Term
| In what extremities is PVD more symptomatic? |
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Definition
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Definition
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Term
| What is the prognosis for ppl w/ PVD? |
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Definition
| 50% of pts w/ PVD will have a major CV event in 5yrs. 25% will be dead in 5yrs. |
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Definition
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Definition
| Take radial (not brachial) pulse of both arms and use the highest. Take the post tib and dorsalis pedis and use whichever is highest. ankle systolic/radial systolic = ABI. |
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Term
| What are the landmark ABI values and their meanings? (6) |
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Definition
| >.95 = normal. <.95=PVD. <.6=Intermittent Claudication, <.5=Multilevel disease, <.26=resting ischemic pain. <.2=gangrenous extremity. |
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Term
| What is the earliest and most common presenting Sx? |
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Definition
| Intermittent claudication. |
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Term
| What is critical leg ischemia? Is this common in PVD pts? |
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Definition
| Enough ischemia to cause gangren. Not many PVD pts have this. |
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Term
| Define stable claudication. |
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Definition
| Very predictable and easy to ID which activites cause the claudication. |
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Term
| Once intermittent claudication is present, what is the best outcome you can hope for? |
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Definition
| Stable claudication. It won't go away completely but you can at least get it to the point of being predictable. |
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Term
| What are the major risk factors for PVD?(7) |
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Definition
| 1. Age, 2. Gender. 3. Smoker 4. Diabetes 5. HTN 6. Hyperlipidemia 7. Homocystine |
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Term
| What is the muliplicative effect? |
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Definition
| 2 risk factors don't necessarily double the risk. It may triple or quadruple it. |
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Term
| What are the goals for PVD Tx?(2) |
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Definition
| Prolong life and QOL, and decrease adverse cardiovascular events. |
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Term
| What are the major Tx areas appropriate for all PVD pts? (4) |
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Definition
| 1. Smokin cessation. 2. Platelet inhibition 3. Lipid Tx 4. Exercise training |
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Term
| Additional PVD Tx goals for some pts as appropriate: (3) |
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Definition
| 1. Control diabetes 2. BP control 3. Weight loss |
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Term
| Does diabetes control help PVD or CAD more? |
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Definition
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Term
| What are some platelet inhibiting meds, and +/- of each? (3) |
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Definition
| Asprin: cheap/GI side effects. Clopidogrel(plavix): good drug/expensive. Warfarin(coumadin):No GI probs, cheap/more expensive than asprin. |
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Term
| What drugs are given for BP control? |
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Definition
| ACE inhibitors, Calcium channel blockers, Beta blockers |
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Term
| What is the painful walking questionnaire? |
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Definition
| Looks at walking distance, speed and impairment. Asks questions about ADLs/walking activites and the difficulty w/ that activity is ranked on a lichert scale. |
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Term
| What is the recommended exercise for PVD?(5) |
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Definition
| 1. Train to max pain 2. Train>6mos 3. Training=walking 4. 3x/wk supervised, 2/wk indep. 5. 30min/session, excluding rests. |
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Term
| Research found that walking at least 2x/wk to claudication pain resulted in changes. What were they? (4) |
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Definition
| Increased pain-free walking distance, Increased max walk time, Mean ABI improved, peak exercise calf bld flow improved. |
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Term
| Exercise @ 40% VO2peak but still into painfiul claudication range resulted in what? (6) |
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Definition
| Increased VO2peak 15-30%, Increased fiber size, mitochondrial # and vol, Oxidative enzymes, leg perfusion, a-vO2. |
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Term
| How do vasodilators impact PVD? |
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Definition
| They don't, because they don't affect stenotic vessels. |
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Term
| The medications pentoxifulin and cliostazol do what in the Tx of PVD? |
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Definition
| 1. Increase cAMP which effects RBC flexibility. 2. Vasodilative effect. 3. Changes plasma viscosity. |
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Term
| Which is a better tx for PVD: exercise or meds? |
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Definition
| Walking is far more effective than meds. |
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Term
| What are the general exercise recommendations for pts w/ PVD? |
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Definition
| 3-5x/wk, produces leg pain within 5 mins, start @15min -> 35-50min/session, Walking (non WB warm up and cool down can be used), for at least 6 months. |
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