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196 Cards in this Set

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Describe the conducting system of the heart.
1) Neural impulse starts at the Sinoatrial Node within the right atrium, then to the left atrium, causing both to contract
2) impulse continues to the ventricles via the shared Interventricular Septum (Bundle of His fibres)
3) finally the wave of impulse reaches the Purkinje fibres in the inferior aspects of both ventricles causing them both to contract and squeeze blood out of the heart via the aorta into the systemic circulation.
Explain how right sided heart failure could lead to swelling of the ankles.
In right ventricular failure the right side of the heart cannot deal with the volume of blood returning to the heart. Fluid backs up in the systemic circulation and causes peripheral oedema.
Compare and contrast the structure and function of an artery and a vein.
-
List the 6 signs of acute ischaemia in the foot.
1) Pallor
2) Pulselessness
3) Perishing cold
4) Parasthesia
5) Paralysis
6) Pain
What does each of the "6 Ps" indicating acute ischaemia occur?
1) Pallor - lack of bllod supply to area
2) Pulselessness - reduced blood flow within arteries due to macroangiopathy
3) Perishing cold
4) Parasthesia - ischaemia causes sensory neuropathy, distally first
5) Paralysis - ischaemia causes motor neuropathy, distally first
6) Pain - may be neuropathic pain, intermittent claudication (insufficient supply to working muscles) or rest pain
Ideal position for ABPI? (and why?)
Patient lies supine with legs on same level as the heart.
Avoids false elevation of ankle pressure.
When would you carry out an ABPI?
to establish whether PAD is present
How do you interpret ABPI results?
<0.5 severe ischaemia
0.5-0.7 moderate
0.7-0.9 mild
0.9-1.1 normal
>1.1 calcification
State the signs/symptoms of arterial insufficiency in the lower limb.
Arterial insufficiency:
1) "6 ps"
2) Intermittent Claudication
3) rest pain relieved by putting legs in dependency position
4) delayed healing of lesions
5) no swelling
6) Skin atrophy
7) Ulceration, superficial gangrene
State the signs of venous insufficiency in the lower limb.
Venous insufficiency:
1) oedema
2) pain, moderate-->severe, aching
3) varicosities
4) skin scales and thickens
5) haemosiderosis
6) telangiectases
7) swelling
8) ulceration
9) warm mottled skin
Explain how the presentation of DVT and acute ischaemia would differ.
DVT = venous insufficiency
painful swelling of calf
pain in calf on passive DF
oedema
redness or cyanosis

