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35 Cards in this Set
- Front
- Back
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6 "P"s of PAD (Peripheral Arterial Disease)
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PAIN
Weak PULSE PALLOR PARESTHESIA PALPABLE coolness (poikolithermia) PARALYSIS |
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Risk factors for PAD (6)
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Smoking
Obesity Inactivity Hypertension Hyperlipidemia Diabetes |
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Risk factors for peripheral venous disease (7)
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Coagulation abnormalities
Abdominal/pelvic surgery Estrogen or OCPs Pregnancy Obesity Heart disease Advanced neoplasm |
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Major cause of PAD
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Arteriosclerosis
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Primary symptom of PAD
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Intermittent claudication
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Signs of longstanding PAD (3)
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Muscle atrophy
Dec hair growth Discolored, hardened toenails |
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3 types of arterial PVD (peripheral vascular disease)
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PAD (arterial insufficiency)
Arteritis Aneurysms |
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Virchow's triad (causes of blood clots)
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Venous stasis
vessel wall damage/injury coagulopathy |
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What is postphlebitic syndrome?
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Clot causes irreversible valve damage leading to pooling and HTN = chronic pain, swelling, and venous ulcers
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Overt signs of DVT
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Unilaterally:
Warmth Erythema Edema Ropiness/pain along vein distension of venous collaterals +/- Homan's sign (unreliable) |
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What cardiac abnormalities increases risk of cerebral throboembolism in presence of DVT?
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Abnormal communication between L and R chambers -- i.e. ASD, VSD, patent foramen ovale
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Grading system for peripheral pulses
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0 = absent
1+ = diminished 2+ = normal 3+ = bounding |
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Pulses to check when evaluating for PVD (7)
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Cervical
Radial Brachial Femoral Popliteal Dorsalis pedis Posterior tibial |
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What % of population has benignly absent pedal pulses?
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10%
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In PAD, dependent extremities are what color?
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Reddish-blue
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In CVI, extremities have what type of discoloration?
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Brownish hyperpigmentation
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Signs of CVI
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Brownish hyperpigmentation
Shiny skin Edema Subcutaneous fibrosis Ulcers on medial malleolus |
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What test is used in the office for suspected arterial insufficiency?
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Doppler flow study
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What is a normal ABI? (aka AAI)
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Ratio of ankle BP to Brachial BP.
Nl = > 0.9 |
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What ABI range indicates claudication?
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0.6 - 0.9
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What does an ABI of 0.5 or less indicate?
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Severe arterial insufficiency
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What diagnostic test is indicated for suspected DVT?
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Ultrasound. Inability to compress vessel is +, may not actually see the clot.
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Use of D-Dimer in suspected DVT?
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D-Dimer is breakdown product of fibrin and can be + in thrombus and PE.
Non-diagnostic, but may support dx. |
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Differentials for PVD? (8)
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Thrombosis
Phlebitis Polycythemia Anemia Raynaud's disease Buerger's disease aneurysms Peripheral neuropathy |
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Basic mgmt for PAD (7)
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Quit smoking
Walk 30 min 3-4/wk Legs dependent Avoid compression Immediate care for lesions/ulcers Diabetic foot checks with mirrors No bare feet Comfortable, supportive shoes and socks |
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Med used to treat leg pain and cramping in PAD?
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cilostazol (Pletal) 100 mg BID without food. Contraindicated in CHF
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3 meds for use in PAD?
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Aspirin - dec platelet aggregation
Plavix (clodiprogel)- platelet inhibitor Pletal (cilostazol)- vasodilator and dec platelet aggregation |
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Conservative tx for CVI?
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Weight loss
Exercise Compression stocking Avoid nicotine |
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4 criteria for outpt DVT tx?
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Supportive environment
Hemodynamically stable No renal failure Low risk of bleeding |
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FU interval for pt with PAD without ulcer?
With ulcers? |
Q 3 mos
Weekly until ulcer resolves |
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Pt Ed for PVD?
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Avoid nicotine
Tight control of DM, HTN, dyslipidemia Dec dietary fat and salt Foot care Exercise Report inc pain, pallor, cyanosis, rest pain, ulcers No bare feet Podiatrist for nail trimming |
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Components of foot care for PVD or DM?
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Meticulous daily inspection (with mirror) incl between toes
No bare feet No soaks Careful (or practitioner) nail trimming Supportive shoes Immediate tx for ulcers, abrasions, sores |
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Describe Buerger-Allen exercises for PAD
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Raise extremities to 45 deg angle, then lower to supine position
Two minutes per rep, 5 reps per cycle, 3-4 cycles per day Position changes cause veins to refill by gravity |
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How does exercise help PAD?
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Encourages growth of collateral vessels
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Outpt mgmt of mild superficial thrombophlebitis?
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Heat
Elevation NSAIDS No smoking Bed rest x 3-5 days Coumadin for anticoag |
