Peripheral vascular dysfunction and other contributors to cardiac dysfunction

Question 1

Metabolic syndrome, dysmetabolic syndrome or syndrome X

Answer 1

• a cluster of conditions that occur together increasing risk of heart disease, stroke and type 2 diabetes
• the presence of at least three of the diagnoses in an individual confirms the condition of metabolic syndrome

Question 2

What combinations of conditions are incluced in metabolic syndrome

Answer 2

• visceral obesity
• insulin resistance
• hTN
• high triglycerides
• low HDL cholesterol

Question 3

Microvascular complications of diabetes

Answer 3

• eye: damage to eye blood vessels = retinopathy, cataracts and glaucoma
• kidney: damage to small blood vessels overworks kidneys resulting in nephropathy
• neuropathy: damages PNS

Question 4

Macrovascular complications of diabetes

Answer 4

• brain: increase risk of CVA/TIA
• Heart: increase risk of CAD
• Extremities: PVD

Question 5

Complications of body weight

Answer 5

• impaired fasting glucose
• metabolic syndrome
• HTN
• dyslipidemia
• early plaques and CAD
• psychosocial issues
• higher risk of DVT/PE
• undiagnosed sleep apnea/restrictive lung disease
• higher risk of cardiac arrhythmias/sudden death
• susceptible to pressure wounds and skin infections

Question 6

Peripheral Arterial disease

Answer 6

• angina of the LE
• ischemia to LE tissue
• pain is referred to as intermittent claudication
• pain occurs with activity initially is relieved by rest
• benefit from exercise esp. walking to tolerance

Question 7

Ischemia Pain scales

Answer 7

• higher number equates to increased more debilitating pain
• intermittent claudication rating scale 0-4

Question 8

PAD walking program

Answer 8

• warm up
• then walk at a speed that elicits mild symptoms within 3-5 minutes
• continue walking until pain is moderate, rest until resolved and then walk again
• Goal = 30+ minutes of walking to assist with development of collateral circulation in LE’s
• walk into the 2/3 level of pain

Question 9

Ankle brachial index

Answer 9

• BP in ankle compared to brachial artery
• less BP in LE (low ABI) = likely PAD/arterial insufficient

Question 10

Progression of Arterial insufficiency

Answer 10

1. painful walking (intermittent claudication)
2. elevated foot develops increased pallor (lose the assistance from gravity)
3. venous filling delayed following foot elevation
4. redness of distal limb (depended rubor)
5. death of tissue (gangrene)

Question 11

Carotid artery blockage treatment

Answer 11

• large % of blockage = can do carotid endarterectomy
• plaque is removed and incision repaired with stitches
• can also get carotid artery stenting = plaque removed and stent put in

Question 12

Renal stenosis

Answer 12

• a blockage of the renal artery
• this artery can also be stented
• kidney will atrophy and can increase fluid in the body if the kidney is not filtering it out

Question 13

Abdominal aortic aneurysm

Answer 13

• dilation/buldging of the artery wall
• can be caused by HTN and atherosclerosis
• triple A

Question 14

Aortic dissection

Answer 14

• a serious condition which a tear occurs in the inner layer of the aorta
• blood rushes through the tear, causing the inner and middle layers to split
• mostly seen in males over 60 years old
• symptoms mimic and MI but often experience back pain

Question 15

Aortic rupture

Answer 15

• disection requires immediate treatment
• can lead to aortic rupture which is through the entire vessel
• significant back pain

Question 16

Open repair vs endovascular aneurysm repair

Answer 16

• the point of entry for endovascular repair is via the femoral artery to insert a stent (the stent gives structure and strength)
• the open repair will be a graft that is usually synthetic

Question 17

Venous insufficiency

Answer 17

• due to not have muscular walls veins need valves
• if the valve doesn’t close properly = back flow

Question 18

Venous insufficiency: varicose veins vs chronic venous insufficiency

Answer 18

• varicose veins = bulging veins
• chronic: leg swelling –> skin color and texture changes –> venous ulcers

Question 19

hemosiderin staining

Answer 19

• related to venous insufficiency
• brown color
• extra pressure causes RBCs to be pushed out of the circulation and die
• the color comes from the Fe

Question 20

What is a DVT

Answer 20

• a blood lot that forms in a deep vein of the leg or pelvis either partially or totally blocking the flow of blood
• pt can have stasis/poor valves = stagnate blood
• hypercoaguabilty
• endothelial trauma
  have one of the three/combination

Question 21

What is pulmonary embolism caused by

Answer 21

• caused when
  1. DVT or part of it breaks off from the vein
  2. the break away clot travels through the bloodstream, too the heart and migrates towards the lung
  3. the clot blocks a vessel in the lungs interrupting blood supply

Question 22

S&S of DVT

Answer 22

• swelling
• pain or redness
• warmth
• red or discolored skin
  not all people with DVT have symptoms

Question 23

S&S of PE

Answer 23

• unexplained SOB
• chest pain and or palpitations
• anxiety and or sweating
• cough (may be blood tinged)
• fatigued and/or fainting

Question 24

What diagnostic test DVT/PE

Answer 24

• blood test for PE = D-dimer
• wells prediction rule for DVT
• Wells production rule for PE

Question 25

Pulmonary embolism and Heart failure

Answer 25

- Dependent on the size and the location of the embolism - tissue death of pulmonary cells - increase pulmonary artery pressure - increase stress on the right side of the heart - if large enough to block a significant amount of blood volume can impact V/Q and creates deadspace

Question 26

Treatments for hypercoaguability/PE

Answer 26

- thrombolytic meds - anticoags - oxygen - embolectomy - insertion of IVC filter

Question 27

IVC filter

Answer 27

- go in through femoral artery - will be inserted in the vena cave to catch clots - typically will be removed once the co-agulation condition is under control

Question 28

May-thurner syndrome

Answer 28

- iliac vein compression - an anomaly where the right iliac artery compresses the left iliac vein against the spine - blood is not flowing freely

Question 29

Renal insufficiency/kidney failure effects what systems

Answer 29

- hematlogic - cardiovascular - metabolic - neurologic - musculoskeletal

Question 30

Treatment for renal insufficiency/kidney failure

Answer 30

- dialysis - transplant

Question 31

Kidney failure

Answer 31

- Acute renal failure - chronic renal failure (end stage renal disease) - stage 1-5 - typically don't know until stage 3

Question 32

hemodialysis

Answer 32

- uses dialysis machine to filter blood external to the body - access is gained via: central venous catheter, AV fistula. AV graft

Question 33

Peritoneal dialysis

Answer 33

- uses the peritoneum within the abdominal cavity as the membrane through which toxins are exchanged with the blood - access via intrabdominal catheter

Question 34

AV fistula

Answer 34

- used for hemodialysis - connects an artery/vein

Question 35

AV graft hemodialysis

Answer 35

- under the skin to connect the artery and vein - material self seals - don't take BP/put pressure in this arm

Question 36

How does hemodialysis work

Answer 36

- uses a lower concentration of toxins then in the blood to get them to move out of the blood into the machine - people typically will gain weight between dialysis - dry weight = weight after dialysis

Question 37

Peritoneal dialysis (how it works)

Answer 37

- Waste products cross the semipermeable membrane into the peritoneal space - typically used at home

Question 38

Kidney transplant

Answer 38

- types of donors: living, deceased, paired - typically added to around the hip area of the abdominal cavity - other kidney atrophies