Lecture 1: Cardiopulm Module 2

Lecture Objectives

1. Identify health conditions affecting the peripheral vascular system.

2. Describe signs and symptoms in individuals with vascular disease.

3. Differentiate between signs and symptoms of peripheral arterial vs. venous diseases.

4. Explain medical and surgical management of vascular diseases.

5. Discuss tests/measures for PT examination related to peripheral vascular diseases.

6. Identify impairments linked to peripheral vascular diseases and effective physical therapy interventions.

7. Explain how diabetes mellitus and its related pathologies may lead to vascular impairments that can be treated by physical therapy.

Peripheral Vascular Disease (PVD) Terminology

• Thrombus: Blood clot

• Phlebitis: Vein inflammation, increasing thrombosis risk

• Thrombophlebitis: Venous inflammation accompanied by thrombus

• Embolism: Detached clot traveling in the bloodstream

• DVT: Deep vein thrombosis

• VTE: Venous thromboembolism

• PE: Pulmonary embolism

Cardiovascular System Overview

Arterial System

• Blood Flow: From the left heart

• Type of Blood: Oxygenated with low CO2

Venous System

• Blood Flow: Returning to the right heart

• Type of Blood: De-oxygenated with higher CO2

Arterial vs. Venous System Structure

Venous System

• Structural Characteristics:

  • Less distinct layers

  • Thinner walls

  • Presence of valves to prevent backflow

Arterial System

• Structural Characteristics:

  • Well-defined layers with thicker walls

  • Supports higher pressure blood flow

Arteries of the Lower Extremity

• Major Arches and Branches:

  • External iliac, internal iliac, femoral, popliteal

  • Anterior and posterior tibial, dorsalis pedis, plantar arch

Venous System of the Lower Extremity

• Key Veins:

  • Femoral vein, great saphenous vein, popliteal vein

  • Deep and superficial veins, perforating veins

Types of Peripheral Vascular Diseases

Arterial Diseases

• Conditions:

  • Atherosclerosis

  • Arterial thromboembolism

  • Aneurysm

Venous Diseases

• Conditions:

  • Varicose veins

  • Thrombophlebitis (including DVT)

  • Venous thromboembolism

Role of Physical Therapy in Peripheral Vascular Disease

• Comprehensive examination of lower extremity (LE) including:

  • Observation and quantification of skin, temperature, edema, circulatory changes

  • Screenings for VTE or arterial embolism

  • Assessment of functional mobility (e.g., gait speed)

  • Sign and symptom quantification (e.g., claudication)

Interventions Developed by Therapists

• Safe exercise to promote circulation and improve tissue oxygenation.

• Education on PVD signs/symptoms and importance of physical activity.

• Foot care in diabetic patients to prevent complications.

Peripheral Arterial Disease (PAD)

Relation to Atherosclerosis

• Same pathology as Coronary Artery Disease (CAD)

• Can lead to cerebrovascular accidents (strokes) from carotid artery involvement.

Risk Factors for PAD (CDC)

• Smoking

• Hypertension (HTN)

• Diabetes

• High cholesterol

• Age >60 years

Diabetes and Increased Risk for PAD

• Causes include:

  • Hyperglycemia-induced vascular damage

  • Microvascular dysfunction affecting blood vessels

  • Neuropathy affecting pain perception and vascular responses

Clinical Presentation of PAD

• Symptoms include intermittent claudication characterized by:

  • Pain or cramping during activity

  • Relief usually within 10 minutes of rest

  • Progressively worsening condition with increased risk factors (diabetes, smoking)

Assessment and Diagnosis

• Ankle-Brachial Index (ABI):

  • Essential for diagnosing PAD; <0.9 indicates disease.

  • Measurement procedures for resting and exercise ABI.

Treatment and Intervention Strategies

• Supervised treadmill training (intermittent exercise) for claudication management:

  • Frequency: 3 times/week

  • Duration: 30-50 minutes goals

  • Intensity: 40%-60% of max workload.

Arterial Thromboembolism Overview

Embolic Sources

• Atherosclerosis, A-fib, endocarditis, myocardial infarction, aneurysms.

Clinical Signs and Symptoms

• Diminished or absent pulses, pain, pallor, muscle weakness.

Medical and Surgical Interventions

• Use of thrombolytics and embolectomy for management.

Aneurysm Overview

Types of Aneurysms

• True and false aneurysms, dissecting aneurysms.

Symptoms and Signs

• Severe pain, changes in tissue perfusion if ruptured, palpable masses in some cases.

Treatment Approaches

• Options include surgical repair, stenting, or clipping.

Venous Disease - Varicose Veins

Causes and Signs

• Causes include vessel wall weakness and disease.

• Symptoms include heaviness, engorgement, skin changes.

Implications for Physical Therapy

• Monitor for skin integrity and complications, offer education on management strategies.