Presentation on theme: "Vascular Medicine for medical students"— Presentation transcript:
1Vascular Medicine for medical students Zsolt PécsváradyPécs
2Basic considerations: ARTERIES:Atherosclerosis is the 1st major cause of the morbidityand mortality in the western societies. ( 50% or morefrom all diseases ) Must find as early as possible.Atherosclerosis alter the whole vascular system of thebody. The symptoms and signs of the diseasedepend on the localisations of the organs involed ( heart,brain, kidney, GI tract, extremities ), but we have tocheck the disease in all locations.Because of the symmetry of our body, bilateral simultaneouspalpation or auscultation is a great help in the diagnosis.Nearly 80 % of the diagnosis is available from medicalhistory and physical examination.
3Medical history: symptoms Not enough blood supply- early stages: during activity ( reversible )- advance stage: end organ failure ( irreversible )
4Periferal arterial disease – PAD – Main symptom is intermittant claudication ( IC )Latin word claudico = to limp90 % of patients, IC is due to stenosis or occlusionof the arteries supplying the lower extremitiesBruit at the place of stenosis( between % stenosis only )
5Rose criteria as tool for intermittent claudication 1 Rose criteria as tool for intermittent claudication 1. Do you get pain in either leg on walking? Yes No2. Does this pain ever begin when you are standing still or sitting? Yes No3. In what part of your leg do you feel it? Pain includes calf/calves Pain does notinclude calf/calves ( If calves not mentioned, ask: Anywhere else?)4. Do you get it if you walk uphill or hurry? Yes No Never hurries or walks uphill5. Do you get it if you walk at an ordinary pace on the level? Yes No6. Does the pain ever disappear while you are walking? Yes No7. What do you do if you get it when you are walking? Stop or slow down Carry on8. What happens to it if you stand still? Relieved Not relieved9. How soon? min. or less More than 10 min.
6Sign and symptoms of PAD Exercional leg pain and relief with restCool or cold feet to palpationNocturnal and rest pain relieved with dependencyAbsent pulsesBlanching or pallor on elevationDelay venous filling after elevationDependent ruborAtrophy of subcutaneous fatty tissueShiny skinLoss of hair on foot and toesThickened nails, often with fungal infectionsGangrene or nonhealing ulcer
14ABI = Ankle-brachial index BP lower extremities *ABI =BP upper extremities*** The higher between aDP or aTPin one leg** The higher between the two armsNormal: –1.30Mild to moderate: 0.70–0.90Moderate to severe: 0.40–0.69Severe: <0.40Non compressable >1.30
15Segmental blood pressure measurement w / CW Doppler a. T.P.a. D.P.