LEC 14: Cardiovascular Disease - Peripheral Vascular Disease, Deep Vein Thrombosis and Pulmonary Embolus

What is peripheral vascular disease (PVD)?

Disease of blood vessels outside heart and brain AKA peripheral arterial disease (PAD) – narrowing of arteries supplying blood to the periphery due to atherosclerosis (or vessel spasm), resulting in decreased blood flow to the legs or arms

What is the epidemiology of PAD?

236 million people globally 14% of people > 70 22% of people > 80 3 million Canadians aged 50–79

What is the aetiology + risk factors of PAD?

Atherosclerosis Older age Smoking Diabetes Dyslipidemia Hypertension

What are the signs and symptoms of PAD?

Often asymptomatic until artery is >60% narrowed Collateral blood supply may mask symptoms Claudication – painful leg cramping during exercise relieved by rest Skin changes (↓ temperature, thin shiny skin, ↓ hair, discoloration) ↓ pulses in legs and feet ↓ wound healing Ulcers Gangrene

What is the pathology of PAD?

Endothelial dysfunction Lipid disturbances Platelet activation Thrombosis Severe narrowing leads to ischemia and tissue damage, most often in the legs

What is critical limb ischemia?

Most advanced stage with severely reduced blood flow causing intense pain, ulcers, gangrene, and possible amputation

How is PAD diagnosed?

Blood tests (glucose, lipids) Ankle-brachial index (ABI) Ultrasound Doppler ultrasound Angiography

What is ankle-brachial index?

Systolic ankle pressure divided by highest brachial pressure 0.9 or lower indicates PAD

How is PAD managed?

Medications (statins, blood pressure control, diabetes management, anti-clotting) Surgery (stent, graft) Lifestyle (diet, exercise, avoid smoking)

What is the prognosis of PAD?

10-year mortality ranges from 22–70% depending on age and risk factors Increased cardiovascular risk Decline in physical function and increased disability

What is deep vein thrombosis?

Blood clot (thrombus) in a vein, usually in the legs

What is the epidemiology of deep vein thrombosis?

0–120 cases per 100,000 per year Canada ~81 per 100,000 Higher incidence with age Females > males

Which vein does deep vein thrombosis occur in?

Iliofemoral Femoral-popliteal

What is the aetiology + risk factors of DVT?

Slow blood flow Immobility Inactivity Injury Surgery Hospitalization Travel Damaged vein

What is the pathology of DVT?

Virchow’s Triad: venous stasis, vascular injury, hypercoagulability

How is DVT diagnosed?

D-dimer blood test Ultrasound Venography Homan’s sign (less reliable)

What are the signs and symptoms of DVT?

Leg swelling Pain or cramping (often in calf) Skin color change Warmth Enlarged superficial veins

How is DVT managed?

Anticoagulants Thrombolytics Compression stockings Thrombectomy Inferior vena cava filter Leg elevation

What is the prognosis of DVT?

Generally not life-threatening if treated early Low complication rates with treatment Clot resolution may take months Risk of permanent damage or pulmonary embolism if untreated

What is a pulmonary embolism?

A life-threatening condition where a clot travels (usually from the leg) and blocks a lung vessel

What is the epidemiology of pulmonary embolism?

Nearly one-third of hospitalized patients are at risk Increasing diagnosis rates 5–10% of in-hospital deaths due to PE

What is the aetiology of pulmonary embolism?

DVT Fat embolism Tumor fragments Air bubbles

What is pulmonary embolism classification?

Massive Submassive Low risk

How is pulmonary embolism diagnosed?

Wells score D-dimer

What are the signs and symptoms of pulmonary embolism?

Sudden shortness of breath Chest pain worse with breathing or coughing Lightheadedness or fainting Rapid pulse Rapid breathing Hemoptysis

What is the prognosis of pulmonary embolism?

Major cause of morbidity and mortality Mortality ranges from ~2% to 95% depending on severity 20–25% present as sudden death 10–30% die within 30 days Some develop long-term complications (post-PE syndrome