Ischaemia = arterial insufficiency
no swelling
severe pain, less localised
calf pain on walking (IC)
What are the three main functions of the lymphatic system?
Lymphatic system:
1) Returns escaped tissue fluid back to the circulatory system
2) Transports dietary fats straight from gut to blood (via lacteals)
3) Protects agains pathogen invasion (lymphocytes)
Name two pathways by which ingested fats reach the bloodstream.
Ingested fats may reach the blood stream:
1) via the liver
2) avoiding the liver, from gut lacteals-->thoracic duct-->venous system
What are the component organs/tissues of the lymphatic system, and their functions?
The lymphatic system comprises:
1) Spleen (filters blood)
2) Lymph nodes (filter lymph, make lymphocytes)
3) Thymus gland (gives lymphocytes an antigen marker rendering them "T-cells")
4) Tonsils (produce lymphocytes)
5) Peyer's patches (neutralise antigens)
6) Bone marrow (produces lymphocytes)
Where are Peyer's patches found?
Peyer's patches are found in the small intestine (ileum).
Which organ represents the largest mass of lymphatic tissue in the body?
The spleen is the largest mass of lymphatic tissue in the body.
What would happen if the lymphatic system failed to return escaped tissue fluid to the bloodstream?
If the lymphatic system failed to return the escaped tissue fluid to the bloodstream, body tissues would become waterlogged (oedema), blood volume would fall and the cardiovascular system would fail.
What is the function of Peyer's patches?
Peyer's patches are stretegically placed at the end of the small intestine to neutralise ingested antigens and prevent them from entering the large intestine.
Name the body's two lymphatic ducts.
The two lymphatic ducts are 1) the Right Lymphatic Duct
2) the Thoracic Duct
What is the difference between lymph capillaries and those of the blood vascular system?
Lymph vs blood capillaries:
- Lymph capillaries are blind capillaries
- Lymph capillaries have a larger diameter than blood capillaries
- they have minivalves formed by overlapping endothelial cells, and pressure operated by anchoring fine filaments
Is there any difference between "interstitial fluid" and "lymph"?
No. Once interstitial fluid enters a lymph vessel it is then termed "lymph". The two fluids are identical.
How to lymph veins differ from blood veins?
Lymph veins have thinner walls and more valves than blood veins.
True/false: lymph and blood vascular veins both have tunica intima, media and adventitia?
True: lymph and blood vascular veins have three layers (tunics).
What mechanisms ensure lymph circulation?
The lymphatic system is at low pressure and relise on other means to ensure circulation of lymph.
1) venous pump of skeletal muscles
2) valves to prevent backflow
3) movement of adjacent tissues
4) changes in pressure of the thoracic cavity during breathing
What is the function of lymph nodes?
Lymph nodes filter lymph and produce lymphocytes. This is particularly important because of the minivalve system at capillary level.
How is the heart protected?
The heart is protected by a bag called the pericardium, which has three layers:
1) Visceral Serous layer - immediately next to the heart
2) Visceral Parietal layer - separated from the serous layer by serous fluid
3) Fibrous Pericardium - anchors the heart to the diaphragm
Describe the structure of the heart.
Size of closed fist
Apex(inferior end points towards hip), base(superior end)
Made of cardiac muscle with intercolated discs to increase the speed of transmission along fibres
Three walls - endocardium (endothelium), myocardium (cardiac muscle), epicardium(slippery-reduces friction)/serous pericardium
Four chambers: atria & ventricles
Atriventricular valves, semilunar valves prevent backflow
Left side bigger than right - greater force to pump blood around body.
How many times per minute does the heart beat, on average?
The heart beats approximately 72 BPM.
How many layers do blood capillaries have ?
Capillary walls are one cell thick. They have a single layer of epithelial cells on a basement membrane (basal lamina).
What are the two major types of arteries? Explain their features.
Arteries may be:
1) ELASTIC arteries - arteries that receive blood from the heart
2) DISTRIBUTING arteries - their entire middle layer is smooth muscle, also have additional layers of elastic tissue in their inner and outermost layers
Which vessel layer contains blood vessels supplying the blood vessel itself?
The Tunica Adventitia (outer layer) contains the vasa vasorum.
Give two examples of an elastic artery.
The Ascending Aorta and Coronary Arteries are "elastic" arteries.
Give two examples of a muscular artery.
The Internal Carotid Artery and the Anterior Cerebral Artery are both Muscular Arteries.
Trace the arterial pathway from the heart to the knee.
Starting at the heart, blood leaves the ascending aorta, into the aortic arch and descends as the thoracic then abdominal artery.
2) It splits into the R and L Common Iliac Artery, then into the Internal and External Iliac Arteries
3) the External Iliac Artery passes through the Inguinal Ligament and becomes the Frmoral artery, then Popliteal Artery.
Describe the main structural differences between an artery and a vein.
(draw diagram)
Arteries:
1) blood at high pressure
2) no valves
3) smaller lumen
4) Tunica intima (plus basal lamina), tunica media (mostly smooth muscle) & tunica adventitia (contains vasa vasorum)

