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
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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
1.1.1.1 Earliest sign
1.1.1.1.1 Pain in the calf muscles
1.1.1.1.1.1 Increases with exercise and subsides with rest
1.1.2 Fontaine Stages
1.1.2.1 Stage 1
1.1.2.1.1 Asymptomatic
1.1.2.2 Stage 2
1.1.2.2.1 Intermittent claudication
1.1.2.2.1.1 Differential diagnosis of claudication
1.1.2.2.1.1.1 Musculoskeletal claudication
1.1.2.2.1.1.1.1 Arthritis
1.1.2.2.1.1.1.2 Chronic compartment syndrome
1.1.2.2.1.1.1.3 Muscle strain
1.1.2.2.1.1.1.4 Symptomatic Baker cyst
1.1.2.2.1.1.2 Neurologic claudication
1.1.2.2.1.1.2.1 Nerve entrapment
1.1.2.2.1.1.2.2 Nerve root compression
1.1.2.2.1.1.2.2.1 Herniated disc
1.1.2.2.1.1.2.2.2 Radiculopathy
1.1.2.2.1.1.2.3 Peripheral neuropathy
1.1.2.2.1.1.2.3.1 Diabetes mellitus
1.1.2.2.1.1.2.3.2 Alcohol abuse
1.1.2.2.1.1.2.4 Spinal stenosis
1.1.2.2.1.1.2.4.1 Pseudoclaudication
1.1.2.2.1.1.3 Vascular claudication
1.1.2.2.1.1.3.1 PVD
1.1.2.2.1.1.3.1.1 DVT
1.1.2.2.1.1.3.1.2 Popliteal artery entrapment
1.1.2.2.1.1.3.1.3 Vasculitis
1.1.2.2.1.1.3.1.4 Venous insufficiency
1.1.2.2.1.1.3.2 Muscle pain on mild exertion
1.1.2.2.1.1.3.3 Relieved by a short period of rest
1.1.2.2.1.1.3.4 Early-stage peripheral artery disease
1.1.2.3 Stage 3
1.1.2.3.1 Rest Pain
1.1.2.4 Stage 4
1.1.2.4.1 Ischemic Ulcers or Gangrene
1.1.3 Causes
1.1.3.1 Atherosclerosis
1.1.3.1.1 Pathogenesis
1.1.3.1.1.1 Physical or chemical insults to the endothelial cell layer of arteries
1.1.3.1.1.1.1 The fatty streak
1.1.3.1.1.1.1.1 Stable and Unstable Plaques
1.1.3.1.1.1.1.1.1
1.1.3.1.1.1.1.2
1.1.3.1.1.1.2
1.1.3.2 Injury to the arms or legs
1.1.3.3 Irregular anatomy of muscles or ligaments
1.1.3.4 Infections
1.1.3.5 CAD
1.1.3.6 Venous problem
1.1.3.6.1 Deep Vein Thrombosis
1.1.3.6.1.1 Virchow’s triad
1.1.3.6.1.1.1 Stasis
1.1.3.6.1.1.2 Hypercoagulability
1.1.3.6.1.1.3 Endothelial damage
1.1.3.6.1.2 Signs and symptoms
1.1.3.6.1.2.1 Asymmetrical edema
1.1.3.6.1.2.2 Erythema
1.1.3.6.1.2.3 Warmth
1.1.3.6.1.2.4 Asymmetrical calf swelling
1.1.3.6.1.2.5 Asymmetrical localized pain
1.1.3.6.1.3 Complications
1.1.3.6.1.3.1 Pulmonary embolism
1.1.3.6.1.3.2 Post thrombotic syndrome
1.1.3.6.1.3.3 Acute GI bleeding
1.1.3.6.1.4 Investigations
1.1.3.6.1.4.1 Full blood count
1.1.3.6.1.4.2 D-dimer lab test
1.1.3.6.1.4.3 Liver function test
1.1.3.6.1.4.4 Urea and creatinine
1.1.3.6.1.4.5 INR
1.1.3.6.1.4.6 APTT
1.1.3.6.1.4.7 Venous duplex ultrasound
1.1.3.6.1.4.8 Venography
1.1.3.6.1.4.9 CT and MRI
1.1.3.6.1.4.10 Chest imaging
1.1.3.6.1.5 Causes and Risk factors
1.1.3.6.1.5.1 Immobility
1.1.3.6.1.5.2 Birth control use
1.1.3.6.1.5.3 Pregnancy
1.1.3.6.1.5.4 Smoking
1.1.3.6.1.5.5 Obesity
1.1.3.6.1.5.6 Genetics
1.1.3.6.2 Varicose Veins
1.1.3.6.2.1 Risk factors
1.1.3.6.2.1.1 Women
1.1.3.6.2.1.2 Aging
1.1.3.6.2.1.3 Prolonged standing
1.1.3.6.2.1.4 Crossing knees for long time
1.1.3.6.2.1.5 Obesity
1.1.3.6.2.1.6 Pregnancy
