Vascular history and examination Flashcards
3 things to take in history
name
age
occupation
5 things to ask to diagnose leg effects of atherosclerosis
- nature/site of pain
- how far can you walk before pain starts (some distance)
- how far before you have to stop
- does pain go away on rest
- does pain come on quicker when walking up hills/ hurrying
3 diagnosing factors for critical ischaemia
- rest pain affecting foot when elevated at rest (eg at night)
- tissue loss (ulceration)
- gangrene
5 risk factors for vascular disease
- smoking
- hypertension
- diabetes
- hypercholesterolaemia
- family history
7 types (+ names) of medications pt with vascular disease may be taking
SAME AS ANGINA DABDS
- anti-platelets (aspirin, clopidogrel)
- statins
- ACE inhibitors (pil)
- B blockers (lol)
- calcium antagonists
- diuretics
- vasodilators
6 signs of vascular problems
- arcus senilis (white crescent around pupil due to hypercholesterolaemia)
- xanthelasma (white patch on eyelid. hypercholesterolaemia)
- angular stomatitis (red, swollen corners of mouth. indicates anaemia)
- embolic digital ischaemia (embolus lodged in digital aa –> tissue necrosis
- splinter haemorrhage: micro-emboli. sign of valvular heart disease/ septic endocarditis
- clubbing: arterial venous shunts/splints, sign of sianotic heart disease –> oedema of fingerbed, loss of angle of nail
details of 3 main areas of atherosclerosis effects
- BRAIN: stroke, TIA, amaurosis (vision loss)
- HEART: angina, MI (if cardiac muscle has died)
- LEG: intermittent claudification (muscle pain), critical ischaemia
4 trophic changes with atherosclerosis
dry skin (bc sweat glands die) hair loss (follicles die) nail changes cold
what to check with the pulse 6
presence/absence
- rate
- rhythm
- volume
4 places to check pulse for atherosclerosis
- dorsalis pedis
- posterior tibial
- popliteal (behind knee)
- femoral (groin)
describe Buergers test
pallor on elevation
rubor on dependency
3 signs of diabetic foot
ischaemia
neuropathy
infection
5 signs of neuropathy with atherosclerosis
hot water bottle burn
friction from bed clothes
burning and tingling –> throws bedclothes off at night
loss of pinprick sensation
neuropathic ulcers (painless, over bony prominences)
what causes patchy localised infarction
embolism
how to diagnose pvd 4
-ABPI: ancho-brachial pressure index
take bp using Doppler probe
lower bp in feet than arm
-duplex doppler ultrasound –> spectoral analysis, digital
-MRA magnetic resonance angiogram (map of arteries)
-digital subtraction angiography: contrast injected through vessels
