PHAR 741

1. PHAR 741 Peripheral Vascular System

2. •Anatomy and Physiology Pregnant Women • Blood pressure decreases. • Peripheral vasodilation occurs. • Blood pools in legs. • Varicosities in legs and vulva may occur. • Hemorrhoids are common.

3. •Anatomy and Physiology Older Adults • Arteries calcify. • Arterial walls lose elasticity and vasomotor tone. • Superficial vessels become more prominent. • Increased peripheral vascular resistance elevates blood pressure.

4. Review of Related History

5. •Review of Related History History of Present Illness (1) • Leg pain or cramps • Onset and duration • Character • Skin changes • Dizziness • Fatigue • Wakefulness at night

6. •Review of Related History History of Present Illness (2) • Severe headaches • Onset and duration • Location • Character • History of hypertension • Swollen ankles • Onset and duration • Related circumstances • Associated symptoms

7. •Review of Related History History of Present Illness (3) • Treatment attempted • Rest • Massage • Heat • Elevation • Medications • Alternative therapies

8. •Review of Related History Past Medical History • Cardiac surgery or hospitalization • Chronic illness • Cardiovascular • Cerebrovascular • Endocrine (DM)

9. •Review of Related History Family History • Diabetes • Heart disease • Hyperlipidemia • Hypertension (HTN)

10. •Review of Related History Personal and Social History • Employment • Tobacco use • Nutritional status • Use of alcohol or illegal drugs • Use of alternative therapies

11. •Review of Related History Pregnant Women • Blood pressure elevation • Legs • Edema • Varicosities • Pain or discomfort

12. •Review of Related History Older Adults • Leg edema • Claudication • Medications

13. •Examination and Findings Peripheral Arteries • Three P’s of occlusion • Pain • Pallor • Pulselessness

14. •Examination and Findings Peripheral Veins • Venous obstruction or insufficiency • Thrombosis • Edema • Varicose veins • Assess for • Constant pain • Swelling or tenderness over muscles • Engorgement of superficial veins • Erythema and/or cyanosis

15. Common Abnormalities

16. Vascular Disease Peripheral obstructive disease Arterial embolic disease Deep vein thrombosis Varicose veins Raynaud’s Disease

17. Obstructive arterial disease • Caused by plaque buildup, similar to that in the heart. • Patients complain of fatigue, tightness of muscles, pain and weakness in their legs after walking or activity. • These symptoms are often termed intermittent claudication: meaning to limp intermittently.

18. Obstructive arterial disease

19. Risk factors • Male • Diabetes • Smoking • Age

20. Symptoms • Pain occurs after a predictable amount of activity. • Limb may appear normal and healthy. • Pulses may be diminished. • Hair on lower limbs and toes may be sparse or absent.

21. Arterial embolic disease (AED) • An embolus in the arterial system. • Occludes oxygenated blood flow to tissues below the block. • May lead to necrosis of tissue below blockage.

22. Risk factors for AED • Atrial Fibrillation • Prosthetic heart valves

23. Differential diagnosis of AED • Sudden onset of pain. • Distal to emboli the limb may feel: -Cold -Pale -Pulseless -Blue in color • Muscle tenderness

24. Deep vein thrombosis (DVT) • An clot that forms in veins. • Occurs in 2 milllion Americans each year.

25. Risk factors for DVT • Women • Age over 40 • Cardiovascular disease • Oral contraceptives • Hormone replacement therapy

26. Risk Factors for DVT • Prolonged immobility • Obesity • Cancer • Stroke • Surgery • Trauma

27. Signs of DVT • Swelling of affected leg • Possible pain • Skin warm to touch • Reddish-blue discoloration

28. Example of DVT

29. Differential diagnosis of DVT • Previous symptoms can be seen in with other disease problems. • Confirmation of DVT must be performed by diagnostic tests. -Duplex or Doppler ultrasonography -Venography -MRI

30. Undiagnosed DVT • If DVT is undiagnosed it can lead to even more severe pulmonary emboli.

31. Varicose Veins

32. Varicose Veins • Veins carry blood back to the heart and act as one way valves. • Blood can leak back, pool and get congested in the veins. • This can enlarge the veins and bring them closer to the surface and change color.

33. Varicose Veins • Most patients have no symptoms other than physical changes. • Risk Factors -Weak valves -Obesity -Hormone changes (puberty, pregnancy, menopause) -Leg injury -Standing for long periods of time

34. Raynaud’s disease (1) • Affects blood vessels in the fingers, toes, ears, and nose • Intense vasospasm triggered by cold or emotional stress • Women more likely than men to have the disorder

35. Raynaud’s Disease (2) • Cold initiates paroxysmal spasm of arterioles in the extremities • Arteries in fingers and toes may collapse

36. Raynaud’s Disease (3) • Three phases of skin discoloration • White – Pallor caused by spasm of arterioles and artery collapse. • Blue – Cyanosis may appear because of poor perfusion. Fingers and toes may be numb and cold. • Red – As the arterioles relax blood supply returns. May result in throbbing and tingling.

37. Raynaud’s Disease (4) • The order of color changes is not the same for all patients. • Not all patients will have all three color changes. • An attack can last from less than a minute to several hours.

38. Raynaud’s Disease • Non-drug Treatments • Take action during an attack. • Keep warm • Stop smoking • Control stress • Exercise regularly

39. Stasis Dermatitis • With ulceration

40. Stasis Dermatitis

41. Edema

42. Edema

43. Gangrene

44. Gangrene

45. Gangrene

46. Gangrene

47. Gangrene

48. Gangrene