Danielle Duchaine
Cardiopulmonary Diseases and Disorders
Peripheral Artery Disease
Introduction & Thesis statement
Pathophysiology: the disordered physiological processes associated with PAD, abnormal functioning of diseased vasculature with applications to medical procedures and patient care, emphasizes quantifiable measurements, looks at the specific malfunctioning that comes from or causes disease
Peripheral artery disease is a narrowing and hardening of the blood vessels that supply oxygen and nutrients to the periphery of the body. Arterial occlusion from atherosclerosis could be found in many locations throughout the body; however, the lower extremities are affected more often than the upper extremities. This narrowing is caused by the
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They may not have pain with exercises, however, their distal lower extremity pulses may be weak or absent. In stage two, the patient will have consistently reproducable pain with exercise. Exercise may cause burning and cramping muscle pain, which alleviated by rest. If a patient is in stage three, their symptoms will happen with exercise and at rest. In this stage, the pain may wake the patient up at night, and may be relieved by hanging the leg off of the side of the bed. These patients will prefer sitting with their legs low, as in a recliner, because gravity will help force blood down into their distal lower extremities. This could cause some edema. Pain in stage three is often described as numb, burning, or a toothache-type …show more content…
This could involve revascularization procedures like endarterectomy or arterial bypass, or percutaneous catheter interventions involving angioplasty and stent placement. 4% of patients with PAD will need major amputation, and 16% will see an increase in the severity of their intermittent claudication over time.3
Brief Overview of medical and pharmacological Management
Pharmacologic management of PAD typically involves statins, which help manage cholesterol, and antihypertensives to decrease blood pressure. Anti-platelets including aspirin (for later stages) and clopidogrel (Plavix) can be used to reduce the risk of vascular accidents in patients with PAD.4
Cliostazol (Pletal) and pentoxifylline (Trental) are both newer drugs for treating intermittent claudication; they inhibit platelet aggregation and dialate arteries to decrease platelet coagulation and increase blood supply to the lower extremities. 4
Lifestyle changes may also be beneficial to the patient. They should quit smoking, and exercise regularly to improve collateral circulation in the lower extremities.5 If the patient is diabetic, it is important to ensure that their diabetes is well
Ace Inhibitors are used to treat hypertension and congestive heart failure (CHF). Most of the drugs that are Ace Inhibitors have the common ending –pril. It inhibits an enzyme; that decreases the tension of blood vessels and the blood volume, thus lowering blood pressure. Lotensin (benzapril) comes in tablets and is used for oral administration. It is one of the ace inhibitors that are indicated for treating hypertension. There is warning while using Lotensin when pregnant, it indicates to stop using immediately when pregnancy is detected. Vasotec (enalpril) comes in tablets and injection. It is indicated for the treatment of hypertension and is effective alone or in combination with other Ace Inhibitors agents, especially thiazide-type diuretics. There is a warning for fetal toxicity; when pregnancy is detected; stop using.
...so discuss making a exercise plan that will work for the patient, and will not cause him/her any pain. If all of the correct measures are taken, and the patient is taking care of themselves, they can prevent more serious complications from occurring. They must know that they are serious complications from one not taking care of themselves, or living a unhealthy life style. It does involve a lifelong commitment to change. Medication will help, but one must also be willing to change.
Transcatheter aortic valve replacement (TAVR) introduction to the clinical practice revolutionized the interventional cardiology ,it is a valuable option for a non –operable patient with sever aortic stenosis or high risk population however ,TAVR is associated with a risk of cerebral embolization and ischemic vascular events and possible neurological impairment the estimate of these complication is vary but it have been reported early and late after the procedure moreover the reported incidence of bleeding associated with TAVI is relatively high .with this given incident of complication required adequate antithrombotic therapy during and following procedure ,however despite the current guidelines recommendation the optimal antithrombotic is not very well established .
Ofri, D (2000). Diagnosis and Treatment of Deep-Vein Thrombosis. Western Journal of Medicine; 173: 194-197.
Although atherosclerosis affects millions of people around the world, there are many ways to prevent and treat it once it has developed. Simple life style changes can greatly reduce the inflammation and damage to the endothelial wall of the artery. It is very important that people who have high blood pressure or diabetes get regular checkups; if atherosclerosis goes untreated, the adverse effects, such as stroke or myocardial infarction can be deadly.
Peripheral Vascular Disease (PVD) is a generalized term referring to a spectrum of vascular disorders that alter the structure or function on any non-coronary artery. Atherosclerosis is the most common vascular disorder affecting the peripheral arteries (Ali & Carman, 2012). Atherosclerosis, commonly known as hardening of the arteries, is a general vascular disorder that can be located in any blood vessels throughout the body. It causes a reduction of blood flow and loss of function. Peripheral Arterial Disease (PAD) is a blood vessel disease resulting from atherosclerosis. PAD focuses on how that reduced blood flow affects the lower extremities. PAD affects approximately 8.5 million adults 40 and older in the United States (Kohlman-Trigoboff, 2013).
Some of the symptoms include itching and ulcers. There may also be symptoms of venous insufficiency such as calf pain and tenderness, ankle swelling and a heaviness in your legs that gets better when you sit down.
