3BDS: CVD4

what is peripheral vascular disease

Atherosclerosis affecting peripheral (arteries) vessels
- In lower limbs
- Abdominal aorta

Chronic insufficiency blood supply to feet can cause an infarction of the feet. (pulseless, painful, numb feet

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what are the symptoms of chronic ischaemia in feet (+what is intermittent claudication)

symptoms of chronic claudation:
skin changes (ulcers, hair loss), nail changes (brittle),
intermittent claudication= leg pain typically in calf occurring when walking a distance, relieved by resting

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what are the symptoms of critical limb ischaemia (embolus or atherosclerosis plaque rupture)
acute ischaemia of lower limb

may be a background of intermittent claudication, severe constant pain in foot, calf, leg at rest
pale, pulseless, perishing cold, paralysis, paraesthesia of limb, gangrene, limb threatening.

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what is the management of PVD

• Risk factor modification (stopping smoking, managing hypertension/ diabetes/weight, diet)
• Exercise programme
• Surgery (bypass grafts, stents, amputation of limb)

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What is PVD- abdominal aortic aneurysm

symptoms

damage to vessel wall from atherosclerosis = dilated aorta. risk of catastrophic rupture or tear

often asymptomatic, sometimes vague abdominal pain, often presents acutely with rupture- Collapse, severe abdominal pain, surgical emergency, high mortality

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how does ischaemic heart disease manifest as

• Stable angina – exertional
• Acute coronary syndrome- symptoms as rest (unstable angina, myocardial infarction)
• Heart failure
• Arrhythmias

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what is the difference between ischaemia and Myocardial infarction

Ischaemia results when the heart muscle is starved for oxygen and nutrients due to atherosclerosis . When damage or death of part of the heart muscle occurs as a result of ischaemia= MI

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how does ischaemic heart disease manifest as stable angina

due to narrowing of coronary arteries by atherosclerosis.
lack of blood (oxygen) to heart- ischaemia- visceral pain

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what are the symptoms of angina

exertion central chest pain radiating down left arm. atypical= jaw, back, upper abdomen
can often be perceived as heaviness or breathlessness. sometimes associated nausea. often gets better with rest and nitrates if patient has a GTN spray

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what is the management of stable angina

- Lifestyle modification (adjust modifiable risk factors)
- Managing underlying medical conditions (diabetes, HBP, cholesterol)

- Medical management
Anti platelets-> aspirin, clopidogrel
Cholesterol-> statin
Symptom relief-> vasodilators= beta blockers

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what is acute coronary syndrome

unstable angina (myocardial ischaemia), myocardial infarction (both present with the same symptoms, with ate most often due to atherosclerosis of coronary arteries )

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what are the symptoms of acute coronary syndrome

- more severe than angina but sometimes indistinguishable.
-central crushing chest pain at rest or on minimal exertion
- pain maybe felt as indigestion, radiation does left arm or to jaw
- often clammy, nauseated, dizzy, breathless
- feeling of imminen

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what is the management of acute coronary syndrome

1. phone 999
2. sit the patient up
3. give high flow oxygen
4. give GTN spray 2 puffs sublingually (up to 3 doses 5 min apart)
5. give aspirin 300mg

also- send someone for the AED, ABCDE assessment , stay with patient, give 3 doses GTN 5 min apart, write

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Why shoudnt you give intramuscle injection to patients with acute coronary syndrome

if given anti-platelets in hospital, they will bleed

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3BDS: CVD4

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