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Section 1

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Risk Factor Modification

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Last updated

6 years ago

Date created

Mar 1, 2020

Cards (12)

Section 1

(12 cards)

Risk Factor Modification

Front

Smoking: -Ask current and former smokers about tobacco use at every visit and/or advise them to quit -Assist patients with counseling and developing a plan for quitting that includes pharmacotherapy (i.e., varenicline, bupropion, NRT) and/or referral to a smoking cessation program -Avoid exposure to environmental tobacco smoke at work, home, and public places Hyperlipidemia: -PAD is a form of clinical ASCVD -Statins are indicated for all patients HTN: -ACE-inhibitors or ARBs are preferred if the patient has HTN Diabetes: -Proper foot care and self-foot examination -Biannual comprehensive foot exams -Wounds +/- signs of infection should be addressed quickly -Goal A1C < 7%

Back

Anti-platelet Therapy

Front

Indicated for risk reduction (MI, stroke, vascular death) in all symptomatic patients - Does not reduce symptoms -Consider for asymptomatic patients with ABI < 0.90 -Use in asymptomatic patients with ABI 0.91-0.99 is uncertain -Consider combination therapy for symptomatic patients after revascularization; otherwise, the benefit is uncertain -Clinical benefit of vorapaxar and warfarin are uncertain 1. ASA 75-325 2. Clopidogrel 75 mg po qd 3. DAPT 4. Do NOT use Vorapaxar, warfarin, ticlopidine,Aggrenox

Back

Cilostazol

Front

Pletal Indication: Symptomatic PAD pts with lifestyle limiting claudication in addition to aspirin/clopidogrel 100mg po BID CI: HF, d/c after 3 months with no improvement, d/c 2 days before surgery, pregnancy (category C)

Back

PAD Disease Progression

Front

1.Asymptomatic 2. Intermittent with exertion 3. mild-Mod.-Sev. symptoms with exertion 4. symptoms at rest 5. minor tissue loss 6. gangrene

Back

Lower Extremity PAD Presentation

Front

Asymptomatic(20-50%) Symptomatic: Atypical leg pain (40-50%) Intermittent claudication (10-35%) Critical limb ischemia (1-2%) S: Claudication, pain, fatigue, discomfort, cramping C: Intermittent but can be persistent H: Reproducible, consistent presentation O: After same degree of exercise L:Buttock, thigh, calf muscles, and rarely the foot A:Exercise R: resting(within 10 minutes)

Back

Common Arteries affected by PAD

Front

Illiac Femoral Popliteal Tibial (anterior/posterior)

Back

Revascularization

Front

Indication: for lifestyle-limiting claudication symptoms and inadequate response to guideline-directed management and therapy - Invasive (e.g., angioplasty, stent placement, bypass, amputation)

Back

Differential Diagnosis

Front

-Neurologic conditions (e.g., peripheral neuropathy) -Inflammatory conditions (e.g., arthritis) -Vascular conditions (e.g., deep vein thrombosis) -Medications

Back

Screening

Front

-Age >/= 65 -Age 50-64 with atherosclerotic risk factors or family history of PAD -Age < 50 with diabetes mellitus and 1 additional atherosclerotic risk factor -Known atherosclerotic or vascular disease in other areas of the body -Overt symptoms of PAD

Back

Atherosclerotic Risk Factors

Front

DM Tobacco Use Hyperlipidemia HTN

Back

Treatment Algorithm

Front

1. PAD Diagnosis 2. Risk Factor Modification(everyone): DM, HTN, Hyperlipidemia, Smoking 3. Anti-platelet Therapy(all symptomatic and some asymptomatic patients) 4. Symptomatic Treatment (ONLY symptomatic pts.) - Cilostazol -Structured Exercise Therapy - Revascularization

Back

Diagnosis (PH,Pt. Exam, Symptoms, Diagnostic testing)

Front

PH questionnaires: (e.g., Rose, WHO/Rose, Edinburgh, San Diego) PE: Decreased blood flow in extremities -shiny skin, lack of hair, cool skin temperature, thickened toenails, nonhealing wounds, discolored wounds, abnormal pulses Diagnostic Testing- ABI -Others (toe brachial index, treadmill exercise test, ultrasound, angiography) </=0.9= Abnormal (PAD) 0.91 - 0.99 = Borderline 1 - 1.4 = normal >1.4 = Abnormal (Noncompressible Arteries)

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