Cardiovascular and Peripheral Vascular/Arterial Disease

Cardiovascular Disease Overlaps

• Many factors contribute to both cardiovascular disease and peripheral arterial disease (PAD).

Peripheral Vascular Disease (PVD) vs. Peripheral Arterial Disease (PAD)

• Differentiation between PVD and PAD is important.
• PAD involves blockages in the arteries.
• Arteries carry oxygenated blood to the periphery.

Factors Contributing to Blockages (PAD)

• Smoking: Narrows blood vessels, especially when other risk factors are present.
• Diabetes: Contributes to decreased immune system and slow wound healing.
• High Cholesterol: Directly contributes to plaque buildup (atherosclerosis).
• Hypertension: Vessel wall narrows, reducing room for blood flow.
• Obesity: Contributes to various health issues, including PAD.
• Chronic Kidney Disease: Increases risk of cardiovascular issues.
• Depression: Can lead to a sedentary lifestyle and poor diet, contributing to PAD.

Arteriosclerosis vs. Atherosclerosis

• Arteriosclerosis: Hardening and thickening/stiffening of the arteries.
• Atherosclerosis: Plaque development inside the arteries.

Deep Vein Thrombosis (DVT)

• Higher risk of developing DVTs in PAD patients due to sedentary lifestyles.
• Lack of skeletal muscle contraction reduces blood flow back to the heart.
• Blood stasis can lead to clotting.

Lymphatic System

• Loss of lymphatic tissue weakens the immune system.
• The lymph system is a drainage system that also has an immune component.

Subjective Data: Assessing Pain and Cramping

• Focus on pain or cramping in the legs.

Intermittent Claudication

• Specific to PAD.
• Pain or cramping occurs in the legs during activity (walking) due to increased oxygen demand.
• The pain is caused by the arteries' inability to deliver enough oxygen to the tissues.
• Musculoskeletal pain should be ruled out.
• Differentiate from musculoskeletal pain by considering factors like exercise, diet, and hydration.

Skin Changes

• Differentiate changes between PAD and PVD.
• Consider edema:
  • Bilateral vs. unilateral.

Pain Characteristics

• PVD: Dull, aching pain.
• PAD: Severe pain during walking (intermittent claudication).
• PVD pain decreases with leg elevation (improved blood return).
• PAD pain decreases with rest.

Lymph Node Enlargements

• Assess for inflamed or enlarged lymph nodes.

Medication History

• Inquire about blood thinners and aspirin use.
• Smoking history.

Healthy Lifestyle Changes

• Similar to those recommended for cardiovascular disease.

Diabetes and PAD

• Diabetes increases the risk of infection and impairs wound healing.
• PAD limits blood flow which further exacerbates these risks.

Patient Teaching: Foot Care

• Wear good footwear.
• Keep feet dry.
• Always wear shoes (avoid walking barefoot).
• Inspect feet regularly.

Compression Stockings

• Avoid compression stockings (Ted hose, SCDs) in PAD as they can further restrict blood flow.

Exercise

• Encourage active range of motion exercises.
• Maintaining activity is important.

Abdominal Findings and Lymphedema

• Lymphedema:
  • Unilateral.
  • Non-pitting.
  • Hard, firm texture.
  • Caused by lymphatic obstruction.

Leg Ulcers

Arterial (Ischemic) Ulcers

• Due to lack of blood flow and oxygen.
• Associated with PAD (clot formation, plaque).

Venous (Stasis) Ulcers

• Due to stagnant or pooling of blood.
• Venous ulcers are irregular and wet.
• They are purple or brownish discolored.
• Warm legs.
• Edema is worse at the end of the day or when sitting and improves with leg elevation.
• Dull, achy pain.
• Pitting edema.

Varicose Veins

• Varicose veins are not the same as PVD.
• Caused by increased pressure (e.g., obesity, pregnancy, prolonged standing).

Intermittent Claudication (PAD)

• Pain when walking because oxygen demand is higher than oxygen delivery.

PVD

• Dull achiness from pressure in the blood, but it doesn't hurt when they walk.
• Improved by walking because it helps move blood up.