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clin med cardio - cardiomyopathy in ekg slides) > PAD > Flashcards

PAD Flashcards

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1
Q

Peripheral arterial disease is a condition which is characterized by _____ stenosis or _________

A

Artherosclerotic or occlusion in peripheral arteries

Which causes narrowing and decreased blood supply

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2
Q

PAD coexists with

A

Coronary artery disease (MI)
Stroke (CVA]
A fib

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3
Q

Most common cause of pad is _____

A

Atherosclerosis

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4
Q

PAD MOST COMMON LOCATION

A

femoral and popliteal arteries are most common location for PAD

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5
Q

PAD RISK FACTORS

A
  • Cigarette smoking (vasoconstrictor) most modifiable risk factor
  • Diabetes mellitus (increases the risk of ischemia)
    Family history of atherosclerosis
  • Sedentary lifestyle
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6
Q

Classification of PAD

A

asymptomatic pad,
Chronic symptomatic - claudication and atypical lower extremity pain ( pain when moving or with exercise)
Critical limb threatening ischemia
Acute limb ischemia

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7
Q

Presentation of symptomatic pad

A

Claudication, pain, or cramping during exercise which occurs distal to site of occlusion (if popliteal artery occlusion, then pain will be located in the calf)

Atypical pain, like pain with exercise and then relief at rest pattern
- 1 block, pain
- 2 blocks, there is now pain

Atypical pain there is random bursts of pain, not consistent with routine

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8
Q

Sign that peripheral arterial disease is worsening includes ?

A

Resting leg pain, worse when laying at night, burning

Improves with dangling feet off bed, or standing

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9
Q

Critical limb ischemia is characterized by presence of any of the following greater than 2 weeks

A

Rest pain
Ulcer
Loss of tissue, gangrene

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10
Q

Areas of ischemia progress to _____ and then lastly to ____ in critical limb ischemia

A

Ulcers
Gangrene

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11
Q

Physical exam finding for pad

A

Skin changes include limb is cool to touch, shiny, dry skin, hair loss on the legs
ASSESS FOR PULSE, WILL BE DECREASED OR WEAK AT SITE THAT IS DISTAL TO THE OCCLUSION

NEURO EXAM
MUSCLE ATROPHY DISTAL TO SITE OF OCCLUSION

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12
Q

Positive Berger sign indicates

A

Pad worsening, advanced disease

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13
Q

Berger sign in pad is what?

A

Skin is pale on elevation
Takes greater than 20 seconds for the color to return to feet when patient sits up at edge of table

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14
Q

Most common artery occluded in pad is the _______ artery, will have normal ___ pulse but none distal

A

Superficial femoral artery
Groin

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15
Q

A occlusion of the aortic bifurcation or at the iliac arteries will cause what syndrome ?

A

Leriche syndrome,

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16
Q

What is leriche triad

A

Decrease femoral pulse
Claudication (symptoms occur during exercise in distal area to occlusion) at buttocks or thigh
Erectile dysfunction from occlusion

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17
Q

pt is having pain in the buttocks and hip region and is hav8mg increased erectile dysfunction despite taking viagra, u feel weak femoral pulse what area do u suspect is occluded in your pt?

A

Aortic bifurcation or iliac arteries

This is leriche syndrome

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18
Q

Criteria for pad is ABI <

A

0.9

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19
Q

Ankle brachial index is first line diagnostic test in_____

A

symptomatic pad, or in asymptomatic pad but with a risk factor

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20
Q

If ABI is greater than (>1.3) non compressible vessel (calcified vessel) what should u do next

A

Next would do toe brachial index, because cannot truly assess the range due to calcium build up

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21
Q

Toe brachial index less than <.7 is consistent with ____

A

PAD

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22
Q

What other test beside an ankle branchiak index will u want to perform in a pt ? If Abi is <.9

A

Ultrasound, assess the location and extent of disease,

Also angiography,

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23
Q

1st line treatment for PAD is ____ and what else will u do in confirmed PAD

A

Structured exercise therapy, of 30-45

Risk factor reduction
STOP SMOKING
Improve diabetes
Antiplatelet therapy, aspirin, or plavix, to protect against cardiovascular event, does not treat symptoms

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24
Q

Foot care for pad

A

Keep clean
Avoid heating pad
Avoid compression stocking
If ulcers or gangrene present, means urgent vascular consult