Veins:
1) blood at low pressure
2) valves
3) larger lumen
4) tunica intima (no basal lamina), tunica media (less muscle, + elastic fibres), tunica adventitia (same as arteries)
What is blood pressure?
Blood pressure is the force applied against the artery walls as the heart pumps blood around the body.
What is normal BP?
Normal BP is 120 systolic/80 diastolic
Compare the mechanisms used for maintaining flow in the blood vascular and lymphatic systems.
Arteries
- pumping action of heart
- smooth muscle in artery walls

Veins
- valves stop backflow
- "muscle pump" in legs
- thorax pressure during breathing sucks blood towards heart "respiratory pump"

Lymph vessels
- valves
- movemenmt of skeletal muscle "venous pump"
- pressure in the thorax during breathing
- contraction of smooth muscle in R. Lymphatic Duct and Thoracic Duct
Name the two circuits of the circulatory system.
The circulatory system is divided into two circuits:
i) systemic (body) circuit; &
ii) pulmonary circuit
What two vessels carry blood into the right ventricle?
The Inferior and Superior Venae Cava bring blood into the right atrium.
By what route does venous blood return from the brain to the neart?
Venous blood returns from the head to the heart:
1) rostrally to caudally
2) venous blood drains via the Superior and Inferior Sagittal Sinuses, through the Straight and Sigmoid Sinus
3) venous blood descends in the Internal Jugular Vein
4) enters the heart via the Superior Vena Cava
What is the purpose of "intercolated discs"?
Intercolated discs are a feature of the structure of cardiac muscle cells, which enables swift impulse transmission between fibres, thus enabling the entire heart to beat at once.
What type of tissue is blood?
Blood is connective tissue.
Describe the structure of blood.
Blood is composed of:
1) a fluid matrix "plasma" containing
2) formed elements (leukocytes, erythrocytes & platelets)
Where is blood formed?
In adults, blood is formed in the marrow of long bones, and in lymphatic tissue.
State the main functions of blood.
Functions of blood:
1) Exchange of oxygen and carbon dioxide
2) Transport of waste products
3) Transport of formed elements
5) Transport of hormones, enzymes and buffers
6) Maintains body temperature
What does blood plasma contain?
Blood plasma contains:
1) Fibrinogen
2) Albumin
3) Globulin
Why aren't erythrocytes termed "cells"?
Erythrocytes are not true cells as they have no nucleus.
Where are RBCs formed and where are they destroyed?
RBCs are formed in the marrow of long bones and in lymphatic tissue.
RBCs are destroyed in the liver (by Kupffer cells) and in the spleen.
What is the name for formation of RBCs?
Erythropoesis is the term for formation of RBCs.
When do RBCs lose their nuclei?
RBCs lose their nuclei when they are still normoblasts within the bone marrow. They shed their nucleus when they leave the marrow and enter the bloodstream.
What are the five different types of leukocyte?
Monocyte
Acidophil
Neutrophil
Basilophil
Lymphocyte
What are the main differences between RBCs and WBCs?
RBCs
- no nucleus
- function within blood vessels
- abundant
- smaller than WBCs

