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Podiatry Yr1 Clinical Demonstrator Lectures > Vascular Conditions > Flashcards

Vascular Conditions Flashcards

1
Q

Vascular disease can be either?…..

A

Central or Peripheral

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2
Q

Central vascular disease increases the risk of what happening?

A

Myocardial Infarction (MI) / Angina

CCF -Congestive cardiac failure
affects the pumping power of yourheartmuscles
Macro and micro vascular changes

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3
Q

Having Peripheral arterial disease makes you more likely to develop another form of Cardiovascular disease (CVD) such as …..

A

Coronary heart disease
stroke
Myocardial Infarction
Angina

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4
Q

What is atherosclerosis?

A

A disease where plaque builds up in the arteries.

The plaque is made up of fat,
cholesterol, calcium and other substances found in the blood.
* Plaque will harden over time restricting
blood flow.

Atherosclerosis can occur in an artery located anywhere in your body, including your heart, legs, and kidneys. in the blood. Over time, plaque hardens and narrows your arteries.
Peripheral smaller easy to block

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5
Q

Fixed risk factors of Atherosclerosis

A

Gender
Age
Family Hx

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6
Q

Variabe risk factors of Atherosclerosis

A

High LDL (low density lipoprotein)
Smoking
Hypertension
Diabetes

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7
Q

What is a thrombus

A

A blood clot in a vessel and stays there

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8
Q

What is an embolism

A

Is a clot that travels to another part of the body

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9
Q

What is the pathology of atherosclerosis plaque development in injury , eg/ hypertension, hyperlipidaemia

A

1) Injury to endothelium induces it to secrete growth factor or cause platelets to adhere to the site

2) White blood cells, (monocytes) attach to endothelium and may also secrete growth factor , plaque begins to form

3) cells from smooth muscle layer migrate towards lesion

4)The deposits may lose their endothelial covering allowing blood platelets to adhere and secret potent growth factors

5) Alternatively the endothelial may remain in tact but growth factors secreted by smooth muscle and endothelial cells continue to enlarge the plaque

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10
Q

Ischaemia is?

A

Reduced blood flow to tissues and presents in different ways dependant on type/location and severity

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11
Q

Ischamia can result in…….

A

Hypertension
Angina
Myocardial Infarction
peripheral arterial disease

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12
Q

What causes ischaemic pain

A

Restricted blood flow from atherosclerosis, thrombosis, embolism

Insufficient supply of o2 and nutrients to tissues

Demand on muscles = forced anaerobic activity

Anaerobic activity = lactic acid build up = pain

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13
Q

What is hypertension

A

high blood pressure
Bp over 140/90

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14
Q

How is blood pressure calculated

A

Bp = Cardiac output x peripheral resistance

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15
Q

Ideal blood pressure

A

120/80

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16
Q

Why is it important for us to be aware of hypertension?

A

Increased blood pressure increases resistance and turbulent flow facilitating the process of plaque formation

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17
Q

In accordance to NICE Guideline management of Ischaemia is

A

Lifestyle changes eg/ diet
Exrecise pattern
relaxation therapies
alcohol consumpton
caffeine consumption
smoking

*Ace inhibitor -relax endothelial cells
Beta Blockers - slow heart rate
CCB, calcium channel blockers - Calcium = stronger pump, take calium away heart more relaxed
Thiazide Diuretics- increases urine flow

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18
Q

Ischaemic heart disease can lead to ?

A

Myocardial Infarction (heart attack- A bloackage occurs in the artery))
Angina pectoris (lack of o2 to heart - plaque builds up in vessel walls)

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19
Q

Define Angina Pectoris

A

chest pain caused by reduced blood flow to the heart muscles

Symptoms of Coronary Heart Disease
Not usually life-threatening
Warning sign that you are at risk of heart attack or stroke

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20
Q

Symptoms of angina pectoris

A

Pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress

21
Q

Stable Angina

A

Usually comes on predictably after physical exertion or emotional stress.
The pain or discomfort usually goes after you’ve rested or taken medicines for chest pain

22
Q

Unstable Angina

A

Most dangerous
The chest pain happens more easily & unpredictable.
The discomfort is more severe than with stable angina and lasts for longer.
Doesn’t respond to medication or rest

23
Q

Management of Angina pectoris

A

Management depends on severity and other cardiovascular factors
Short acting nitrate drug (GTN spray)
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass graft (CABG)

24
Q

What should you do if you experience chest pain (GTN Spray)

A

*Stop what you’re doing sit down and rest
*If pain persists use 1 spray under your tongue and wait 5 mins
*If pain persists use another spray and wait 5 mins
*If pain still persists ring 999 and unlock the door.

