Signs and Symptoms
This is a pain in calves with activity due to decreased oxygen to the muscles.
What is intermittent claudication?
What is an ABI and how do you calculate it?
What is ankle brachial pressure?
What is the highest systolic ankle pressure over the highest systolic brachial pressure for each limb?
The ACC/AHA recommends all patients with symptomatic PAD to be on...
What is a high-intensity statin?
In this condition skin typically appears hardened, leathery and has a brownish discoloration.
What is venous insufficiency?
This is the single greatest modifiable risk factor
for the development and progression of PAD...
What is smoking?
This is the leading cause of peripheral arterial disease (PAD)?
What is atherosclerosis?
With your handheld doppler, you obtain the following systolic blood pressures:
Left brachial: 130
Left DP: 98
Left PT: 103
Calculate the ABI...
Using the highest left ankle pressure (103) over the highest brachial pressure (130), the calculated ABI for the left limb is 0.79
What is the target LDL for individuals with PAD and another major atherosclerotic cardiovascular disease event (or 2 minor risk factors)?
What is LDL<70?
*ACC for Very High Risk patients: LDL-C < 55 mg/dL.
In this condition skin typically appears shiny, hairless, dry, flaky, pale or mottled.
What is peripheral arterial disease (PAD)?
What are other modifiable risk factors (5)?
What are diabetes, HTN, HLD, obesity, sedentary lifestyle?
What is a symptom of PAD that can occur only in men?
What is erectile dysfunction?
What does it mean to have an ABI value > 1.4?
What is paradoxically indicate advanced PAD, with calcified vessels that resist compression by the blood pressure cuff, falsely elevating the ABI?
This medication is contraindicated in patients with heart failure...
What is Cilostazol?
- Due to a class effect of phosphodiesterase inhibitors increasing long-term mortality in patients with reduced ejection fraction.
Pain behind the knee, tender to touch, aggravated by walking but not relieved by rest...
What is a Baker's cyst?
Non-modifiable risk factors (6)?
What are age, family hx, race/ethnicity (AA higher risk), genetics, CKD, CAD*?
Dead tissue due to lack of blood flow?
What is gangrene?
Who should be screened with ankle brachial index (ABI) for PAD? (4)
1. All patients older than age 65y
2. Age > 50-64 with risk factors
3. Patient < age 50y if diabetes and 1 other risk factor (smoking, HTN, HLD)
4. Exertional leg symptoms and/or non-healing wounds
First line therapy for symptomatic PAD? (2)
Supervised exercise therapy and antiplatelet therapy (aspirin or clopidogrel).
-European guidelines favor clopidogrel over ASA
*If patient has been recently revascularized then DAPT
This presents classically in young, female patients with paroxysmal color changes of fingers and/or toes in response to cold or stress...
What is Raynaud’s phenomenon?
This is the most serious complication of PAD...
Critical Limb ischemia
What are the 6 "P's" in acute limb ischemia?
Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (Perishingly Cold): The affected limb feels cold and loses its ability to regulate temperature, becoming the same temperature as its surroundings.
What imaging modalities would you consider (4)?
Duplex ultrasound, CTA, or MRA. Invasive angiography
What are the indications for vascular surgery referral?
What are patients with moderate to severe arterial disease?
ABI 0.5 – 0.8
ABI < 0.5
An idiopathic condition affecting young, female patients, characterized by painless, cool, bluish discoloration of the feet and strong pulses...
What is Acrocyanosis?
Patients with PAD have an increased rate of...(3)
What are ischemic stroke, (MI), and cardiovascular death?