WBCs
- have a nucleus = are "cells"
- live/function outside of blood vessels
- 5 different types of cells
- larger and less abundant than RBCs
Where do WBCs live and function?
WBCs live and function outside of blood vessels, in connective tissue proper.
What is the role of a lymphocyte?
Lymphocytes are immunocompetent i.e. they are able to react to antigens (foreign material inc. bacteria, fungi, abnormal cells).
What is the role of monocytes?
Monocytes are phagocytic cells.
Which type of leukocyte is first on the scene of infection?
Neutrophils will arrive first after infection.
Which WBC is active during allergies and asthma?
Acidohils are active during allergies and asthma !
What is the process of nerve conduction through the heart??
1) Sinoatrial node below entrance of Superior Vena Cava starts excitation
2) both atria contract
3) action potential passes to Atrioventricular
4) Impulse reaches "Bundle of His" in intraventricular septum which bifurcates into left and right branches
5) Action potential reaches Purkinje fibres at bottom of ventricles
6) ventricles contract
Describe the structures through which blood will pass on its way through the heart.
- blood enters heart at right atrium via inferior and superior venae cava
- right atrium
- tricuspid valve
- right ventricle
- semilunar valve
- pulmonary artery (trunk)
(lungs - alveoli)
- pulmonary vein(s)
- left atrium
- bicuspid valve
- left ventricle
- semilunar valve
- ascending aorta
Describe what happens in the heart during systole and diastole.
1) blood flows into the right/left atria (atrioventricular valves are open, allowing the ventricles to fill)
2) Atrial systole occurs, emptying the atria and filling the ventricles
3) Slight delay before ventricular systole, as impulse reaches Purkinje fibres
4) Ventricular systole, causing atrioventricular valves to close to prevent backflow
5) blood is pumped out of both ventricles simultaneously
6) complete cardiac diastole occurs, blood flows in again
Define "diastole"
Diastole is the period during the cardiac cycle when the ventricles and atria are relaxing.
Define "systole"
Systole is the period during the cardiac cycle when atria, then ventricles, contract.
Happens in two phases 1) atrial systole, then 2) ventricular systole
How long does a complete cardiac cycle last?
A complete cardiac cycle lasts 0.8 seconds. Systole lasts 0.4 and diastole lasts 0.4.
Atrial systole = 0.1 secs
Ventricular systole = 0.3 secs
List the events occuring in diastole and systole of the cardiac cycle.
Diastole:
- blood flows in passively to atria to ventricles
- A/V valves open
Atrial systole:
- atria contract
- A/V valves close "Lub"
Ventricle systole:
- ventricles contract
- A/V valves remain closed
- Semilunar valves open
Diastole:
- Semilunar valves close (Dup)
(repeat)
Are the atria in systole or diastole when the ventricles contract?
Atria are in diastole when the ventricles contract.
What measurements do you take for an ABPI reading?
ABPI:
1) Highest systolic pressure (ankle)
2) Highest systolic pressure (brachial)
3) divide ankle by brachial readings to give ABPI
>1.1 arterial calcification
0.9-1.1 normal
<0.9 mild PVD
<0.5 severe PVD
What are "venae comitantes"?
Venae comitantes are the deep veins that accompany arteries in the lower limb.
What are the podiatric implications of vascular insufficiency (Peripheral Vascular Disease)?
Podiatric implications of PAD:
1) reduced oxygen perfusion of tissues (ulceration, gangrene, amputation)
2) impaired healing
3) increased chance of infection
4) lower limb pain
What can we learn from a vascular assessment of the lower limb?
1) whether blood supply to/from a limb is adequate
2) identifies if problem is arterial/venous/lymphatic
3) if any vascular abnormalities present
4) identifies patients needing referral
Name the 3 layers of the arterial walls
Arterial walls:
1) tunica intima
2) tunica media
3) tunica adventitia
In which layers of the arterial wall is there most smooth muscle?
Tunica media
State the arterial tree from aorta down to foot
Aorta
Common iliac
External iliac
Femoral
Popliteal
Anterior tibial (dorsalis pedis)
Posterior tibial (medial/lateral plantar)
Peroneal
State the venous system of the lower limb
Dorsal venous arch
Greater saphenous (medial)
Lesser saphenous (lateral, drains into Popliteal vein)
Deep veins - anterior and posterior tibial
Femoral vein
External iliac vein
Common iliac vein
What is the function of communicating veins?
Communicating veins allow drainage from superficial to deep veins.
What is the purpose of valves?
Venous valves prevent backflow of blood.
Into which major vein do the systemic veins of the lower limb drain, before returning to the heart?
The Inferior Vena Cava
What do capillaries do?
Capillaries deliver oxygen and nutrients to local tissue.`
What controls capillary perfusion?
Pre-capillary sphincters in meta-arterioles control capillary bed perfusion
What is an arteriovenous shunt?
