Week 6 - Peripheral Arterial Disease

Question 1

What generally occurs in PAD? (2)

Answer 1

• arteries become narrower and build up with plaque
• diseased vessels, so impaired to no perfusion

Question 2

What is claudication?

Answer 2

pain in your thigh, calf, or buttocks that happens when you walk a certain distance

Question 3

What occurs in Stage 1 of PAD? (4)

Answer 3

• asymptomatic
• no claudication
• Bruit or aneurysm may be present
• Pedal pulses are decreased or absent
  so decreased perfusion to lower extremities

Question 4

What occurs in stage 2 of PAD? (4)

Answer 4

• claudication (pain w/ walking - calves using that O2 but not getting enough)
• Muscle pain, cramping, burning occurs with exercise
• relieved with rest
• symptoms are reproducible with exercise

Question 5

What occurs in stage 3 of PAD? (5)

Answer 5

• Rest Pain
• Pain while resting commonly awakens the patient at night
• numbing, burning, toothache type pain
• usually in distal part of extremity
• relieved by placing extremity in dependent position (gravity)

Question 6

What occurs in stage 4 of PAD? (3)

Answer 6

• Necrosis/gangrene
• ulcers and blacked tissue occur on the toes, forefoot, heel
• Distinctive gangrenous colour
  so perfusion stops altogether

Question 7

What are PAD clinical manifestations? (8)

Answer 7

• Loss of hair on lower calf/ankle/foot
• Dry, scaly/dusky pale or mottled skin (spotty)
• Thickened toenails
• Decreased or absent pulses
• Pain at rest, leads to (worsening) at night (stage 3?)
• Cold and cyanotic or darkened skin*
• Muscle atrophy in chronic cases (stage 4?)
• Ulcers to toes, metatarsal heads, heels, and lateral ankle*

Question 8

What occurs in PAD when there is cold and cyanotic or darkened skin? (2)

Answer 8

• pallor with elevation
• dependent rubour when lowered
  necrotic bc tissue dies

Question 9

What do ulcers to toes, metatarsal heads, heels, and lateral ankle look like? (3)

Answer 9

• pale ischemic base
• well-defined edges
• no bleeding

Question 10

What are complications with PAD? (2)

Answer 10

• infection, gangrene
• Delayed/non-delayed healing, amputations

Question 11

The diagnosis for PAD is the ankle brachial index. What is the formula? (2)

Answer 11

ABI = Ankle pressure/Brachial pressure
- Normal = 1.00-1.40

Question 12

What values classify PAD severity? (3)

Answer 12

Mild: 0.9-0.71
Moderate: 0.71-0.41
Severe: < or = 0.40