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25
If after 3 months of initial measures and pt has had no improvement treat using a _____ inhibitor such as ___
PDE Inhibitor Cilostazol which is an arterial vasodilator
26
Pt who is candidate for revascularization for pad indications include
Limb threatening ischemia Failure of other pharmacological treatment, Unable to perform exercise Rest pain
27
Revascularization options
Balloon Angioplasty, Atherectomy Amputation last resort if there is gangrene
28
29
A sudden decrease in arterial supply resulting in signs and symptoms of ischemia for <2 weeks in duration, this is _______
EMERGENT
30
Causes of acute limb ishcmeia
Embolism MC FROM A FIB THROMBOTIC , rupture of plaque Trauma to an artery, crush injury
31
32
When assessing acute limb ischemia what exam should be performed
Neurological exam
33
Clinical manifestation of acute limb ischemia
Pain Pallor Perishingly cold Pulselessness Parenthesis Paralysis
34
Pts u suspect have acute limb ischemia need evaluation by a ____ specialist
Vascular
35
First initial test in acute limb ischemia
Handheld Doppler to assess for dorsalis pedis and popliteal tibialis
36
Loss of arterial and venous pulse on Doppler indicates what Rutherford classification and what does this signify
Classification 3 and indicates, amputation, very severe
37
Imaging for acute limb ischemia
Ct angiography Assess for occlusion
38
In acute limb ischemia, Complete arterial occlusion will lead to irreversible tissue damage within ___ hours
6
39
Acute limb ischemia tx regimen
If thromboembolism Iv unfractionated heparin Catheter thrombolysus Amputation, non viable limb
40
Fibromuscular dysplasia what is it?
Abnormal growth of the lining of tissue of arteries which then lead to arterial stenosis, occlusion and dissection
41
Who is fibromuscular dysplasia often seen in
Young women, 30-50 years More common in those who smoke, or have a family history of fibromuscular dysplasia
42
Fibromuscular dysplasia appears as a secondary cause of ____
Hypertension
43
Think Fibromuscular dysplasia when
If abrupt/sudden hypertension young women , History Tia if has significant rise in serum creatinine after ace and arb, and no significant reduction in blood pressure
44
When arteries are most commonly involved in Fibromuscular dysplasia
Most commonly, the renal arteries are the arteries that are involved in Fibromuscular Then internal carotid arteries
45
Most common signs of Fibromuscular dysplasia
Cerebrovascular (involving internal carotid artery) Headache Pulsatile tinnitus TIA Horner Carotid bruit on exam Renal, renal artery stenosis Hypertension Abdominal bruit Signs of ckd
46
Fibromuscular dysplasia diagnosis by
CTA, PREFERRED,
47
Fibromuscular dysplasia common two types of angiographic appearence
1. Multi focal fmd, most common, angiography reveals string of beads 2. Focal fmd, angiography reveals band like stenosis
48
Treatment for fmd
Non renal= Aspirin, without stent, revascularization
49
Treatment for fmd if multi focal fmd *renal stenosis Tx if focal fmd
Medical therapy (ace or an arb) after revascularization with angioplasty NO STENT Focal fmd. No ace or arb, revascularization , without a stent
50
Thrombosngiitis obliterans most frequent effects who?
Males, and cigarette smoker Strongly associated with tobacco use Higher prevalence among Asian population,
51
Thromboangiitis obliterans occurs why
It is a vaso, occlusive disease, that involves small and medium sized arteries and veins commonly affects distal upper and lower extremities most frequently
52
Triad of thrimboangiitis obliterans
Raynaud phenomena Migratory superficial vein thrombophlebitis Distal extremity ischemia (upper extremity and lower)
53
Thromboangitis obliterans early signs
Distal arteries Tender nodules along veins. Superficial thrombophlebitis Raynaud’s phenomenon
54
Thromboangitis obliterans later on
Ischemia progresses to ulcers and gangrene
55
Diagnosis of thromboobliterans obliterans is _______,
Angiography arteriography
56
What will angio show in thromboangiitis obliterans
Corkscrew collaterals
57
Thromboangitis obliterans imaging/diagnosis
Diagnosis, Doppler is initial imaging Angiography, arteriorgraphy, modality of choice,
58
Treatment for Thromboangitis obliterans is first ______ cessation
Smoking Ca channel blockers for raynauds to protect against the cold Ulcers may require debridement
59
What is thoracic outlet syndrome
Compression of neuro vascular bundle (brachial plexus, subclavian artery, and subclavian vein)
60
Thoracic outlet syndrome signs