Arteriovenous shunts are anastomoses linking arterioles and venules.
What purpose do arteriovenous shunts serve?
Arteriovenous shuntshelp preserve core body temperature by shunting blood from superficial to deep regions, bypassing cutaneous regions.
Where in the body are there no collaterals?
The heart has no collaterals
What do lymphatic vessels do?
Lymphatic vessels drain the tissues and transport lymph through lymph nodes.
WHere does lymph join the peripheral circulation?
The thoracic duct
What purpose does tissue fluid serve?
Tissue fluid is a diffusion medium for exchange of waste fluids, gases and nutrients between cells, blood and lymph.
How does tissue fluid form?
Tissue fluid forms by hydrostatic and oncotic pressure
By what two main mechanisms does the CV system ensure adequate tissue perfusion?
- altering rate and force of heart contraction
- varying the diameter of the peripheral circulation
What is a pulse?
A pulse is the shockwave through the blood from the diastolic rebound, felt at ponts along the arterial tree.
What is "peripheral resistance"?
Peripheral resistance represents vessel resistance to bloodflow.
What is "afterload"?
Afterload is the resistance against which the left ventricle must eject its volume of blood during systole.
What is "preload"?
Preload is the stretch of ventricular muscle fibres at end diastole.
What is the effect of poor perfusion on body tissues?
tissues are deprived of oxygen, nutrients and waste product removal
= hypoxia/ischaemia
The most common cause of ischaemia is?
Atherosclerosis and associated complications
Name three complications of atherosclerosis
1. ischaemic heart disease
2. PAD
3. CVA
State four main risk factors for atherosclerotic disease>
1. smoking
2. hypertension
3. hyperlipidaemia
4. diabetes mellitus
What is the effect of poor perfusion on tissues?
Tissues cannot:
- get sufficient oxygen
- get sufficient nutrients
- get rid of waste products
= hypoxia/ischaemia
What is the most common cause of ischaemia?
Atherosclerosis
What common conditions can atherosclerosis cause?
1- CVA
2- ischaemic heart diaease
3- PAD
Which size of arterial vessels does atherosclerosis mainly affect?
medium to large diameter arterial vessels
What groups of patients are more likely to suffer distal atherosclerotic diaease?
- diabetic patients
- black and asian patients
Where in the body is atherosclerotic disease most likely to occur?
the section of arterial vessels between the Femoral and Polipteal arteries
Features of an angina attack?
mild-severe crushing pain
may radiate down left arm
may radiate to jaw
relieved by GTN
lasts minutes
What is dyspnoea?
breathlessness
What is breathlessness a sign of ?
congestive heart failure or angina
Why does cardiac failure cause fatigue?
insufficient oxygen to brain and muscle tissue (hypoxia)
What is "oedema"?
Oedema is the accumulation of tissue fluid in local tissue, due to disturbance of the normal fluid formation/reabsorption process
What can cause oedema?
- trauma
- occluded drainage vessels
- congestive heart failure
- right sided heart failure
- renal disease
What is cyanosis?
bluish discolouration of lips, tongue and mucous membranes
What causes cyanosis?
- inadequate oxygen to tissues
- heart failure
- COPD
If the tongue is bright red, what might this indicate?
B group vitamin deficiency
What is vasculitis?
Inflammation of the blood vessels
Koilinychia (spooned nails) is a sign of...?
iron-deficiency anaemia
Clubbed nails is due to...?
congenital cyanotic heart disease or respiratory problems
Splinter haemorrhages in the nails may indicate...?
vasculitis or trauma
bacterial endocarditis
What is the normal adult resting pulse rate?
60-80 bpm
What term described slow heart rate of <60 bpm?
Bradycardia
What term describes raised heart rate of >100 bpm?
Tachycardia
What terms are used to describe heart rhythm?
regularly regular
regularly irregular
irregularly irregular
In what groups of patients might you observe non-pathological bradychardia?
Athletes
Explain "arrhythmia"
abnormal heart rate or rhythm
What is hypertension "of no known cause" described as?
essential hypertension
Define hypertension according to NICE.
persistent raised BP above 140/90 mmHg
What errors can occur when taking BP measurement?
worn out rubber tubing
faulty valve
wrong size cuff for limb
arm not at heart level
If ankle pulse cannot be measured because of calcification, what would you do as an alternative? Why?
use toe/brachial index
(more distal vessels less likely to calcify)
Define atherosclerosis
Atherosclerosis is a pathological process involving formation of a fatty plaque in the subintimal space of large and medium-sized arteries.
Recognised risk factors for atherosclerosis are...?
hypertension
hypercholesterolaemia
diabetes
obesity/smoking
What is Monckeberg's sclerosis? What causes it?
medial arterial calcification, generally of smaller vessels not affected by atherosclerosis

