Peripheral Vascular disease

Question 1

PAD and PVD are…

Answer 1

Circulatory diseases

Question 2

PAD

Answer 2

only the arteries are affected

Question 3

PVD patho

Answer 3

• affects lower extremes (PVD)
• athero occurs, fills with lipid macrophages in venous walls - plaques - tissue ischemia
• dec mobility, pain, and dec perfusion

Question 4

Risks for PVD

Answer 4

SMOKE, uncontrolled DM, inc chol, HD, stroke, age 50+

Question 5

etiologies for PVD

Answer 5

• ATHERO
• thrombus
• thromboangiitis obliterans (inflam)
• permanent occlusion of peripheral arteries
• vasospasm–Raynaud’s or autoimmune

Question 6

CM of PVD

Answer 6

• pain in calf or buttock
• numb/burn
• heaviness
• intermittent claudication
• trophic skin chx (shiny skin, thick nails, lose leg hair)
• dec pulse
• pallor, cyanosis
• reactive hyperemia when legs hang and dependent edema
• dec sensation in extremities
• erectile dysfunction

Question 7

Intermittent claudication

Answer 7

consistent pain with exercise, stops at rest, depends on where plaque is built and collateral circ

Question 8

PAD sx

Answer 8

• often femoral artery, athero, lack circ
• IC pain
• dec pulse
• cool leg
• leg pallor
• lose foot sensation
• ischemia of LL–cell hypoxia

Question 9

5 Ps of PAD

Answer 9

• paresthesia
• pain (IC)
• pulselessness
• palpable coolness
• paresis

Question 10

PVD dx

Answer 10

• ankle-brachial index
• compare BP in leg and arm
• ankle ratio is greater than brachial
• severe PAD index; ABI = 0.5

Question 11

Chronic venous insufficiency

Answer 11

ventricular wall and/or valves no worky
- blood pools in veins - stasis
- 40 of the U.S.??
- chronic

Question 12

CVI CM

Answer 12

• edema, achy and tired legs, leathery, stasis ulcers, flake/itch, varicose veins

Question 13

nonpharm tx for peripheral vascular disease

Answer 13

• smoke cessation
• inc PA
• dec wt
• dec stress to dec inflam
• control DM and HTN
• if thrombus, balloon shunt
• if chronic, stent

Question 14

Pharm tx for vascular diseases

Answer 14

• antiplt
• anticoag
• thrombolytics
• lipid decreasing agents
• agents that inc blood to extension

Question 15

What are valves made of?

Answer 15

Leaflets; tri, pulm, and aortic have 3, bi have 2

Question 16

AV nodes

Answer 16

bi and tri

Question 17

Ventricular valves

Answer 17

atrial and pulmonic

Question 18

Which valves open with systole and close with diastole if the atria

Answer 18

tri and bi

Question 19

How can valves get damaged

Answer 19

• wear and tear
• calcium deposits (calcification)
• problem with the pannus (leaf not close/open well)
• endocarditis - valve infx
• clot formation (thrombus)
• AV valves –papillary muscle

Question 20

What happens when leaflets are damaged?

Answer 20

Can’t close and open all the way

Question 21

Aortic stenosis

Answer 21

Leaflets are too tight and hard to get blood thru
- most common
- no sx until severe
syncope, lightheaded, chest pain
- can also get SOB and pulm edema
- blood does not leave the heart so coronary vessels lack BF

Question 22

Mitral regurg

Answer 22

• fatigue and SOB
• blood backs up to the left atrium so lack oxy blood supply
• valve is loose

Question 23

aortic stenosis and mitral regurg are both probs of the…

Answer 23

Left side

Question 24

dx and tx for valve diseases

Answer 24

• dx with ECHO (transthoracic or transeso)
• tx with valve replace often bc meds not great

Question 25

Common cause of valve probs

Answer 25

genetics or childhood diseases - endothelial diseases

Question 26

Infective endocarditis

Answer 26

Infx of the valves that cause vegetations on the valves that can become septic emboli if broken off

Question 27

Which valve is most often affected by infective endocarditis?

Answer 27

Tricuspid bc it is the first valve blood goes thru and can lead to a PE

Question 28

Where will a vegetation from the mitral valve go?

Answer 28

brain, coronary artery

Question 29

Risks for infective endocarditis

Answer 29

prosthetic, pacemaker (wires with bac), IVDU with contaminated needle (esp tricuspid valve)

Question 30

NC for prosthetic valves

Answer 30

Take prophylactic abx before a dental procedure to dec risk of infx

Question 31

Sx of infective endocarditis

Answer 31

VERY SICK - fever, chills, anorexia, wt loss, myalgia, arthralgia, heart murmur (may not hear) - many diff based on where vegetations are incl neuro meningitis, sz, enceph, brain abscesses

Question 32

Often the first CM of infective endocarditis?

Answer 32

signs of ischemia or infarction of the extremities, spleen, kidney, bowel, or brain based on where vegetations are

Question 33

Septic emboli

Answer 33

microorgs to heart, adhere to damaged endothelial tissue and attracts WBCs and plts, release cytokines and coag factors

Question 34

Septic emboli

Answer 34

- microorganisms trigger the coag cascade to make fibrin deposits that develop into vegetations - veg often on leaflets and break into circ - carried by blood and cause ischemia and infx in remote tissue

Question 35

CM of septic emboli

Answer 35

petechiae, splinter hemorrhages, Janeway lesions, osler nodes, Roth spots

Question 36

Tx for infective endocarditis

Answer 36

- replace valves - often ppl with rheumatic HD need replacement - if blood infx often 24h abx pre-surg

Question 37

What brings ppl with heart failure to the hospital?

Answer 37

need for diuretics; heart can't maintain oncotic pressure

Question 38

First line rate control drugs

Answer 38

Beta blockers