Cardiovascular - CVD : Arterial

What is Peripheral Vascular Disease (PVD)?

A group of disorders affecting arteries and/or veins that decrease tissue perfusion.

What is the leading cause of lower extremity amputation?

Peripheral vascular disease.

What arterial disorders should you know?

Peripheral Arterial Disease (PAD), Raynaud's Disease, and Buerger's Disease.

What is Peripheral Arterial Disease (PAD)?

A chronic arterial insufficiency caused primarily by atherosclerosis that decreases blood flow to the extremities.

What is the most common cause of PAD?

Atherosclerosis.

What vessels are commonly affected by inflow obstruction in PAD?

Aorta and iliac arteries.

What vessels are commonly affected by outflow obstruction in PAD?

Femoral, popliteal, and tibial arteries.

What are the major risk factors for PAD?

HTN, diabetes, hyperlipidemia, smoking, obesity, family history, and increasing age.

What is intermittent claudication?

Leg pain that occurs with walking or exercise and is relieved by rest.

What is the hallmark sign of chronic PAD?

Intermittent claudication.

What does intermittent claudication indicate?

The artery is greater than 75% occluded.

What does pain at rest indicate in PAD?

Severe arterial disease.

Why does intermittent claudication occur?

Muscle ischemia causes anaerobic metabolism, lactic acid buildup, and pain.

Intermittent claudication is often called what?

Angina of the legs.

What causes acute arterial occlusion?

Sudden blockage of arterial blood flow.

What are the 6 P's of acute arterial occlusion?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis/Paresis, Poikilothermia.

Which of the 6 P's is usually the earliest symptom?

Sudden severe pain.

Which of the 6 P's indicates loss of circulation?

Pulselessness.

What does poikilothermia mean?

A cold extremity.

Acute arterial occlusion is what type of emergency?

A vascular emergency.

What are the signs of chronic arterial insufficiency?

Intermittent claudication, pallor, dependent rubor, rest pain, hair loss, thick toenails, nonhealing wounds, arterial ulcers, gangrene, and muscle atrophy.

What happens when a PAD patient's leg is elevated?

The foot becomes pale.

What happens when a PAD patient's leg is lowered?

The foot becomes bright red (dependent rubor) or cyanotic.

What is the Ankle-Brachial Index (ABI)?

A comparison of ankle systolic BP to arm systolic BP.

How is ABI calculated?

Ankle systolic BP ÷ Arm systolic BP.

What is a normal ABI?

1.0–1.3.

What ABI suggests borderline PAD?

0.9–1.0.

What ABI indicates PAD causing claudication?

0.41–0.90.

What ABI indicates severe PAD?

0.00–0.40.

What ABI value suggests calcified noncompressible arteries?

Greater than 1.30.

What diagnostic tests evaluate PAD?

ABI, Doppler ultrasound, duplex ultrasound, angiography, MRA, and cardiac evaluation.

What are the goals of PAD treatment?

Improve blood flow, prevent progression, and reduce cardiovascular risk.

What nonsurgical treatments are used for PAD?

Smoking cessation, exercise, positioning, medications, fibrinolytics, and cardiovascular risk reduction.

What surgeries treat PAD?

Balloon angioplasty, stent placement, atherectomy, peripheral bypass, and amputation.

How should a patient with PAD position their legs?

Keep legs dependent (dangling).

Why are legs kept dependent in PAD?

Gravity improves arterial blood flow.

What bed position benefits PAD?

Reverse Trendelenburg.

What should PAD patients avoid?

Crossing legs, compression stockings, constrictive clothing, and direct heat.

Should compression stockings be used for PAD?

No.

Why should direct heat be avoided in PAD?

Patients may have decreased sensation and can be burned.

What temperature should extremities be kept at in PAD?

Warm, but never with direct heat.

What is the smoking recommendation for PAD?

Complete smoking cessation.

What skin care should PAD patients perform?

Daily foot inspection and foot care.

What exercises are recommended for PAD?

Daily walking and Buerger-Allen exercises.

What diet is recommended for PAD?

Low-fat, low-sodium cardiac diet.

What medications are commonly used for PAD?

Statins, ACE inhibitors, antiplatelets, and anticoagulants.

What are the advantages of endovascular surgery?

Small puncture wound, less anesthesia, and faster recovery.

What is PTA?

Percutaneous transluminal angioplasty.

What should be monitored after PTA?

Peripheral pulses, circulation, bleeding, hematoma, and ecchymosis.

What are the two major complications after PTA?

Acute re-occlusion and bleeding.

What long-term medication is commonly prescribed after PTA?

Aspirin.

How are circulatory changes monitored after PTA?

By assessing the 6 P's.

What is the greatest concern during the first 24 hours after bypass surgery?

Graft occlusion.

What findings suggest a patent bypass graft?

Warm extremity, redness, edema, and palpable distal pulses.

What finding may indicate graft occlusion?

New pain.

What is expected after bypass surgery for 4–8 weeks?

Swelling.

What medications are commonly prescribed after bypass surgery?

Heparin, LMWH, warfarin, aspirin, and clopidogrel.

What is a peripheral arterial bypass?

Using the patient's saphenous vein or a synthetic graft to bypass an arterial blockage.

What is Raynaud's Disease?

Intermittent vasospasm of arteries in the fingers or toes.

Who commonly develops Raynaud's Disease?

Women ages 20–49.

What triggers Raynaud's attacks?

Cold, stress, hormones, tobacco, and caffeine.

What are the three color phases of Raynaud's?

White → Blue → Red.

What causes the white phase?

Vasoconstriction.

What causes the blue phase?

Pooling of deoxygenated blood causing cyanosis.

What causes the red phase?

Vasodilation with return of oxygenated blood.

What symptoms occur during the red phase?

Burning, tingling, throbbing, and pain.

What is Buerger's Disease?

Inflammatory disease of small and medium arteries and veins strongly associated with smoking.

Who commonly develops Buerger's Disease?

Men younger than 40 who are heavy smokers.

What triggers Buerger's Disease?

Smoking, cold exposure, and stress.

What are the symptoms of Buerger's Disease?

Pain, cold sensitivity, paresthesia, rubor, edema, ulcers, gangrene, and possible amputation.

What is the first-line medication for Raynaud's Disease?

Calcium channel blockers.

Which calcium channel blockers are commonly used for Raynaud's?

Diltiazem and nifedipine.

What other medications may be used for Raynaud's?

Vasodilators and alpha blockers (prazosin).

What are the nursing interventions for Raynaud's and Buerger's Disease?

Keep warm (not hot), avoid cold, stop smoking, avoid nicotine patches, assess skin, and provide wound care.

Why should nicotine patches be avoided in Buerger's Disease?

Nicotine causes vasoconstriction and worsens the disease.

What is the highest-yield positioning difference for PAD?

PAD = Legs DOWN (dependent).

What is the hallmark symptom of PAD?

Intermittent claudication.

What are the highest-yield emergency findings for acute arterial occlusion?

The 6 P's.

What are the three highest-yield ABI values to memorize?

Normal 1.0–1.3, Claudication 0.41–0.90, Severe PAD 0.00–0.40.

What is the highest-yield memory trick for Raynaud's Disease?

White → Blue → Red.

What is the highest-yield fact about Buerger's Disease?

It occurs almost exclusively in heavy smokers.