Nerve symptoms= pain, weakness, and numbness in the ulnar nerve distribution Vascular symptoms= Arterial, diffuse arm and hand pain, fatigue and ache after exertion Venous, distended veins
61
Thoracic outlet syndrome cause
Extra rib from the 7th vertebrae Hypertrophy of nearby muscles (in athletes) Pancoast tumor
62
3 spaces of compression
1. Scalene triangle 2. Costoclavicular triangel 3. Subcoracoid, space
63
Special test for thoracic outlet syndrome
Addisons test Wrights maneuver
64
If thoracic outlet syndrome due to suspected extra rib u want to do ?
X ray
65
If vascular symptoms from thoracic outlet syndrome want to perform what test (imaging)
Want to perform an ultrasound or angiography
66
Tx for thoracic outlet syndrome
Conservative, involving physical therapy, avoid aggravating positions , ⭐️ Medical, NSAIDS, pain management Surgical decompression, in pt with cervical ribs, or they are refractory to conservative measure
67
Peripheral artery aneurysm definition
Abnormal dilation of peripheral arteries caused by weakening of the arterial wall
68
Most common peripheral artery aneurysm is
Popliteal artery aneurysm
69
Peripheral artery aneurysm more common in ____ then in women
Men
70
High association of popliteal aneurysm with ______
Abdominal aortic aneurysm
71
For peripheral artery aneurysm diagnosis is confirmed via
Imaging
72
Best test peripheral artery aneurysm
Duplex ultrasound
73
Treatment for peripheral artery aneurysm
Screen for abdominal aortic aneurysm and Anticoagulation (Heparin in all patients) Surgical if >2 cm in diamete
74
Peripheral artery aneurysm includes
Femoral and popliteal (MC)
75
If a femoral peripheral aneurysm is present what is one sign
Pulsatile mass in groin
76
Peripheral artery aneurysm signs
Popliteal aneurysm usually a symptomatic knee and limb swelling First symptoms usually due to ischemia ,cold, pale pulse less
77
What is raynaud phenomenon
Exaggerated vasoconstriction in response to cold or to emotional stress
78
Classificaction of raynaud
Primary= idiopathic, no known cause, young women 15-30, attacks are usually symmetrically Secondary , due to underlying disease, rheumatic disease , hypothyroid, frostbite, attacks are asymmetrical, only one side
79
Raynaud phenomenon phases How long does it last for?
Ischemia phase Fingers are white first HYPOXIC phase. Then blue as vessels dilate to keep blood in the tissues Hyperemic phase, red due to repercussion Typically resolves within an hour
80
Diagnostic for raynauds
Primary, clinical, since it is idiopathic Secondary requires additional test
81
What diagnostic test distinguish primary Raynaud from secondary
Capillary nail bed, 1= normal capillary bed 2= abnormal cap bed
82
Treatment for primary Raynaud includes
Keep extremities warm, wear gloves in winter time Smoke cessation [don’t want vasoconstrictuon] Calcium channel blocker, amlodipine, nifedipine, [DILATE)
83
Treatment for secondary raynauds
Consult to rheumatologist and general measure, keep warm, no smoking
84
What symptoms will patients have with raynauds
Numbness, aching, and pins and needles
85
Acrocyanosis vs Raynaud
Persistent cyanosis (not episodic like raynauds) Can affect mainly hands and occasionally,feet, and nippples, Due to coldness Tx is reassurance, nothing else besides avoid cold
86
Pernio what is it
Abnormal reaction to the cold, causing inflammation of small vessels
87
Clinical manifestation of pernio
Pruritis and erythmatous papules 12-24 hours after cold Severe blisters form
88
Tx for pernio is
Calcium channel block, nifedipine Nitroglycerin for blisters Avoid cold
89
If Abi is borderline <.97 and pt is symptomatic, then what test would u want to do next
Want to do exercise treadmill test
90
Pericardial effusion, is accumulation of fluid within ____
Pericardial cavity
91
Two forms of effusion
Transudative, Chf, cirrhosis, Exudative, direct irritation of pericardium due to inflammation, infection,
92
Physical exam for pericardial effusion
Friction rub Diminished heart sounds, due to accumulation of fluid Tachycardia Tachypnea Hepatojugular reflex, pt is 45 degree, jvp rise greater than 3 cm
93
Pericardial effusion what will you be looking for in a chest x ray
Cardiomegaly, water bottle heart
94
Pericardial effusion what will u see on ekg
Low voltage <5 in limb leads <10 mm in other precordial leads
95
What is done in pericardial effusion for symptom relief
Pericardiocentesis, Culture to assess for bacteria
96
In T
97
If ABI <0.9 what will u do next ?
Next will do segmental blood pressure, and pulse volume recording

clin med cardio - cardiomyopathy in ekg slides) (8 decks)

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