Info-giving: Vascular Diseases Flashcards
(102 cards)
Superficial thrombophlebitis
Varicose veins
How do you explain to a patient what peripheral arterial disease is?
Arteries are the tubes in the body that carry blood away from the heart and to the rest of the body, to deliver oxygen and nutrients. Peripheral arteries are the arteries that are further from the heart, and are located in arms and legs instead.
Peripheral arterial disease is a condition where the arteries to arms and legs are narrowed, reducing blood flow to those areas
How do you explain to a patient the underlying cause of peripheral arterial disease?
Arteries that supply blood to the arms and legs become narrowed, usually due to build up of fatty deposits on the inner lining of the artery. These deposits make it harder for blood to pass through.
As less blood travels to the arms and legs, they receive less oxygen and nutrients. The oxygen and nutrients are needed for the muscles, skin and other parts in the arms and legs to stay healthy.
Lack of oxygen n to these areas is what causes your signs and symptoms
How do you explain to a patient the risk factors for developing peripheral arterial disease? SMASH
These are the risk factors that can cause you to develop peripheral arterial disease?
S: Smoking
M: Metabolic conditions such as diabetes, high cholesterol, chronic kidney disease, heart diseases, high blood pressure
A: Age over 60, atherothrombosis
S: Stress
H: Hypothyroidism
How do you explain to a patient the symptoms of the claudication stage (stage II, Fontaine classification) of peripheral arterial disease?
Intermittent claudication: Pain in the legs due to peripheral arterial disease, that comes with activity and relieves with rest
Cramping/throbbing/burning pain in calf/thighs/buttocks
Pain occurs when doing an activity such as walking
Pain is relieved by resting legs, usually takes less then 10 minutes for pain to completely disappear
How to do you explain to a patient the symptoms of the asymptomatic stage (stage I, Fontaine classification) of peripheral arterial disease?
Patient has peripheral arterial disease but is not yet experiencing any symptoms
This is because even though the arteries in the arms and legs are narrowed, they are still wide enough for enough blood to reach these areas during any activities that you do
How do you explain to a patient how their intermittent claudication can further be classified, if they have stage 2 PAD?
Intermittent claudication is described as one of two types: Mild or moderate-severe claudication
Mild claudication: Cramping pain in legs occurs after walking more than 200 metres
Moderate-severe claudication: Cramping pain in legs occurs after walking less than 200 metres
How do you explain to a patient the symptoms of the rest pain stage (stage III, Fontaine classification) of peripheral arterial disease?
Severe, persistent burning pain in the legs, even when the person is not moving
So claudication does not disappear upon rest anymore
These symptoms start to occur when you develop chronic limb-threatening/critical ischaemia: It is a result of structures in the legs being starved of oxygen and nutrients for a long time, due to narrowed arteries
How do you explain to a patient the tissue loss stage (stage IV, Fontaine classification) of peripheral arterial disease?
This occurs when you have had chronic limb-threatening/critical ischaemia for a long time, and you will start to see loss of skin and underlying structures: Mainly in the form of arterial ulcers and gangrene in areas.
How do you explain to a patient what arterial ulcers are?
An open sore in the skin caused by lack of blood flow in the arteries
They occur because lack of oxygen to the arteries causes a break in the skin, then this can extend deeper into the leg until it reaches the bone
How would you explain to a patient how to recognise arterial ulcers, in 4 ways?
Location: They usually form in bony areas and pressure points, such as the outside heel, outer toes and ankle bones
Look: Very defined round shape as if the a hole has been ‘punched out’ in the skin, look deep, have red/yellow/black base colour
Feeling: Very painful, and the pain is better when dangling leg and is worse at night when elevated and rested
Other signs to look for: There can be hair loss around the ulcer area so the skin looks shiny and smooth, nails can also look different
How do you explain to a patient what gangrene is?