autonomic neuropathy causes atrophy of smooth muscle
What systemic conditions are linked with Monckeberg's sclerosis?
diabetes

ageing
Two reasons for non-compressible vessels, when testing?
Medial arterial calcification

Atherosclerotic disease
What is "vasculitis"?
Inflamation of any blood vessel.
Conditions associated with vasculitis?
RA
SLE
Raynaud's disease is...?
Episodic digital ischaemia, brought on by cold or emotion
Chilblains are...?
Localised inflammatory lesions, provoked by cold and injudicious heating.

Itchy, dusky-red swellings turning purple when chronic.
Emboli commonly occur in what situations?
during arterial fibrillation

from an aortic aneurysm

following MI
After how many hours occlusion will irreversible tissue damage occur?
6-8 hours
What are the signs of irreversible tissue damage in the lower limb?
mottled skin

muscle tenderness

motor & sensory deficit

necrosis
What does intermittent claudication indicate?
insufficient arterial supply to the peripheries
What is the "claudication distance"?
the reliable distance at which claudication pain is felt
symptoms of claudication?
muscle cramping or aching

tightness, fatigue or burning sensation
explain why claudication occurs
exercising muscles respire anaerobically
metaboloites aren't cleared by blood and cause ischaemic pain

resting reduces metabolites produced
The region of aschaemic muscle pain indicates....?
the site of the arterial occlusion
If claudication pain occurs in the calf, where likely is the occlusion?
in the next proximal region i.e. the thigh/buttock/hip
reason for night cramps?
limb ischaemia

lying reduces gravity assistance to circulation

bedclothing warmth increases metabolic demands of tissues, which can't be met
symptoms of rest pain?
unremitting, debilitating pain

common in heels, toes & soles

pain aggravated by elevation
signs of poor tissue viability in the lower limb?
thin, papery skin
lack of skin appendages
wasting of soft tissue
common sites of ischaemic ulceration?
subungually
apices of toes
around the borders of the feet
what leg position lessens the pain of ischaemic ulcers?
dependency
thickened, crumbly and discoloured nails are a sign of ...?
poor arterial supply

