Flashcards in Arterial Disease of the Limbs Deck (57)
What is intermittent claudication?
Cramp like pain in the muscles of the buttock, thigh and calf which occurs on exercise and is relieved by rest
What is critical limb ischaemia?
A more severe disease than intermittent claudication
Rest pain, ulceration and gangrene which starts peripherally and moves centrally
What are the potential causes of peripheral arterial disease?
Less common vasculitis e.g. Beurger's disease, hyperhomocysteinaemia, thromboangiitis obliterans
How is peripheral arterial disease diagnosed?
Ankle brachial pressure index (ABPI)
What investigations are needed if surgery or angioplasty is planned to treat peripheral arterial disease?
What is the prevalence of intermittent claudication in patients > 55 years?
What percentage of people with intermittent claudication require intervention to prevent limb loss?
What percentage of people with intermittent claudication require amputation?
1% per year
What are the important aspects to consider in amputation/treatment of perisperhal vascular disease?
Quality of life
What is the reduction in functional capacity in people with intermittent claudication compared to a healthy population?
50% reduced functional capacity
What are the risk factors of peripheral arterial disease?
Lack of exercise
What drugs can be prescribed for peripheral arterial disease prevention/secondary prevention?
What is the single most powerful risk factor associated with the aetiology and clinical progression of peripheral arterial disease?
Within how long does the excess risk of cardiovascular disease diminish following smoking cessation?
What should be screened for in peripheral arterial disease? Why?
10% of those attending clinic will have undiagnosed diabetes
What effect does diabetes have on peripheral arterial disease?
Associated with more severe peripheral arterial disease
What will tight glycaemic control help the prevention of in peripheral arterial disease?
What will tight blood pressure control lead to in peripheral arterial disease?
Reduction in macrovascular complications and mortality rates
When is lipid lowering therapy with a statin recommended (according to SIGN)?
For patients with peripheral arterial disease and total cholesterol > 3.5 mmol/l
What do statins decrease the 5 year incidence of?
Major coronary events, coronary revascularisation and stroke by 1/5th per mmol/l reduction in LDL cholesterol
What are the kinds of statins?
How do statins work?
Inhibit platelet activation, thrombosis, plaque rupture, inflammatory activation and endothelial activation
According to SIGN, what is the current BP target for hypertensive patients with peripheral arterial disease?
According to SIGN/TASC II, what patients with peripheral arterial disease should be prescribed anti-platelet therapy?
What measures can be taken in the secondary prevention of peripheral arterial disease?
Anti-platelet therapy with aspirin (or clopidogrel 2nd line)
Screen for diabetes
Diabetics achieve HbA1C < 7% and reassess at 3-6 months for exercise and PTA
BP control, to < 140/85 mmHg
What can be done for the symptom improvement of peripheral arterial disease?
After an acute MI, what is the reduction in mortality caused by cardiovascular rehabilitation?
What does exercise in peripheral arterial disease improve?
What is severe limb ischaemia?
Rest pain in more than 2 weeks per year
ABPI < 0.5