what do we take note of when reporting arterial disease?
ulcers and gangrenous digits