fungal infection

psoriasis
bilateral oedema is a sign of...?
congestive heart failure
unilateral oedema is a sign of...?
infection, trauma, poor venous or lymphatic drainage
Name some clinical tests of arterial supply
1. pulse palpation
2. ABPI
3. Capillary refill
4. Buerger's test
What might warm knees signify?
stenosis at mid-thigh level, and development of a genicular collateral ciraultion
Why use Buerger's test?
if negative, you can rule out distal occlusive arterial disease
What does the frequency of the pulse represent?
the rhythm of the ventricular systole
reasons for lack of pulse in an apparently healthy individual?
-anatomical variation
-under development
-congenital absence
absence of pedal pulses means...?
possible arterial occlusion
poor clinician technique
define "bruit"
abnormal sound in an artery, indicating increased velocity or obstruction
Doppler ultrasound provides info about what?
the character and velocity of arterial pulse
explain the three sounds heard in a triphasic waveform
1. ventricular systole (ejection of blood bolus)
2. elastic distention of arteries
3. final forward flow as arteries rebound
What does an ABPI test for?
presence of ischaemia in the lower limb
State the ABPI result thresholds
>1.30 Uncompressable
0.9-1.29 Normal
0.7-0.96 Mild obstruction
0.4-0.69 Moderate obstruction
<0.4 Severe obstruction
to carry out an ABPI you will need ...?
Doppler
Sphygnomenometer
Stethoscope
the difference between diastolic and sytolic BP is...?
Systolic BP measures the force on the artery wall of ejected blood and diastolic BP measures the elastic rebound of the systemic vessels.
where can you measure the brachial pulse?
medial to the bicipital aponeurosis
What are the sounds heard through the stethoscope when taking an ABPI called?
Korotkoff sounds
what is the first sound you will hear when reducing cuff pressure during an ABPI?
a tapping sound
ABPI tapping sound means...?
cuff pressure = systolic pressure
ABPI muffled sound means...?
cuff pressure = diastolic pressure
ABPI silence means...?
artery occluded by cuff
the Buerger's test assesses...?
arterial supply to lower limb

extent to which arterial pressure overcomes effects of gravity
when would you do a Buerger's test?
if medial arterial calcification is suspected
clinical signs of medial arterial calcification are...?
artifically raised systolic BP
what classification system is used for PAD?
the Fontaine system
name Fontaine's four stages of PAD
1) symptom free occlusion
2) claudication
3) rest pain
4) ulceration and gangrene
describe how to do a Buerger's test
1) patient supine, leg at 45 degrees
2) keep raised for 60 seconds & observe colour of feet
3) patient sits, legs in dependency
4) note reperfusion foot colour
what results would you expect from Buerger's test in normal feet?
leg raised = toes stay pink

leg dependent = reperfusion in 10 secs
what results would you expect from Buerger's test in an ischaemic limb?
legs raised= legs/toes blanche

dependency = patchy rubor

(why?=reactive hyperaemia)
the Buerger's angle is...?
the angle to which the legs must be raised before it becomes white
erythema is...?
redness of the skin caused by dilation of blood vessels
hyperaemia is...?
excess blood in a body part from increased bloodflow to it
what does tissue cyanosis indicate?
inadequate oxygen to tissues
describe the venous filling time test
patient supine, leg raised to 60 degrees
observe prominent vein
put leg in dependency and note time for vein to refill
what are the key times for venous refill test?
<15 secs = normal
30 secs moderate ischaemia
>40 severe ischaemia
what is the venous refill test assessing?
the time taken for the veins to distend i.e. refill with blood
how do you pronounce "bruit"?
brooo-aye
What cardiac condition might shortness of breath indicate?
Left sided heart failure
What is rest pain?
persistent pain caused by nerve ischaemia
What causes rest pain to occur?
PAD
Why does rest pain occur when a patient is lying down?
1. reduced superficial circulation at night
2. severe atherosclerosis causes reduced peripheral perfusion
What relieves rest pain?
putting legs into dependency
What aggravates rest pain?
application of heat, leg elevation and exercise
Buerger's test - describe how to perform it
1) With patient supine elevate both legs to 45 degrees for 2 mins and note angle of elevation needed to blanche
2) with legs in dependency observe colour as blood returns
Buerger's test - what does it indicate?
Buerger's test is used to assess the adequacy of the arterial supply to the leg
What leg colour would you expect to see with PAD?
Legs blanche quickly on elevation.
Legs go blue then red on dependency.
Why do the legs go blue at first on dependency in a patient with PAD?
The blueness is the blood deoxygenating as it returns to ischaemic tissue.
What is the redness caused by when legs are dependent after elevation in Buerger's test?
This is reactive hyperaemia. It is a phenomenon in which there is increased bloodflow to an area of transient ischaemia.