Glyceryl trinitrate – Rectogesic brand - Nitroglycerin causesthe relaxation of vascular smooth muscles, causing arteriolar and venous dilatation.
CABG – graft from great saph vein, replace blocked coronary arteries

25
Q

Myocardial Infarcton (MI)

A

caused by blockage of a coronary artery
producing tissue death

26
Q

Symptoms of MI

A

Chest pain that may feel like pressure, tightness, pain, squeezing or aching.
Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
Cold sweat.
Fatigue.
Heartburn or indigestion.
Lightheadedness or sudden dizziness.
Nausea.
Shortness of breath

27
Q

Why does this affect podiatry

A

Clinical emergencies

Contraindications for some treatments and procedures

indication of potential atherosclerotic disease elsewhere = vigilance required and vascular assessment may be necessary

28
Q

Peripheral Arterial Disease

A

Reduction in blood supply to peripheral tissues
(ISCHAEMIA)
* Same pathology as MI but peripheral arteries
* Extremely common, particularly in the elderly
patients.
* Majority of patients with PAD are undiagnosed
and undertreated

29
Q

Podiatric Implications of PAD

A

Increased risk of foot ulceration
* Reduced inflammatory response
* Impaired wound healing
* Increased risk of anaerobic bacterial infection due to tissue hypoxia
* Systemic antibiotics may be ineffective
* Dystrophic nails prone to onychomycosis

30
Q

Classificaton of lower limb ischaemia

A

Onset
Acute (Ischaemia <14 days)
Acute on chronic (Worsening symptoms and signs <14 days)
Chronic (Ischaemia stable for >14 days)

Severity
Incomplete (Limb not threatened)
Complete (Limb threatened)
Irreversible (Limb non-viable)

31
Q

6 P’s of acute limb ischaemia

A

The 6 P’s
Pulseless
Paraesthesia - abnormal sensation, tingling/pricking (pins and needles)
Paralysis
Perishingly cold
Pallor
Pain

32
Q

When patient is suspected of having acute limb ishaemia

A

When a patient is suspected to have an acutely ischaemic limb URGENT referral to the vascular surgeon is needed or A&E
A few hours can make the difference between death or amputation and complete recovery of limb function

33
Q

signs of chronic limb ischeamia

A

Signs:
Hair loss
Thin, shiny, atrophic, seemingly transparent skin
Crumbly, thickened nails
Reduced temperature
Atrophy of fibro-fatty padding
Loss of pulses
Reduced tissue viability
Previous or current ulceration

34
Q

Clinical signs of Chronic limb ischaemia?

A

Intermittent Claudication
Pain on exercise, relieved by rest
Cramp-like pain in the calf (can be thigh/buttock)
Claudication distance is of great diagnostic

Ischaemic Rest Pain
As above but worse
Typically worse at night in bed

35
Q

Stages of chronic Ischaemia

A

Stage I
Asymptomatic
Stage II
Intermittent claudication
Stage III
Ischaemic rest pain
Stage IV
Ulceration or gangrene, or both

36
Q

Critical Limb ischaemia

A

It can be clinically defined in three ways:
Ischaemic rest pain for greater than 2 weeks duration
Presence of ischaemic lesionsor gangrene
ABPI less than 0.5

This should be treated as a clinical emergency requiring URGENT referral to the vascular surgeon or A&E

37
Q

Gangrene

A

Gangreneis a condition that occurs when body tissue dies. It is caused by a loss of blood supply due to an underlying illness,

(localised and extensive gangrene)

38
Q

Edinburgh Claudicaton questonaire

A

Do you get any pain or discomfort in your legs when you walk? (YES)
Does this pain ever occur when you are standing still or sitting? (NO)
Do you get this pain when you walk uphill or hurry? (YES)
Do you get this pain if you walk at an ordinary pace on level ground? ( NO = mild, YES = moderate/severe)
What happens to the pain if you stand still (IT GOES AWAY)
Does the pain disappear within 10 mins or less when you stand still? (YES)
Where do you get the pain or discomfort? (pt to indicate on diagram)
Claudication indicated when questions above are answered as illustrated

39
Q

Stages of Interittent claidicataion pa

A

Intermittent claudication
Rest pain
Ulceration
Gangrene/ tissue necrosis
Amputation

40
Q
A
41
Q

How do we assess pad

A

History and observations
hands on vascular assessment
Doppler ultrasound
ABPI
TBPI

(pulses are ether palpable or they are not. If not further assessment needs to be arranged

42
Q

Doppler Ultrasound- Non-invasive vascular assessment
Interpretation of sounds

A

Triphasic -healthy - sound has 3 parts
Bi-phasic - vessel has become less elastic. part of normal physiology of ageing or due to stenosis - sound has 2 parts
Monophasic- Diseased vessel- sound has a single component (whooshy)

43
Q

Ankle Brachial Pressure

A

Ankle systolic blood pressure
Brachial systolic blood pressure

An ankle brachial pressure index (ABPI) is a simple non-invasive method of identifying arterial insufficiency within a limb.It compares the ankle and brachial systolic blood pressures.

44
Q

Interpreting results of ankle brachial pressure

A

above 1.3 - calcification
>0.8 < 1.3 - normal
>0.5 >0.8 - moderate PAD / intermittent claudication
>0.5 - Sever PAD / rest pain and possible tissue loss

45
Q

What is the name for plaque formation in the arteries?

A

Atherosclerosis

46
Q

When conducting an ABPI, what do the results 0.5-0.8 signify?

A

Intermittent Claudication

47
Q

Name the 6 P’s

A

Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishingly Cold

48
Q

What constitutes Hypertension?

A

BP over 140/90

49
Q

What is a the difference between thrombus and embolism?

A

A thrombus is a blood clot in a vessel and stays there, an embolism moves to a different part of the body

Podiatry Yr1 Clinical Demonstrator Lectures (5 decks)

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