Vascular Disease Flashcards
What can atherosclerosis cause?
- Angina
- ACS
- Transient ischaemic attacks
- Strokes
- Peripheral arterial disease
- Chronic mesenteric ischaemia
What are the risk factors for PAD?
- Increasing age
- Male sex
- Family history
- Smoking and alcohol
- Obesity
- Poor diet
- Low exercise
- HTN
- Cholesterol
- DM
What does PAD include?
- Acute limb-threatening ischaemia
- Critical limb-threatening ischaemia
- Intermittent claudication
How do you identify acute limb-threatening ischaemia?
6 P's • Pale • Perishing cold • Pulseless • Painful • Paraesthetic • Paralysed
What can cause acute limb-threatening ischaemia?
May be due to thrombosis in situ, emboli, graft/angioplasty occlusion or trauma
How do you identify chronic limb-threatening ischaemia?
- Progressive claudication in calf, thigh or buttock
- Rest pain >2 weeks
- Non-healing wounds on lower limb (gangrene, ulcers, necrosis)
- Absent foot pulses
What is claudication?
- Aching of muscles on effort
- Reoccurring
- Worse on hills, with loads and at speed
- Settles swiftly with rest
What is rest pain?
- Icy, burning, constant aching pain in foot
- Worse on elevation or at night
- Needs opiates
What indicates tissue loss?
- Ulcers
- Necrosis
- Gangrene
What may indicate PAD in a vascular exam?
o Rubor, pallor on elevation of extremity o Temperature differences between legs o Thin, shiny skin o Skin discolouration o Hair loss o Reduced CRT o Ischaemic ulcers o Non-healing foot wounds o Gangrene o Absent foot pulses
What investigations would you do for suspected PAD?
- Ankle-brachial pressure index (ABPI)
- Arterial doppler
- Angiography (CT or MRI)
What is an Ankle-brachial pressure index (ABPI)?
Ratio of systolic BP in the ankle vs the arm
What do the values of an Ankle-brachial pressure index (ABPI) indicate?
- > 0.9 = normal
- 0.6-0.9 = mild disease
- 0.3-0.6 = moderate to severe disease
- <0.3 = severe disease to critical limb ischaemia
How do you manage CV risk in PAD?
- Smoking cessation, exercise, weight loss
- Optimise medical
- Clopidogrel 75mg
- Atorvastatin 80mg
How do you manage acute limb ischaemia?
- Surgical emergency requiring revascularisation within 4-6hrs to save the limb
- Anticoagulated with heparin after procedure
How do you manage critical limb ischaemia?
• Pain ladder management
• Advice on:
o Foot care
o Driving
How do you manage intermittent claudication?
- Supervised exercise programme
- Angioplasty or bypass surgery
- Naftidrofuryl oxalate
What are the differentials for acute limb ischaemia?
o Chronic peripheral neuropathy (Diabetic neuropathy)
o Acute compressive peripheral neuropathy (Compartment syndrome)
o Acute DVT
What are the differentials for intermittent claudication?
o Nerve root compression
o Hip arthritis
o Spinal stenosis
o Foot and ankle arthritis
What can cause chronic limb-threatening ischaemia to be missed?
Can be missed if symptoms are confused with other causes of foot pain:
- Plantar fasciitis
- Cellulitis
- Gout
- Arthritis
