S2 L7.2: Peripheral Arterial Disease & Vasomotor Disease Flashcards
A clinical disorder in which there is a stenosis or
occlusion in the aorta or arteries of the limbs.
PERIPHERAL ARTERIAL DISEASE
Modified T/F: Atherosclerosis is the leading cause of PAD in patients >
40 years old. The highest prevalence of atherosclerotic PAD occurs in
the sixth and seventh decades of life.
True
What are the risk factors for peripheral arterial disease?
Risk factors: tobacco smoking, diabetes mellitus,
hypercholesterolemia, hypertension or
hyperhomocysteinemia.
most common symptom
Intermittent claudication
What is being described
○ A clinical emergency
○ Rest pain or a feeling of cold or numbness in the foot
and toes
○ Occur at night or when lying down when the legs are
horizontal and improve when the legs are in a
dependent position
Critical limb ischemia
With severe ischemia, rest pain may be persistent
T/F: In PAD, increased pulses distal to the obstruction
False. Decreased or absent pulses distal to
the obstruction
T/F: Bruits over the narrowed artery
True
What is the normal range of ABI?
○ ≥ 1.0 normal
○ ≤ 1.0 PAD
○ < 0.05 severe PAD
How do you diagnose PAD?
● ABI
● Arterial Ultrasonography/Duplex Scan
● Pulse volume recordings
● Treadmill Stress Test
● Arteriography
● MR Angiography
● CT Angiography
What is being described
● Buerger’s disease (strongly associated with smoking
usually in younger individuals)
● An inflammatory occlusive vascular disorder involving
small and medium-sized arteries and veins in the distal
upper and lower extremities
● More on the LE.
THROMBOANGIITIS OBLITERANS
What comprises of the triad in THROMBOANGIITIS OBLITERANS
○ Claudication of the affected extremity
○ Raynaud phenomenon
○ Migratory superficial vein thrombophlebitis
In THROMBOANGIITIS OBLITERANS, claudiccation is usually confied to the ?
calves and feet or
the forearms and hands
T/F: No specific treatment except abstention from tobacco for TAO
True
What is being described
● Episodic digital ischemia
● Triphasic color change: digital blanching, cyanosis, and
rubor of the fingers or toes following cold exposure and
subsequent rewarming
● Emotional stress may also precipitate Raynaud’s
phenomenon
● Color changes are usually well demarcated and are
confined to the fingers or toes
RAYNAUD PHENOMENON
In ischemic phase, the following can be observed:
A. Blanching or pallor
B. Results from vasospasm of digital arteries
C. Capillaries and venules dilate
D. Sensation of cold or numbness or paresthesia of the
digits (it’s painful)
E. All of the above
E
What is being described
● Applied when the secondary causes of Raynaud
Phenomenon have been excluded
● >50% of patients with Raynaud phenomenon have
Raynaud disease
● 5x F>M; 20-40 years
● Fingers > toes
RAYNAUD DISEASE
T/F: In RAYNAUD DISEASE, Rarely, the earlobes, the tip of the nose, and the penis are
involved
True
What are drug treatments that should be reserved for the severe cases in raynaud phenomenon?
○ Dihydropyridine calcium channel blocker (nifedipine)
■ Dilate arteries
○ Postsynaptic1-adrenergic antagonist (prazosin)
■ Dilate arteries
○ Sympatholytic agents (methyldopa)
■ “Tame down” sympathetics that will tend to
vasoconstrict
○ Topical glyceryl trinitrate
■ Vasodilation
○ Digital sympathectomy
What is being described
● Previously known as Reflex Sympathetic Dystrophy
● A regional pain syndrome that usually develops after
tissue trauma
COMPLEX REGIONAL PAIN SYNDROME I
● Within weeks to 3 months after the precipitating event
● Pain and swelling in the distal extremity
PHASE I
● 3–6 months after onset of trauma
● Thin, shiny, cool skin appears
PHASE II
● Additional 3–6 months
● Atrophy of the skin and subcutaneous tissue
● Flexion contractures complete the clinical picture
● Lose the hair growth
● If the PT discovers early on, our job is to prevent phase 2
and phase 3
PHASE III
What is the meaning of STAMP under phase III?
○ Sensory
■ Allodynia
■ Hypo-hyperanalgesia
■ Hypo-hyperesthesia
○ Trophic
■ Skin, Hair, Nail changes
○ Autonomic
■ Swelling
■ Edema
■ Sweating
○ Motor
■ Weakness
■ Contractures
■ Atrophy
○ Pain (Major Symptom)
T/F: Complex regional pain syndrom’s primary clinical feature is pain
True
What is being described:
● Natural history may be benign
○ In the end may be so severe
● A variety of surgical and medical treatments have been
developed, with conflicting reports of efficacy
● Early mobilization with physical therapy
● Brief course of glucocorticoids
COMPLEX REGIONAL PAIN SYNDROME II
Previously known as Causalgia
COMPLEX REGIONAL PAIN SYNDROME II
T/F re CRPS II: Spontaneous pain initially develops within the territory of
the affected nerve in contrast to CRPS I
True
Once an aneurysm ruptures, how long does the patient
have until it’s too late?
○ It depends on the BP
○ It is already considered an emergency once it tears
○ Stanford A: an emergency, since it already affects
the heart (once heart is in MI, acute regurgitation,
aortic regurgitation, HF → will make a patient die
instantly, also can die from the blood extravacating
the aorta)
○ Stanford B: not so an emergency, since only
If the surgery is successful, what kind of life awaits?
○ Once managed early, there is no such damage to the
brain (since the circulation to the brain will predict to
what life the patient may have after a successful
surgery)
○ Depends on the complication, that is why it is
needed to act fast
Following an aortic aneurysm operation surgery, when is
the ideal time to begin physical therapy?
○ As soon as possible. Depends on the situation,
more so when there is a stroke. We don’t want to
prolong debilitation.
○ The only criterion before proceeding with physical
therapy is having stable vital signs.
○ Being intubated or connected to a lot of tubes is not
contraindicated. Can always do strategies like
preventing atrophy and bed sores or maintaining jt
movement
