Matters of the Heart - PAD/PVD
Hey guys! This week we are moving in the completely opposite direction from the heart. This week we are talking about disease processes that impact the peripheral venous and arterial vessels.
What is peripheral vascular disease (PVD)?
The result of narrowed and constricted arteries (stenosis, outside of leading to a decrease in blood flow to the extremities.
What is peripheral artery disease (PAD)?
PAD is considered to be a type of PVD as the term vascular in Peripheral Vascular Disease can refer to all peripheral vessels. PAD indicates narrowing of arteries outside of the heart, primarily in the legs, which leads to poor circulation in the extremities.
In many cases, PAD and PVD are used interchangeably, even on the National Institute of Health’s Website, here.
What causes PAD/PVD?
PAD/PVD can have a number of origins. Some common risk factors and origins are as follows.
Physical inactivity
Smoking or use of tobacco products
Coronary artery disease
High blood pressure
Being over 55 years old and older.
History of heart disease
Postmenopausal women
Being obese or overweight.
Diabetes
High cholesterol
Being male
Having a family history heart and vascular
How to prevent PAD/PVD?
Tobacco/Nicotine cessation
Low-Fat diet
Manage diabetes mellitus well, keep HgbA1C Level Less than 7
A regular exercise program, avoiding long periods of inactivity. Even doing pedal pushes while sitting…. Basically get up and move every once in a while…..
What are the signs and symptoms of PVD/PAD?
Cramping of extremities, especially after activities like walking or climbing stairs, known as claudication.
Leg numbness or weakness
Discoloration of skin in the impacted extremity. Many people will have a darker tinting.
Development of sores and ulceration on impacted extremities
Development of a sheen or shiny quality to the legs
No pulse or a weak pulse in your legs or feet
Possible erectile dysfunction in men
Bruits present in impacted extremities, which presents as whooshing sounds upon auscultation.
How do you treat PVD/PAD?
Diagnostic Methods
Radiography
MRA - Like a MRI, but it focuses on imaging the blood vessels.
Angiogram - X-RAY that examines blood vessels.
Ankle-Brachial Index (ABI) - Like taking a BP in the lower extremities and comparing it to your brachial blood pressure.
Treadmill Exercise Stress Test - Not exactly the same as the stress test done to assess for CAD or Coronary Artery blockages, but the same concept.
Laboratory Tests
Hemoglobin A1c
Apolipoprotein A
Screening for hypercoagulability
Additionally, the degree of Occlusion or poor circulation can be graded using a number of classification systems, the most common being Rutherford's Classification system for peripheral vessel ischemia.
Treatments
Pharmacological
Antiplatelet Therapy, Like Aspirin (ASA) or Clopidogrel (Plavix)
Antihyperlipidemic medications, such as Statins, Like Atorvastatin (Lipitor) or Lovastatin
Treatment for possible Hypertension
Diabetes management
Procedural
Angioplasty, sometimes with stent placement.
Amputation for more severe cases.
Nursing Considerations
Here is a cool checklist for PAD found on midline plus.
Patients with PAD/PVD should NOT wear compression stocking/TED hose. They will further compress already poor circulation. Here is a good article mentioning why this is the case.
Don’t think that PAD can’t impact the arms, because it can. Although PAD in the arms is not common.
Thanks for listening. Keep pumping……
Sources
Family Practice Notebook Website & App
NIH National Heart, Lung, and Blood Institute Website
Medical Surgical Nursing, Demystified 2nd Edition
American Heart Association Website
This post was written by Patrick of PatMacRN.com. Patrick works as CVICU nurse and Float Pool Nurse at an Academic medical center. In his spare time, Patrick enjoys reading, traveling, and improving his French Language skills.
Disclaimer: This material should be used to supplement your understanding of the cardiovascular system. Any use of the information given in this post series is at your own risk and should be verified prior to making it a part of your nursing practice. There may be affiliate links associated with some products but we promise that we will never recommend anything that we don’t use ourselves.
