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Exam 1: CAD & PAD

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what is a major symptom of PAD

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6 years ago

Date created

Mar 1, 2020

Cards (38)

Section 1

(38 cards)

what is a major symptom of PAD

Front

claudication pain -pain and/or cramping in the lower leg due to inadequate blood flow to the muscles -often happens with walking and resolves with rest

Back

Goals for PAD

Front

#1 goal= adequate tissue perfusion -never elevate (arteries- A's down) -Pentoxifylline -Anticoagulants Other goals: -relief of pain -increased exercise tolerance -intact, healthy skin

Back

what is the leading cause of PAD in a majority of the cases?

Front

atherosclerosis

Back

progressive narrowing and degeneration of arteries of upper and lower extremities

Front

peripheral artery disease (PAD) this disease is preventable!

Back

what is the ankle-brachial index (ABI)?

Front

PAD screening tool. Measures difference between ankle and brachial systolic pressures Divide ankle SBP by brachial SBP (A to B)

Back

what is the most effective therapy for claudification?

Front

walking 30-60 mins per day, 3-5 times a week

Back

procedures for PAD

Front

-angioplasty -stent placement -femoral-popliteal surgery -endarectomy- NOT in CAD -Go in and open artery & physically pull out the plaque—then sew it back up.

Back

nocturnal angina

Front

Angina that happens at night. wake up with chest pain

Back

important questions to ask with angina?

Front

-precipitaing factors -location of pain -length of time -alleviating factors -other associated symptoms

Back

Angina decubitus

Front

chest pain that occurs only while the person is lying down and is usually relieved by standing or sitting lying down increases preload and work load of heart causing chest pain

Back

Prinzmetal angina (variant)

Front

only angina that is not caused by cholesterol Plaque Caused by spasms in the arteries

Back

stable angina

Front

Symptoms subside after taking medication (nitro) or rest Can progress to unstable angina

Back

what is the first line therapy for lipid lower agents for CAD?

Front

statins -Give at night -muscle aches/weakness= big side effect - Need liver function tests b/c can decrease liver function

Back

diagnostic tests for PAD

Front

-doppler ultrasound- checks arteries & pulses(used frequently) -Segmental blood pressures- thigh, ankle, brachial & lower arm BP, check both sides -Angiography- the go to- inject dye and look at vessels -Duplex imaging- arterial to venous doppler -Magnetic resonance angiography: more specific to structure -Ankle-Brachial Index

Back

anticoagulants for PAD

Front

Blood thinner -warfarin -heparin (drip)- used in hospital -enoxaparin

Back

what are the stages of CAD?

Front

1. Fatty streaks - earliest lesion of atherosclerosis 2.Fibrous plaque - beginning of progressive change. collagen covers over the fatty streak & can narrow lumen borders 3.Complicated Lesion - final stage. Platelets accumulate in large numbers & totally occlude the artery

Back

thrombosis vs embolization

Front

Thrombosis: clot inside blood vessel obstructing blood flow Embolization: traveling clot embolus

Back

what happens with angina?

Front

-decreased oxygen -contractility ceases (no cardiac output from cell) -myocardial cells are deprived from O2 -anerobic metabolism--> lactic acid build up- irritates nerve roots -pain messages sent to cardiac nerves & upper thoracic posterior nerve roots

Back

Assessments for PAD

Front

The 6 P's -pain -pallor -pulselessness -parasthesia -paralysis -Poikilothermia- coolness -Loss of hair on lower legs -Thickened or brittle nails -Thin, shiny, taut, dry skin -Cool skin temperature -Erectile dysfunction -Reactive hyperemia -Rest Pain -Claudication pain- walking and you get a bad pain in the calf

Back

Heparin lab values

Front

Ptt (aPtt) normal level: 30-40 sec Therapeutic level= 1.5 to 2.5 x the control (60-90)

Back

drug therapy for CAD

Front

ACE-I (i.e. captopril, Lisinopril, enalapril) Beta blockers (i.e. metoprolol, labetalol) Nitrates (i.e. nitroglycerine, isosorbide dinitrate) Anti-hyperlipidemics Calcium channel blockers (i.e. verapamil, diltiazem) ARB (i.e. losartan)

Back

anti-platelet therapy in PAD

Front

keep blood slippery -aspirin -Clopidogrel (plavix) combination not recommended unless selective high risk PAD patient

Back

Warfarin lab values must be closely monitored

Front

PT/INR (as easy as 1-2-3) normal: 1 therapeutic: 2-3

Back

what are the normal lipid levels?

Front

triglycerides: < 150 mg/dL LDL: < 130 HDL: > 45 LDL/HDL ratio: < 3.25

Back

complications from PAD

Front

prolonged ischemia leads to many problems -Delayed wound healing - Wound infection -Tissue necrosis -Arterial ulcers -Gangrene—most serious complication—most likely amputated (d/t unable to get blood flow back) dry gangrene self-amputates

Back

silent ischemia

Front

Not true, stabbing, crushing chest pain (or classic chest pain)—often associated with diabetics (d/t neuropathy) Presentations: SOB, feeling of doom

Back

unstable angina

Front

chest pain that is new in onset, occurs at rest, or occurs with increasing frequency, duration, or with less effort than the patient's chronic stable angina pattern. priority patient, need to intervene!

Back

first thing to do with chest pain?

Front

apply O2 and then call the doctor

Back

how to care for the ischemic leg

Front

-Inspection, cleansing, & lubrication of feet -NO lubrication between toes or soaking of feet -Wound care (if ulceration keep dry and clean) -Avoid chemicals, heat, and cold -Heels free of pressure (place pillow underneath calves) -Protect extremity from trauma -No restrictive clothing

Back

what are the drugs used to stop smoking?

Front

Zyban & Chantix

Back

what happens when the coronary arteries narrow?

Front

less blood flow is able to reach the heart muscle which can lead to ischemia

Back

when do clinical manifestations of PAD occur?

Front

when the artery is 60-75% occluded

Back

coronary artery disease (CAD)

Front

blood vessel disorder caused by atherosclerosis (soft deposits of fat—known as plaque—harden with age and become occlusive)

Back

Normal ABI (ankle brachial index): Moderate PAD: Severe PAD:

Front

Normal: 0.91-1.30 Moderate PAD: 0.41-0.70 Severe PAD: ABI <0.40 (surgery needed)

Back

is there distention or edema in peripheral artery disease?

Front

No

Back

what are the anti-claudification drugs and what do they do?

Front

Pentoxifylline -improves the deformability of RBCs and WBCs and decreases fibrinogen concentration, platelet adhesiveness, and blood viscosity. (vasodilator & anti-inflammatory) Cilostazol (Pletal) -inhibits platelet aggregation & increases vasodilation -Do NOT use with heart failure

Back

post procedure assessments

Front

-Assess q15 min for 1 hour THEN hourly - should have a palpable pulse after procedure- If they NO LONGER have a pulse YOU CALL MD -Assess 6 P's—compartment syndrome and v/s -Bleeding, Hematoma -Thrombosis -Embolization

Back

in the segmental blood pressure test a doppler ultrasound & sphygmomanometer at the thigh, below the knee, & at the ankle while the patient is supine. What reading indicates PAD?

Front

A drop in systolic BP of greater than 30mmHG = PAD

Back