A 63 Year old smoker with leg pain

Alya Almualla
Mind Map by Alya Almualla, updated more than 1 year ago
Alya Almualla
Created by Alya Almualla over 1 year ago


Mind Map on A 63 Year old smoker with leg pain, created by Alya Almualla on 03/11/2019.

Resource summary

A 63 Year old smoker with leg pain
1 Due to
1.1 Peripheral Vascular Disease
1.1.1 Circulation disorder due to narrowing or blockage of blood vessels Earliest sign Pain in the calf muscles Increases with exercise and subsides with rest
1.1.2 Fontaine Stages Stage 1 Asymptomatic Stage 2 Intermittent claudication Differential diagnosis of claudication Musculoskeletal claudication Arthritis Chronic compartment syndrome Muscle strain Symptomatic Baker cyst Neurologic claudication Nerve entrapment Nerve root compression Herniated disc Radiculopathy Peripheral neuropathy Diabetes mellitus Alcohol abuse Spinal stenosis Pseudoclaudication Vascular claudication PVD DVT Popliteal artery entrapment Vasculitis Venous insufficiency Muscle pain on mild exertion Relieved by a short period of rest Early-stage peripheral artery disease Stage 3 Rest Pain Stage 4 Ischemic Ulcers or Gangrene
1.1.3 Causes Atherosclerosis Pathogenesis Physical or chemical insults to the endothelial cell layer of arteries The fatty streak Stable and Unstable Plaques Injury to the arms or legs Irregular anatomy of muscles or ligaments Infections CAD Venous problem Deep Vein Thrombosis Virchow’s triad Stasis Hypercoagulability Endothelial damage Signs and symptoms Asymmetrical edema Erythema Warmth Asymmetrical calf swelling Asymmetrical localized pain Complications Pulmonary embolism Post thrombotic syndrome Acute GI bleeding Investigations Full blood count D-dimer lab test Liver function test Urea and creatinine INR APTT Venous duplex ultrasound Venography CT and MRI Chest imaging Causes and Risk factors Immobility Birth control use Pregnancy Smoking Obesity Genetics Varicose Veins Risk factors Women Aging Prolonged standing Crossing knees for long time Obesity Pregnancy Family history Signs and symptoms Dark blue or purple veins Spider veins Bulging and twisted veins Heavy feeling in legs Burning and throbbing muscle cramping in lower legs Itchiness and redness around veins Pain worsened after standing for long time Diagnosis Physical examination and ultrasound Chronic Venous Insufficiency Causes DVT Phlebitis Congenital defects Signs and symptoms Ulcers Hyperpigmentation Pruritis Varicose veins Pain Edema Diagnosis Duplex ultrasound & venography Vasculitis Inflammation of the blood vessels Mechanisms Immune mediated vasculitis Immune complex deposition ANCA Perinuclear Cytoplasmic Direct invasion by microorganism Radiation, mechanical trauma or toxins Clinical features Fever / Arthralgia / Myalgia / Malaise Classification Based on Size of Vessel Anatomical Site Histological Features Large Vessel Vasculitis Giant cell arteritis "Temporal arteritis" Above the age of 50 Affects ophthalmic artery Sudden blindness Takayasu disease "Pulseless disease" Females less than 40 Medium Vessel Vasculitis Polyarteritis Nodosa Necrotising arteritis “immune complex mediated” Kawasaki disease "Mucocutaneous lymph node syndrome" Children below 4 years / Common in boys Delayed hypersensitivity reaction Buerger’s disease "Thromboangiitis obliterans" Males / Heavy smokers / Below 35 Wegener’s granulomatosis Necrotizing granulomas Adult males Churg-Strauss Syndrome History of airway allergic hypersensitivity (atopy) Small Vessel Vasculitis Henoch-Schonlein Purpura (HSP) Children IgA and C3 deposit After acute URTI
1.1.4 Risk factors Modifiable Diabetes High cholesterol High blood pressure Overweight Physical inactivity Smoking or use of tobacco products Non-modifiable Age "Above 50" History of heart disease Male gender Postmenopausal women Family history High cholesterol High blood pressure Peripheral vascular disease
1.1.5 Complications Due to decreased or absent blood flow Amputation Poor wound healing Restricted mobility Severe pain Stroke
1.1.6 Investigations Imaging ABI Duplex ultrasonography Anatomic information Hemodynamic information MRA Angiography CT DSA Physical exam Ankle-Brachial Index Blood tests CBC Blood urea / Nitrogen / Creatinine / Electrolyte Lipid profile Coagulation tests
1.1.7 Management Drugs Cilostazol MOA Phosphodiestrase 3 inhibitors AE Headache / Diarrhea / heat intolerance / Abnormal stool / Increased heart rate / Palpitations Dipyridamole MOA Inhibit the cellular re-uptake of adenosine into platelets phosphpdiesterase enzymes AE Bleeding Pentoxifylline MOA Competitive nonselective phosphodiesterase inhibitor AE Belching / Bloating / Stomach discomfort or upset / N&V Aspirin MOA Cox 2 inhibitor AE GIT bleeding Clopidogrel / Ticlopidine MOA Inhibit ADP AE Bleeding Statin MOA Competitively inhibiting HMC-CoA reductase AE Hepatotoxicity / Myopathy / Gi upset / Cataracts Interventional procedures Angioplasty Stenting Atherectomy Surgical procedures Peripheral artery bypass surgery Atherosclerosis endarterectomy
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