Week 7: Cardio/Peripheral Vascular Flashcards
What would symptoms or peripheral artery disease include? 6)
- Pain or swelling in the legs or arms
- Discoloration
- Pain/Cramping at rest or exertion
- Cold, numbness, pallor
- Hair loss
- Abdominal, flank or back pain (relates to perfusion of the organs)
What is claudication? What are the types of claudication? What do they indicate?
- Claudication: pain caused by too little blood flow to muscles during activity
- Exertional claudication: Pain in the legs during exertion that is relieved within 10 minutes of rest
- Neurogenic claudication: pain with walking or prolonged standing radiating from the spinal area into the buttocks, thighs, lower legs or feet
What symptoms and exam findings would you expect in peripheral arterial disease? (10)
- exertional claudication
- atypical leg pain
- local fatigue
- numbness
- cool dry hairless skin
- trophic nail changes
- diminished to absent pulses
- pallor with elevation
- ulceration
- gangrene
What symptoms and exam findings would you expect in DVT? (2)
- painful or painless calf swelling with erythema
- asymmetric calf diameters
What symptoms and exam findings would you expect in thrombophlebitis? (2)
- swelling
- redness and warmth with a possible subcutaneous cord
What symptoms and exam findings would you expect in cellulitis? (4)
- erythema
- edema and warmth
- involves deeper dermis, adipose tissue
- may include enlarged, tender lymph nodes and fever
What symptoms and exam findings would you expect in lymphangitis? (4)
- infection spreads up the lymphatic channels from a distal portal of entry
- red streaks on the skin with tenderness
- enlarged, tender lymph nodes
- fever
What symptoms and exam findings would you expect in compartment syndrome? (5)
- tight bursting pain in calf muscles, usually in anterior tibial compartment
- overlying dusky red skin
- tingling, burning sensations in calf
- muscles may feel tight or full
- numbness, paralysis if unrelieved
What symptoms and exam findings would you expect in Buerger disease (thromboangiitis obliterans)? (3)
- digit or toe pain progressing to ischemic ulcerations
- gangrene at the tips of digits
- migratory phlebitis and tender nodules along blood vessels
What symptoms and exam findings would you expect in Raynaud disease?
- reversible vasoconstriction in the fingers and toes
- distinct digital color changes of pallor, cyanosis and hyperemia; if secondary - ischemia, necrosis and loss of digits, capillary loops distorted
What is the Allen test? What does a positive test indicate?
- Compares patency of the ulnar and radial arteries
- Technique
- Make a tight fist with one hand then compress both radial and ulnar arteries firmly between thumbs and fingers
- Ask patient to open hand into a relaxed, slightly flexed position - palm should be pale
- Release pressure over the ulnar artery
- Results: palm should flush within 3-5 seconds which indicates a patent ulnar artery
- Release radial artery while compressing ulnar artery
- Results: palm should flush within 3-5 seconds which indicates a patent radial artery
What are the American Heart Association Cardiovascular Categories for Women?
- High Risk
- ≥1 of the high-risk states, including existing CHD, CVD, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or end-stage or chronic renal disease
- 10-year predicted risk of >10%
- At Risk
- ≥1 major risk factors including smoking, blood pressure ≥120/≥80 or treated hypertension, total cholesterol ≥200 mg/dL, HDL-c <50 mg/dL, or treated dyslipidemia, obesity, poor diet, physical inactivity, or family history of premature CVD
- Evidence of advanced subclinical atherosclerosis (e.g., coronary calcification, carotid plaque, intima-media thickness), metabolic syndrome, or poor exer-cise capacity on a treadmill test
- Systemic autoimmune collagen vascular disease (e.g., lupus or rheumatoid arthritis)
- History or preeclampsia, gestational diabetes, or pregnancy-induced hyper-tension
What are the values that fall under the stages of hypertension? Normal, elevated, stage 1, stage 2, hypertensive crisis
Normal: Less than 120/80 mm Hg
Elevated: Systolic between 120-129 and diastolic less than 80
Stage 1: Systolic between 130-139 or diastolic between 80-89
Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
What type of cardiac screening do athletes require?
H&P, no imaging unless risk factors or physical exam abnormalities
Sports physicals - questions to ask regarding personal history (6)
- Chest pain
- Exercise intolerance
- Lightheadedness?
- Birth history
- Previous identified murmur
- Congenital heart defects
Sports physicals - questions to ask regarding family history (3)
- History of sudden cardiac death?
- Sudden cardiac death before the age of 50?
- Heart disease identified before the age of 50?