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PAD- Atherosclerosis
- 1. Atherosclerosis. Layla Abd Alaziz Almzraq Tutor: Dr. Shimaa Group NO: 10
- 2. Learning objectives: Which investigation do you recommend to evaluate PAD? Which other tests would you like to perform? How would you treat the complains of this patient with PAD? What other medical treatments should this patient receive?
- 3. Introduction • Atherosclerosis is a disease in which plaque builds up inside the arteries. • Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
- 4. Introduction cont… Plaque hardens and narrows the arteries. Limits the flow of oxygen-rich blood to the organs and other parts of the body. Serious problems DeathStroke Heart attack
- 6. Learning objectives: Which investigation do you recommend to evaluate PAD? Which other tests would you like to perform? How would you treat the complains of this patient with PAD? What other medical treatments should this patient receive?
- 7. Approaches to reach the diagnosis: Approaches to reach the diagnosis History Examination Investigations
- 8. History Medical history • Risk factor for P.A.D ( diabetes, smoking, older age, hypertension, stroke). • Symptoms (Weak or no pulses in the legs or feet, lower temperature in one leg, decreased hair growth on the legs, intermittent claudication symptoms). Family history • Family history of heart and blood vessels diseases. • Father had MI (58y), mother had stroke (75y). Physical examination • Checking pulses by stethoscope (weak or absent pulses in legs or feet), • Lower temperature in one leg, atrophic leg or feet.
- 10. Investigations • Ankle Brachial Pressure Index • This test compares the blood pressure in the ankle with the blood pressure in the arm to see how well the blood is flowing
- 11. Investigations cont… • Ankle Brachial Pressure Index
- 12. Investigations cont… • Doppler Ultrasound Look at blood flow in the major arteries and veins. Handheld device is placed on: UE: over the axillary, brachial, ulnar, and radial arteries. LE: over the femoral, popliteal, dorsalis pedis, and posterior tibial arteries.
- 13. Investigations cont… • Stress Testing When the heart is working hard, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet the heart's needs. A stress test can show possible signs and symptoms of CHD, such as: Abnormal changes in the HR, BP, heart rhythm or heart electrical activity Shortness of breath or chest pain
- 14. Investigations cont… • Computed Tomography Scan The test can show hardening and narrowing of arteries.
- 15. Investigations cont… • Angiography Type of X-ray used to check the blood vessels.
- 16. Investigations cont… • Blood tests A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes
- 17. Learning objectives: Which investigation do you recommend to evaluate PAD? Which other tests would you like to perform? How would you treat the complains of this patient with PAD? What other medical treatments should this patient receive?
- 18. Treatment • There's no cure for Atherosclerosis (PAD), but lifestyle changes and medication can help reduce the symptoms.
- 20. Treatment cont… Medication • Cholesterol-lowering medications. To reduce the risk of heart attack and stroke. The goal for people who have PAD is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L).
- 21. Treatment cont… Medication • Medication to control blood sugar. • Medications to prevent blood clots. Because PAD is related to reduced blood flow to the limbs, it's important to improve that flow. Such as aspirin therapy or clopidogrel (Plavix). • Symptom-relief medications. The drug cilostazol (Pletal) increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have PAD.
- 22. Treatment cont… Medication • High blood pressure medications. If the patient have diabetes, your blood pressure target is under 130/80 mm Hg. Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering BP and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks. Calcium channel blockers. Diuretics.
- 23. Treatment cont… Surgery • Angioplasty. • In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow.
- 25. Treatment cont… Surgery • Bypass surgery. • Creating a graft bypass using a vessel from another part of the body or a blood vessel made of synthetic fabric. • This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
- 26. Summary: Ankle Brachial Pressure Index Computed Tomography Scan Doppler Ultrasound Investigations Stress Testing
- 27. Summary:
- 28. References: • Kumar & Clark’s Clinical Medicine Book (Ninth Edition), (Page 1049- 1056).
- 29. Questions?
- 30. THANK YOU
Hinweis der Redaktion
- Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.
- Both PAD and CAD are caused by atherosclerosis that narrows and blocks arteries in various critical Mild PAD may be asymptomatic or cause intermittent claudication; severe PAD may cause rest pain with skin atrophy, hair loss, cyanosis, ischemic ulcers, and gangrene. Peripheral arterial disease (PAD) occurs almost always in the lower extremities. Your doctor may ask: Whether you have any risk factors for P.A.D. For example, he or she may ask whether you smoke or have diabetes. About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing. Whether anyone in your family has a history of heart or blood vessel diseases. People who have P.A.D. may have symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. Symptoms may ease after resting. These symptoms are called intermittent claudication. Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit. He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked artery. Your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb. He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of P.A.D.
- Upper Extremity A computer converts sound waves into a picture of blood flow in the arteries and veins. P rovides details of the location and extent of arterial stenosis or occlusion
- During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast. As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats.
- A cardiac CT scan also can show whether calcium has built up in the walls of the coronary (heart) arteries. This may be an early sign of CHD.
- Show pic in the computer
- Symptom-relief medications.drugs use to relief the pain Common side effects of this medication include headache and diarrhea.