3 layers of arteries
intima
media
adventia
Intima (artery)
where atheroma formation begins (fatty streaks)
Media (artery)
smooth muscle cells that dilate and constrict to accommodate BP and flow
consists of elastin
b/c of weaker wall structure leg veins are susceptible to:
irregular dilation, compression, ulceration, and invasion by tumors
peripheral vascular: common/concerning symptoms
abdominal, flank, back pain
pain/weakness in arms/legs
intermittent claudication
cold, numbness, pallor in legs; hair loss
swelling in calves, legs, feet
color change in fingertips, toes in cold weather
swelling w/ redness/tenderness
Peripheral Arterial Disease
refers to stenotic, occlusive, and aneurysmal disease of abdominal aorta, its mesenteric and renal beaches, and the arteries of the lower extremities, exclusive of the coronary arteries
intermittent claudication (pain/cramping in legs during exertion relieved by 10 min rest) - abnormal dx?
atherosclerotic PAD
neurogenic claudication
spinal stenosis (pain relived by sitting/bending forward)
hair loss over anterior tibiae -abnormal dx?
decreased arterial perfusion (dry, brown-black ulcers from gangrene may ensue)
PAD warning signs
- fatigue, aching, numbness, pain that limits walking or exertion in legs
- erectile dysfunction
- poor wound healing of legs/feet
- pain present when ar rest in lower leg/foot and changes when standing/supine
- abdominal pain after meals, “food fear”, weight loss
- first degree relatives w/ AAA
Ankle-Brachial Index
dx PAD non invasively
ratio of BP measurement in foot and arm
values <0.9 abnormal
conditions suspicious of renal artery disease
- HTN onset <30y/o
- severe HTN onset < 55y/o
- accelerated, resistant, malignant HTN
- new worsening renal fx or worsening fx after ACE-I or ARB
- unexplained small kidney size discrepancy of 1.5cm between 2 kidneys
- sudden unexplained pulmonary edema w/ worsening renal fx
asymmetric arm BPs - abnormal dx?
coarctation of aorta
dissecting aortic aneurysm
Pulse Grading
3+ bounding (aortic regurgitation)
2+ brisk, normal
1+ diminished (arterial occlusion)
0 absent
enlarged epitrochlear node - abnormal dx?
local or distal infection
lymphadenopathy from lymphoma
HIV
brownish discoloration or ulcers near ankles - abnormal dx?
chronic venous insufficiency
thickened, brawny skin - abnormal dx?
lymphasema
advanced venous insufficiency
Allen Test
- compress radial and ulnar arteries w/ hand in fist
- open hand: palm pale
- release ulnar pressure than radial
palmar flushing = negative
palmar pallor = positive
Epitrochlear Nodes
flex elbow 90degrees
support forearm
in groove between biceps and triceps muscle, 3cm above medial epicondyle
3 types of peripheral edema:
Pitting: soft, bilateral palpable swelling from increased interstitial fluid volume and retention of salt/water
Chronic Venous Insufficiency: soft w/ pitting on pressure, occasionally bilateral, BRAWNY changes, skin THICKIENING near ankle
Lymphedema: initially soft and pitting then indurated, hard, & non pitting, skin thickened, ulceration rare, no pigmentation
Chronic Arterial vs. Venous Insufficiency:
Pain
A: intermittent claudication progressing to pain @ rest
V: painful
Chronic Arterial vs. Venous Insufficiency: Mechanism
A: tissue ischema
V: venous stasis and HTN
Chronic Arterial vs. Venous Insufficiency: Pulses
A; decreased or absent
V: normal, hard to feel through edema
Chronic Arterial vs. Venous Insufficiency: Color
A; pale on elevation, dusky red on dependency
V: normal or cyanotic on dependency, petechiae and then brown pigmentation
Chronic Arterial vs. Venous Insufficiency: Temp
A; cool
V: normal
