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2a Cardio > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

1
Q

What is peripheral vascular disease (PVD) also known as?

A

Peripheral artery disease (PAD)

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2
Q

What is PVD?

A

A circulatory condition that occurs when there is a narrowing/blockage of blood vessels outside the heart, most commonly the arteries of the legs

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3
Q

What causes PVD?

A

Mostly atherosclerosis within the arteries of the lower limbs

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4
Q

What are the main risk factors for PVD?

A

Smoking
Diabetes
Hypertension
High cholesterol
Age
Obesity
CKD

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5
Q

What are symptoms of peripheral vascular disease?

A

Intermittent claudication (pain on exertion)
Critical limb ischaemia (big occlusion, barely adequate supply to meet metabolic demand. Pain at rest)

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6
Q

With critical limb ischaemia (has pain at rest), there is increased risk of what?

A

Gangrene / infection

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7
Q

What is acute limb ischemia?

A

Total occlusion of vessel due to thrombotic or embolic formation at site of critical limb ischemia lesion.

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8
Q

What are the 6 Ps of acute limb ischaemia?

A

Pulselessness
Pallor
Pain
Perishingly cold
Paralysis
Paraesthesia

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9
Q

If you have all 6 Ps of acute limb ischaemia then it is an _____

A

emergency

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10
Q

There is irreversible nerve damage within _ hours of blood vessel supplying the region being occluded

A

6

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11
Q

Where is irreversible muscle damage in _-__ hours when a blood vessel is occluded in PAD

A

6-10

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12
Q

What is ABPI?

A

Ankle-brachial pressure index

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13
Q

What happens to the ABPI in PVD?

A

Is less than 0.9 as lack of perfusion to lower limb compared to upper limb

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14
Q

What happens to the skin in PVD?

A

Becomes cooler, colour changes and ulcerations

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15
Q

What are bruits?

A

Pulsatile regions due to turbulent blood flow

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16
Q

True or false: bruits are a symptom of PVD

A

True

17
Q

What is the Buerger-Allen test?

A

Examiner occludes both radial and ulnar arteries by firmly pressing on them, patient makes tight fist. One of the arteries is released and patient relaxes hand.
Should see return of colour within a few seconds.
Repeat for the other artery.

18
Q

What is the Buerger-Allen test result in PVD?

A

Clear reduction in foot perfusion (legs are elevated at 45 degrees for 1 minute)

19
Q

What is the classification for PVD?

A

Fontaine classification, stages 1-4

20
Q

What is stage 1 of Fontaine classification (PAD)?

A

Asymptomatic

21
Q

What is stage 2 of Fontaine classification?

A

Intermittent claudication.
2a = Over 200m of pain free walking
2b = Under 200m pain free walking

22
Q

What is stage 3 of Fontaine classification?

A

Chronic limb ischaemia (pain at rest)

23
Q

What is stage 4 of Fontaine classification?

A

Ischaemic ulcers leading to gangrene

24
Q

How is PVD diagnosed?

A

ABPI (comparing blood in posterior and anterior tibial artery to brachial artery with a doppler ultrasound)

Colour duplex ultrasound (assess degree of stenosis)

If surgery considered then CT angiography

25
Q

What is the ABPI range for intermittent claudication?

A

0.5-0.9

26
Q

What is a normal ABPI?

A

0.9-1.3

27
Q

What is the ABPI in critical chronic limb ischaemia?

A

Less than 0.5
Risk of acute limb threatening ischaemia

28
Q

What is treatment for intermittent claudication?

A

Risk factor management:
Smoking cessation
Decrease BMI
Statins
Antiplatelet (aspirin and clopidogrel)
T2DM drugs

29
Q

What is treatment for chronic limb ischaemia?

A

Revascularisation surgery (PCI if small, bypass if longer)

Amputation if severe

30
Q

What is treatment for acute limb threatening ischaemia?

A

Surgical emergency: Revascularisation within 4-6 hours otherwise increased amputation risk

31
Q

What are complications of PVD?

A

Amputation
Permanent limb weakness
Rhabdomyolysis (Ca and K released into blood: AKI and arrhythmias)
Risk of cerebrovascular accidents and CVD

2a Cardio (36 decks)

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