Miller Peripheral Vascular Disease Flashcards
(20 cards)
Major risks for PAD?
- htn
- hyperlipidemia
- low HDL
- high LDL
- DM
- CKD
- Cigarette smoking
“Big picture” of atherosclerosis?
- LDL cholesterol excess
- inflammation
- endothelial dysfunction
- continued accumulation
What are the symptoms of intermittent claudication?
- Fatigue
- discomfort
- cramping
- pain in muscles
What is intermittent claudication the hallmark of?
Chronic ischemia in PAD
What are the symptoms of acute arterial occlusin?
- cold painful and pale extremity with diminished absent/pulses
- weakness
- impaired sensation
-
6 P’s
- Poikilothermia
- pain
- pallor
- pulsellessness
- paralysis
- paresthesia
How long does skeletal muscle tolerate ischemia?
4-6 hours
How will a leg of a person with PAD chronic ischemia look?
- shiny skin with no hair and muscle atrophy
- can have non healing wound or gangrene
What is the first step in the diagnosis of PAD?
- ABI
- systolic bp at brachial artery and ratio of highest systolic pressure in each leg
- >0.9 is good
- <0.9 bad
If an ABI is abnormal what is the next step?
- Arterial US
- CT angiography
- Angiography
How do you treat chronic ischemia seen in PAD?
- exercise
- antiplatelet therapy
- aspirin or clopidogrel
- statin
- ACEI or ARB for those with htn
For patients with lifestyle limiting claudication, what treatment is the next step?
- Revascularization
- angioplasty/stent
- endarterectomy
- bypass grafting
Complications of PAD?
- Critical limb ischemia
- hanging limb over side of bed decreases pain
- creates rubor
- elevate feet creates palor
- non healing ulcers
What are the two manifestations of VTE?
- DVT
- PE
Risk factors for VTE?
- Strong (10-50x)
- Major surgery trauma, plaster cast and cancer
- Moderate (2-10x)
- genetics
- acquired such as lifestyle, medications, non hemological conditions
What is Virchows triad?
- Hypercoagulability
- Changes in flow such as stasis and turbulence
- Endothelial dysfunction
How do we prevent VTE?
- Risk for DVT and PE are assessed when patients are hospitalized
- if at risk given anticoagulants or mechanical methods to keep muscles moving
Management of DVT?
- initial treatment of heparin or direct oral anticoagulants is for 5-10 days
- Long term tx is with warfarin for 3-6 months
- Extended treatment is >6 months
Complications of DVT?
- PE
What are signs of post thrombotic syndrome? What does it increase the risk for?
- Leg pain, heaviness, vein dilation, edema, skin pigmentation, and venous ulcers
- Increases risk for recurrent DVT and chronic venous insufficiency
Diagnosis of chronic venous disease?
- Pain, leg heaviness, aching, swelling, skin dryness, rightness, itching, irritation, muscle cramps
- Dilated veins, leg edema, skin induration hyperpigmentation and skin ulceration
- large shallow superficial ulceration
