Vascular Disease Flashcards
What population is at risk for peripheral artery disease & of that population, who is affected the most /symptomatic?
Mostly Older adults >50 years old
50% are asymptomatic
* leading cause of disability in people over 50 & diabetic patients
What occluded arteries are affected by acute limb ischemia?
Lower extremities: Femoral, popliteal, tibial arteries
→ aortailiac artery
Upper extremities: brachiocephalic arteries
What are the primary risk factors for PAD?
# 1 - smoking •age • diabetes • hyperlipidemia • hypertension: cause & effect relationship between PAD & HTN Disease of any artery or vessel → disease in peripheral arteries - CAD - Cerebrovascular disease
What is the most common cause of PAD & what does it involve?
Atherosclerosis
- development of fibro-fatty mural plaques (endothelial surface of blood vessels)
- Gradual build up that causes artery to become occluded and/or weakened
What are fibro-fatty mural plaques?
Conglomeration of fibrin & lipids that builds up in the endothelial surfaces of arteries
What are two secondary causes/types of PAD?
- Collagen vascular diseases (rheumatalogic)
- diseases that include vessels/arteries - Arteritis
- inflammation of the arteries, disease is limited to the arteries
What are the collagen vascular diseases that can cause PAD & why?
- Rheumatoid arthritis
- systemic lupus ertythematosis
- polyarteritis nodosa
- rheumatalogic diseases = auto immune diseases that often attack the blood vessels
What are the 3 types of arteritis?
- Takayasu’s arteritis
- Buerger’s disease
- Raynaud’s disease
What blood vessels does Takayasu’s arteritis involve & what population is most affected?
Chronic inflammatory
→ large vessel disease of the aorta & its large branches
→ presents w pulseless upper extremity (pulseless disease)
Predominantly affects young women ages 20-30
- no involvement of smaller arteries or capillaries
What arteries are involved in buerger’s disease & what are the most significant risk factors?
Segmental inflammatory vaso-occlusive disease of the small & medium arteries
- one segment (length of artery) is affected → next artery link is unaffected → next segment of artery is affected
Aka- thromboangitis obliterates
Main risk factors:
- heavy tobacco use
- male gender
What arteries are affected by Raynaud’s disease & what are the 3 stages characterized by?
Symmetrical involvement of small to very small vessels
- Vasospastic → well demarcated ischemia to fingers and toes
- Hypoperfusion accompanied by pain in fingers & toes
PE finding: pallor - Hypoxemia resulting in build up of metabolic acids such as CO2 in fingers & toes
PE finding: cyanosis - Reperfusion: spasm of vessels relieves excessive rush of blood flow into area
Symptom; Hyperemia
- painful due to metabolic acids & CO2 flowing out into blood
What are the most common signs & symptoms of chronic peripheral arterial insufficiency?
- intermittent claudication→ progression to intermittent ischemic pain at rest
- buttock pain on exertion: involvement of disease in medial circumflex femoral artery, inferior gluteal artery
- parenthesis or weakness in legs
- burning or aching pain in feet/toes at rest
- skin changes
- diminished to absent pulses
- muscle atrophy
What symptoms are concerning for increasing severity of PAD and why?
intermittent ischemic pain at rest d/t poor blood supply in legs
- body is dependent on gravity to pull blood down to legs
- Pain now occurs with elevation of legs
- Improvement of pain with standing
What exam finding is suggestive of an embolus?
Sudden loss of a strong pulse in lower extremity
→ disappearance of pulse due to lodging of an embolus, artheroma, thrombo embolus into a small vessel in periphery
What physical exam findings indicate peripheral artery insufficiency?
- delayed capillary refill
- hyperpigmentation: patches of light or dark skin
- onychauxis; thick nails
- coldness
- color changes: pallor, cyanosis, mottled
- hair loss in legs
- petechiae and blisters
- necrosis of skin & fat
