unfinished cardiovascular disease

peripheral vascular disease PVD

includes peripheral artery disease

PAD

• decreased arterial perfusion with poor circulation from abnormal narrowing of the arteries

PAD mc from

atherosclerosis can be decreased arterial perfusion from narrowing or occlusion of the peripheral arteries

PAD ms affects

the lower extremities

who is at risk for PAD

• increases with age, especially over 60

• smoking and DM are risk factors

PAD indicated what about the body

systemic atherosclerotic disease

all of PAD risk factors

• smoking

• DM

• obesity

• increasing age

• HTN

• hyperlipemia

• family history

• high levels of homocysteines

atherosclerotic lesions occur where and why

mostly at the arterial branch points there are sites of increases turbulence altered shear stress and intimal injury

what vessels are usually involved in PAD in elderly and DM pt

smaller vessels

asymptomatic PAD

• no reported leg sx can unknowingly limit activity

still increased cardiovascular risk

chronic symptomatic PAD

• gets better with rest

• exertional sx that can be pain, achin, cramping, fatigue, weakness that is relived with rest (within 10 min)

• pallor of the leg when elevated

• location of disease helps identify level

how does location help identify level of disease

• buttocks/hip/thigh = aortoiliac

• calf= femoropopliteal

• foot= infrapopliteal

chronic limb threating ischemia

• chronic ischemia even at rest, non healing wound/ulcer or grangreene

• sx present over two weeks

• worsen with elevation and relived by dependency

requires urgent vascular evaluation

acute limb ischemia

• sudden decrease in limb perfusion

• threatens limbs

• vascular emergency determined by the 6 Ps + sudden limb pain + absent pulse

the 6 Ps for acute limb ischemia

• pain

• pallor

• pulseness

• paresthesia

• paralysis

• poikilothermia

what are physical exam findings for chronic ischemia

• nail thickened

• muscle atrophy

• thin, shinny, hairless skin

Physical exam findings found with advanced dx

• nonhealing wounds

• distal/toe ulcers

• tissue loss or gangrene