Vascular Disease Flashcards
1
Q
What can atherosclerosis cause?
A
- Angina
- ACS
- Transient ischaemic attacks
- Strokes
- Peripheral arterial disease
- Chronic mesenteric ischaemia
2
Q
What are the risk factors for PAD?
A
- Increasing age
- Male sex
- Family history
- Smoking and alcohol
- Obesity
- Poor diet
- Low exercise
- HTN
- Cholesterol
- DM
3
Q
What does PAD include?
A
- Acute limb-threatening ischaemia
- Critical limb-threatening ischaemia
- Intermittent claudication
4
Q
How do you identify acute limb-threatening ischaemia?
A
6 P's • Pale • Perishing cold • Pulseless • Painful • Paraesthetic • Paralysed
5
Q
What can cause acute limb-threatening ischaemia?
A
May be due to thrombosis in situ, emboli, graft/angioplasty occlusion or trauma
6
Q
How do you identify chronic limb-threatening ischaemia?
A
- Progressive claudication in calf, thigh or buttock
- Rest pain >2 weeks
- Non-healing wounds on lower limb (gangrene, ulcers, necrosis)
- Absent foot pulses
7
Q
What is claudication?
A
- Aching of muscles on effort
- Reoccurring
- Worse on hills, with loads and at speed
- Settles swiftly with rest
8
Q
What is rest pain?
A
- Icy, burning, constant aching pain in foot
- Worse on elevation or at night
- Needs opiates
9
Q
What indicates tissue loss?
A
- Ulcers
- Necrosis
- Gangrene
10
Q
What may indicate PAD in a vascular exam?
A
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
11
Q
What investigations would you do for suspected PAD?
A
- Ankle-brachial pressure index (ABPI)
- Arterial doppler
- Angiography (CT or MRI)
12
Q
What is an Ankle-brachial pressure index (ABPI)?
A
Ratio of systolic BP in the ankle vs the arm
13
Q
What do the values of an Ankle-brachial pressure index (ABPI) indicate?
A
- > 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
14
Q
How do you manage CV risk in PAD?
A
- Smoking cessation, exercise, weight loss
- Optimise medical
- Clopidogrel 75mg
- Atorvastatin 80mg
15
Q
How do you manage acute limb ischaemia?
A
- Surgical emergency requiring revascularisation within 4-6hrs to save the limb
- Anticoagulated with heparin after procedure
