Cardiology Peripheral Vascular Disease

Cardiology—Peripheral Vascular Disease - Exercise – increases collateral circulation Peripheral Vascular Disease Treatment - Medical - vascular dz of the extremities. - ASA - AKA ~ arteriosclerosis obliterans. - ASA+ dipyridamole - Agrinox - more common in those > 70 y.o. - Ticlodipine - characterized by atherosclerosis in vessels outside the ♥ & - Clopidogrel (Clavix) phosphodiesterase inhibitor brain. - Cilostazol - Mj cz of limb and life loss. - Pentoxifylline – ↑ fibrinogen [ ], ↓ platelet adhesiveness, & ↓ Risk Factors whole blood viscosity - Cigarette – ↑ the symptoms of ischemia assoc w/ PVD Treatment – Surgical - HTN - Surgical tx is reserved for those with severe dx - Hyperlipidemia - Can B performed 4 low risk surgical pts who will have great - DM improvement in quality of life post-op Pathophysiology - Percutaneous transluminal angioplasty – balloon - identical 2 coronary artery dz. angioplasty - Atherosclerotic plaque forms on the wall of a vessel, ↑ in size - Bypass surgery –saphenous vein bypass. & obst the lumen, ↓ bf. - The most common bypass is the Fem-pop. - It is an imbalance b/t the supply & demand of bf. Acute Arterial Occlusion - most commonly in the superficial femoral & popliteal arts. - is characterized by the sudden interruption of bf usually cz by Signs and Symptoms an embolus. People w/ AF R at risk bec many emboli R - S/S gradual in onset formed - Intermittent claudication –Most common symptom. Induced Signs and Symptoms by exercise and relieved by rest - Acute onset of pain, pallor, weakness, and coolness distal to - Atrophic skin changes – thinning of the skin, loss of hair bec the obstruction nutrients and blood R not being circulated 2 the area - Pulses absent -Cool extremities - Cyanosis - Weak or absent distal pulses below the level of stenosis. - Mottling of skin - Severity of pain depends on degree of stenosis Treatment - Foot/ankle ulcers – pts don’t heal well bec the bf is not good. - restore blood flow as quickly as possible to prevent limb loss most common place for arterial ulcers R the lateral malleolus, - Streptokinase bunion, tip of the toe, & metatarsal heads. - TPA - Rest pain – signifies late disease ~ Elevation worsens pain. - Heparin - Pain in upper 2/3 of calf signifies occl of superior fem art. - Embolectomy - Pain in the lower 1/3 of calf signifies occl of popliteal art. Reynaud’s Disease - Thigh pain signifies occl in common femoral artery. - intense vasospasm of arteries and arterioles in the fingers and - Pain in foot signifies blockage in tibial or peroneal arteries. toes. It is exaggerated vasoconstriction in response to stimuli - Buttock & hip pain signifies aortic and iliac occlusion. such as cold and strong emotions. -Leriche’s syndrome is buttock and hip pain accompanied by Treatment impotence. - Smoking cessation Diagnosis - Protection from cold - Hx - Limit emotional stress - P.E - CCB - ABI – Ankle brachial index. SBP in the ankle/systolic Thromboangitis Obliterans pressure in the arm. Should be the same in healthy people. If - also known as Buerger’s disease. It is always assoc w/ <0.9, it is indicative of PVD. If <0.4, significant of severe smoking. PVD - characterized by thrombus formation in the distal arteries of - Segmental limb pressure the foot, hands, and arm. - Exercise treadmill testing - Patients get pain, increased sensitivity to cold and malformed - Duplex color Doppler nails. Patients should stop smoking. - Magnetic resonance angiography - Conventional angiography Treatment – Risk Factors Modification - Control HTN - Lipid lowering agent - Strict glycemic control - Smoking cessation.