Gangrene is when the lack of blood supply has caused the skin and underlying structures to die. It usually starts in fingers and toes, then spreads up arms and legs
Dry gangrene: The part of the limb that is dead but not infected, so looks black/purple/blue and shrivelled/dry
Wet gangrene: The part of the limb that is dead has become infected, so looks wet, swollen and leaks a foul-smelling pus
Gas gangrene: The part of the limb that is dead has become infected with a type of bacteria that produces gas, so when you touch the gangrenous area it makes a cracking/popping sound due to trapped gas
How do you explain to a patient what acute limb ischaemia is?
Acute limb ischaemia is the most serious form of peripheral arterial disease, as it can be life-threatening so needs emergency treatment
ALI is caused by a sudden and large decrease in blood flow to a limb, which can lead to damage in the structures and limb loss (need for amputation)
How do you explain to a patient what the main causes of acute limb ischaemia are?
Usually the sudden decrease in blood flow occurs due to a blood clot that forms in the artery, or a mass eg. Fatty deposit that breaks loose and travels through the blood stream until it gets lodged in the artery
Give 6 examples of cardiac embolic risk factors for acute limb ischaemia?
There are several heart conditions that can cause blood clots or masses to form in the heart, then these can travel to peripheral arteries and cause ALI.
Atrial fibrillation
Heart attack
Infective endocarditis
Valve diseases
Prosthetic heart valves
Atrial myxoma
Give 2 examples of arterial embolic risk factors for acute limb ischaemia?
Atherosclerosis
Aneurysm: Emboli can lodge within peripheral aneurysms and block off blood flow
Give 3 examples of thrombotic risk factors for acute limb ischaemia?
Previous arterial surgeries eg. Bypass grafts, angioplasty, stents can form blood clots
Hyper coagulable state
Entrapment syndrome
How do you explain to a patient the main symptoms of acute limb ischaemia?
Pain: Sudden onset, severe ‘thunder-stroke’, burning/cramping pain that is constant, can be worse at night when lying down
Pallor: Limb looks white pale, cyanotic or mottled
Pulselessness: Ankle pulses are always absent
Poikilothermia: Inability to regulate body temperature so limb is always cold
Paraesthesia: Reduced sensation or numbness in limb
Paralysis or motor loss
How do you explain to a patient how peripheral arterial disease is diagnosed?
Initially they will have physical examinations and the blood pressure measured in their ankles and arms using a type of ultrasound scan, and an ECG to monitor heart activity
They will also have blood tests to find risk factors like high cholesterol, diabetes and to check the health of the structures in the limbs, as these can release certain substances if damaged
They can also have specialist imaging of their heart and arteries, to identify any emboli or thrombi
How do you explain to a patient how vascular conditions are treated?
There are 2 mainstays of treatment:
- Lifestyle changes
- Management of risk factors by medications: Aspirin, statin/ezetimibe, metformin/SSGLT2I, blood pressure medications
How do you explain to a patient what lifestyle changes are recommended to treat vascular conditions?
Stop smoking
Changing diet: Eat more fruit and vegetables, whole grain foods, protein with less fat like skinless chicken breast, healthy fats like olive oil and eat less salty foods
Exercise: Use ‘stop-start’ method, where you walk until pain becomes intolerable, then rest and repeat until you have done 30 min walking in total. Can also join supervised vascular exercise classes
Which medications are used to treat high cholesterol, in vascular conditions?
Statin
Ezetimibe
How do you explain to a patient what a statin is, and how it can treat vascular conditions?
A statin is a drug that lowers the level of a type of cholesterol in your bloodstream, called low-density lipoprotein.
Low density lipoprotein is classed as ‘bad cholesterol’ as it can build up in blood vessels and form plaques, which can break off and cause blood flow restrictions in other arteries. A statin reduces LDL levels, so it is less likely that plaques will form.
Atorvastatin, simvastatin
What are the main side effects of statins?
Muscle pain, weakness or cramping
Constipation or diarrhoea
Headaches
Sleep problems and fatigue