The visual analysis of this graph shows that the medication, Nuedexta®, reduced the number of PBA episodes for this patient. During the baseline period, episodes of PBA were stable as evidenced by the flat baseline trend. The patient was experiencing between 7 – 9 episodes of PBA daily prior to the introduction of the initial dose of Nuedexta®. When Nuedexta® was introduced once a day for 7 days during the initial intervention (B), PBA episodes decreased with the patient experiencing between 5 - 7 episodes per day. The patient’s PBA episodes dropped to between 2 – 4 episodes per day when Nuedexta® was increased to twice a day during intervention (C).
Circulation, Stratified Meta-Analysis of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Hospitalized Patients, http://circ.ahajournals.org/content/128/9/1003.long
Peripheral artery disease is usually caused by atherosclerosis, which is when fatty deposits accumulate in the arteries of, most likely, limbs. This does affect all arteries throughout the body, then in turn, slowing the blood flow. PAD may also be due to inflammation of the blood vessels, injury to the extremities, or even exposure to radiation. “Peripheral arterial disease (PAD) affects approximately 10% of the American population” (Gurbir Dhaliwal; Peripheral arterial disease: Epidemiology, natural history, diagnosis and treatment; 2007). If not taken care of, PAD may lead to critical limb ischemia, open sores on the feet or legs that become infected by gangrene. The gangrene is then removed surgically, but doctors might have to amputate the extremity all together. Another issue that arises with PAD if it is not under control is the risk of stroke or heart attack. These can cause death to part of the heart or brain, or even death itself. The population more at risk would be smokers, diabetics, people who are obese, those with hypertension or hyperlipidemia, over the age of 50, have a family history of PAD, or those with a high level of homocysteine. If someone does fall into a few of these categories a physician can do a few tests to check for PAD. The doctor will more than likely start off with a physical exam, blood test, and possibly an ultrasound. From there the physician may try an ankle-brachial index, or ABI, which compares the blood pressure of the feet to the blood pressure of the arm. “An American survey of 2174 patients older than 40 years of age used the ankle-brachial index (ABI) as a screening tool, and showed a PAD prevalence of 0.9% between the ages of 40 and 49 years, 2.5% between the ages of 50 and 59 years, ...
The above history is suggestive of Critical Limb Ischemia due to reduced blood flow to legs leading to pain and gangrene. It is a kind of severe peripheral vascular disease and needs comprehensive management. The pain typically occurs at rest and wake up an individual at night. It is often relieved by hanging the leg over the bed or walking.
The coagulation studies show the clotting abilities of the blood and the amount of time it takes for the blood to clot. It is important for the blood to clot in order to prevent blood loss. However, if the factors tested by the coagulation test are not within the normal ranges, the patient is at risk for excessive bleeding or even unwanted blood clots in the body. The coagulation test is also done with patients who are on anticoagulant therapies. The results are used to adjust the doses, and the normal ranges are adjusted to reflect the fact that an anticoagulant is in use to prevent unnecessary blood clots, such as those that cause deep vein thrombosis and pulmonary embolism. The patient however was not on any anticoagulant medication therapies. The test was repeated after surgery in order to make sure no therapy was needed to prevent future clots from
A 76 years old patient was requested for interventional angiography with clinical detail of peripheral arterial disease. Patient has rest pain with duration of 4 weeks. ABI (ankle brachial index) test showed a value less than 0.9 which indicates significant peripheral arterial diseases. Conventional angiogram was requested to confirm the location and degrees of stenosis before revascularisation.
“If you’re at high risk for ischemic stroke, your doctor may prescribe drugs that reduce clots by interfering with the aggregation (clumping together) of blood cells called platelets” (Prevention of a Stroke 4). Your doctor would prescribe a specific type of medication called antiplatelet drugs. Anticoagulants (blood thinners), like antiplatelets, interfere with the formation of blood clots, but they work at a different stage in the clotting process- preventing the formation of fibrin, a protein that plays a role in blood clotting. “Statin medications lower blood cholesterol levels by blocking the activity of an enzyme crucial for the production of cholesterol by the liver. These medications also help stabilize plaques- the fatty deposits in arteries that can rupture and trigger the formation of a blood clot that can lead to a stroke” (Prevention of a Stroke 18). Statins are used to lower blood cholesterol levels and reduce inflammation in the artery walls. The medications your physician prescribes will depend on how great your risk of a stroke is as well as your risk of side effects from these
The purpose of treatment is to relieve his chest pain, maintain heart rhythm, decrease cardiac workload and preserve myocardial tissue. On recognition of STEMI signs and symptoms, John is administered with 300mg of Aspirin as a single dose, which is more than enough in order to achieve results within 30 minutes. As stated by Tiziani (2013), aspirin is an analgesic with an antiplatelet effect, by blocking the enzyme cyclooxygenase needed for thromboxane synthesis it inhibits platelet aggregation and vasoconstriction. Although beneficial for patients in reducing MI mortality, daily use of aspirin above 300mg does not have any further therapeutic benefit. It could increase the risk of adverse effects such as cerebral hemorrhage and gastrointestinal and for that reason, a lower dose should be prescribed with long term