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CVS > Arterial Disease > Flashcards

Arterial Disease Flashcards

1
Q

What are the two main types of arterial limb disease?

A

intermittent claudication

critical limb ischaemia

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2
Q

When does intermittent claudication occur?

A

on exertion / exercise

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3
Q

When does critical limb ischaemia occur?

A

on rest

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4
Q

What symptoms do people with intermittent claudication have?

A

cramp like muscle pain in the calf, thigh and buttocks

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5
Q

What age range of people tend to have intermittent claudication?

A

> 55 years

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6
Q

What skin and limb problems can result from critical limb ischaemia ?

A

ulceration

gangrene

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7
Q

What changes to arteries does diabetes cause?

A

calcification of the arteries which make them less compliant and therefore the lumen size is smaller

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8
Q

What two causes can cause intermittent claudication?

A

atheromatous plaque

diabetes mellitus

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9
Q

Name three uncommon causes for intermittent claudication

A
  • beurgers disease
  • vasculitis
  • hyperhomocysteinaemia
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10
Q

Name three main investigations that should be done for intermittent claudication

A
  • Duplex
  • Magnetic resonance angiogram
  • Ankle Brachial Pressure Index (ABPI) - ankle/brachial pressure (if below 0.4 then prognosis isn’t good)
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11
Q

What does PAD mean in terms of intermittent claudication?

A

peripheral arterial disease

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12
Q

Are patients with PAD at high risk of developing coronary heart disease?

A

yes

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13
Q

What two medications should patients with PAD be prescribed?

A

anti platelets - aspirin or clopidogrel

statins

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14
Q

What are anti platelets used for?

A

to thin the blood and prevent thrombus from forming

decreasing the risk of vessel occlusion

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15
Q

What are statins used for?

A

to reduce the LDLs in the blood and hence reducing the risk of atheromatous plaques from forming
also stabilises the plaque

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16
Q

What three other managements should be done for PAD patients other than medication?

A
  • smoking cessation
  • screen for diabetes/ manage diabetes properly
  • have good control of BP (high BP can result in an embolism)
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17
Q

In what two conditions should the ABPI be measured at?

A
  • during rest

- during stress

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18
Q

For PAD patients, a procedure called PTA is available for some patients. What does this procedure involve?

A

involves using a catheter to increase the diameter of the lumen by inserting a balloon and may include inserting a stent into the vessel to ensure the vessel remains open.

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19
Q

Can exercise therapy be used to improv the symptoms of intermittent claudication patients?

A

yes

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20
Q

How does exercise therapy help intermittent claudication patients?

A

o improves BP, dyslipidaemia, endothelial function
- if each day they walk slightly further then they can improve their symptoms gradually and increase the distance they are able to walk

21
Q

What are the risk factors for PAD?

A
  • smoking
  • hypercholesterolaemia
  • hypertension
  • lack of exercise
  • poor diet
  • diabetes
22
Q

When should angioplasty (PTA) be offered to patients with PAD?

A

If symptoms are bad and cannot be improved through other methods
AND
the occlusion/damage is over a short distance

23
Q

For how long does PTA improve quality of life for?

A

2 years

24
Q

When should surgery be considered for PAD patients?

A
  • extensive disease which isn’t suitable for PTA
  • if PTA/stenting has failed
  • poor quality of life
  • risk factors are well managed
25
Q

Is surgery frequently performed for PAD patients?

A

NO

26
Q

What are the two main types of modern management and give examples for each?

A
  • secondary prevention
    smoking cessation
    control BP and diabetes
    anti platelets and statins
- symptom improvement
exercise therapy 
smoking cessation
Pharmacotherapy
PTA 
surgery
27
Q

What four things does statins inhibit ?

A
  • platelet activation and thrombosis
  • plaque rupturing
  • endothelium dilation
  • inflammatory response
28
Q

What is Dyslipidaemia?

A

abnormal amounts of lipid in the blood

29
Q

What ideal BP should PAD patients have?

A
30
Q

What % of intermittent claudication patients are suitable for PTA?

A

~15%

31
Q

For critical limb ischaemia, does raising the foot increase or decrease the pain for the patient?

A

increase the pain

32
Q

Why does raising the foot increase the pain for the patient?

A
  • there is less blood flow able to get to the tissue in the periphery as gravity is no longer acting to pull the blood down
  • therefore there is more anaerobic respiration and more acid building up in the cells
  • increases the pain in the leg and feet
33
Q

For critical limb ischaemia, would appearance would the feet have if they were raised then lowered again?

A

they would go pale as they were raised as the feet would have less blood flow

they would go bright red as they were lowered again as the collaterals would dilate and fill with blood when lowered.

34
Q

State some methods of secondary prevention for critical limb ischaemia

A
  • smoking cessation
  • control BP
  • control diabetes
  • prescribe anti platelets, ACEI and statins
35
Q

What are the two options if limb ischaemia is severe and the limb needs to be revascularised?

A
  • surgery (fem-pop bypass)

- angioplasty (PTA)

36
Q

If limb ishcaemia is very severe what option is there?

A
  • amputation
37
Q

What is the main complication after surgery for PAD?

A

MI

38
Q

How does angioplasty compare to surgery?

A

PTA

  • less mortality
  • faster recovery time
  • lower reobstruction rate
  • less durable than surgery
39
Q

Where are the four sites where patients are amputated?

A

digital
transmetatarsal
below knee
above knee

40
Q

What is the difference between acute and chronic limb ischaemia?

A

acute limb ischaemia has occurred suddenly so there are no collaterals able to carry the blood flow around the occlusion

41
Q

What is the presentation of acute limb ischaemia ?

6 signs

A 
pain 
pulseless 
paraethesia (pins and needles)
pallor 
paralysis 
perishingly cold
42
Q

What are the two causes of acute limb ischaemia and what are the % of cases?

A
  • embolism (30%)

- in situ thrombosis (60%)

43
Q

Name four other uncommon causes of acute limb ischaemia

A
  • trauma (leg fracture, dislocation, stab wounds, iatrogenic)
  • popliteal aneurysm
  • thoracic dissection
  • intra arterial drug administration
44
Q

What examination would you do to determine the severity of the acute limb ischaemia?
4 things

A
  • peripheral pulses present? including above femoral
  • is sensation or movement restricted or absent in the limb
  • is atrial fibrillation present? (heart related?)
  • how long has it lasted?
45
Q

What are the treatment options for acute limb ischaemia that has been caused by an embolus if the leg is salvageable ?

A
  • if urgent then embolectomy should be performed to remove the embolus
  • if there is time available then thrombolysis should be administered

pain relieve and heparin should also be given

ensure the area of ischaemia has been reperfused

46
Q

What are the treatment options for acute limb ischaemia that has been caused by a thrombosis if the leg is salvageable ?

A

Angiography should be performed to determine the severity of the occlusion

Severity will determine whether 
- thrombolysis 
- PTA 
- by pass 
is required
47
Q

What are the contradictions for thrombolysis ?

A
  • recent haemorrhage
  • recent bleed
  • recent surgery
  • GI bleed
  • recent stroke
  • over 80 years
48
Q

If acute limb ischaemia has been caused by an embolism, how long does the patient have been the leg is unsalvageable?

A

6-8 hours

CVS (20 decks)

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