1.1.3.6.2.1.7 Family history
1.1.3.6.2.2 Signs and symptoms
1.1.3.6.2.2.1 Dark blue or purple veins
1.1.3.6.2.2.2 Spider veins
1.1.3.6.2.2.3 Bulging and twisted veins
1.1.3.6.2.2.4 Heavy feeling in legs
1.1.3.6.2.2.5 Burning and throbbing muscle cramping in lower legs
1.1.3.6.2.2.6 Itchiness and redness around veins
1.1.3.6.2.2.7 Pain worsened after standing for long time
1.1.3.6.2.3 Diagnosis
1.1.3.6.2.3.1 Physical examination and ultrasound
1.1.3.6.3 Chronic Venous Insufficiency
1.1.3.6.3.1 Causes
1.1.3.6.3.1.1 DVT
1.1.3.6.3.1.2 Phlebitis
1.1.3.6.3.1.3 Congenital defects
1.1.3.6.3.2 Signs and symptoms
1.1.3.6.3.2.1 Ulcers
1.1.3.6.3.2.2 Hyperpigmentation
1.1.3.6.3.2.3 Pruritis
1.1.3.6.3.2.4 Varicose veins
1.1.3.6.3.2.5 Pain
1.1.3.6.3.2.6 Edema
1.1.3.6.3.3 Diagnosis
1.1.3.6.3.3.1 Duplex ultrasound & venography
1.1.3.7 Vasculitis
1.1.3.7.1 Inflammation of the blood vessels
1.1.3.7.2 Mechanisms
1.1.3.7.2.1 Immune mediated vasculitis
1.1.3.7.2.1.1 Immune complex deposition
1.1.3.7.2.1.2 ANCA
1.1.3.7.2.1.2.1 Perinuclear
1.1.3.7.2.1.2.2 Cytoplasmic
1.1.3.7.2.1.3 Direct invasion by microorganism
1.1.3.7.2.1.4 Radiation, mechanical trauma or toxins
1.1.3.7.3 Clinical features
1.1.3.7.3.1 Fever / Arthralgia / Myalgia / Malaise
1.1.3.7.4 Classification
1.1.3.7.4.1 Based on
1.1.3.7.4.1.1 Size of Vessel
1.1.3.7.4.1.2 Anatomical Site
1.1.3.7.4.1.3 Histological Features
1.1.3.7.4.2 Large Vessel Vasculitis
1.1.3.7.4.2.1 Giant cell arteritis "Temporal arteritis"
1.1.3.7.4.2.1.1
1.1.3.7.4.2.1.2 Above the age of 50
1.1.3.7.4.2.1.3 Affects ophthalmic artery
1.1.3.7.4.2.1.3.1 Sudden blindness
1.1.3.7.4.2.2 Takayasu disease "Pulseless disease"
1.1.3.7.4.2.2.1
1.1.3.7.4.2.2.2 Females less than 40
1.1.3.7.4.3 Medium Vessel Vasculitis
1.1.3.7.4.3.1 Polyarteritis Nodosa
1.1.3.7.4.3.1.1
1.1.3.7.4.3.1.2 Necrotising arteritis “immune complex mediated”
1.1.3.7.4.3.2 Kawasaki disease "Mucocutaneous lymph node syndrome"
1.1.3.7.4.3.2.1
1.1.3.7.4.3.2.2 Children below 4 years / Common in boys
1.1.3.7.4.3.2.3 Delayed hypersensitivity reaction
1.1.3.7.4.3.3 Buerger’s disease "Thromboangiitis obliterans"
1.1.3.7.4.3.3.1
1.1.3.7.4.3.3.2 Males / Heavy smokers / Below 35
1.1.3.7.4.3.4 Wegener’s granulomatosis
1.1.3.7.4.3.4.1
1.1.3.7.4.3.4.2 Necrotizing granulomas
1.1.3.7.4.3.4.3 Adult males
1.1.3.7.4.3.5 Churg-Strauss Syndrome
1.1.3.7.4.3.5.1
1.1.3.7.4.3.5.2 History of airway allergic hypersensitivity (atopy)
1.1.3.7.4.4 Small Vessel Vasculitis
1.1.3.7.4.4.1 Henoch-Schonlein Purpura (HSP)
1.1.3.7.4.4.1.1
1.1.3.7.4.4.1.2 Children
1.1.3.7.4.4.1.3 IgA and C3 deposit
1.1.3.7.4.4.1.4 After acute URTI
1.1.4 Risk factors
1.1.4.1 Modifiable
1.1.4.1.1
1.1.4.1.2 Diabetes
1.1.4.1.3 High cholesterol
1.1.4.1.4 High blood pressure
1.1.4.1.5 Overweight
1.1.4.1.6 Physical inactivity
1.1.4.1.7 Smoking or use of tobacco products
1.1.4.2 Non-modifiable
1.1.4.2.1 Age "Above 50"
1.1.4.2.2 History of heart disease
1.1.4.2.3 Male gender
1.1.4.2.4 Postmenopausal women
1.1.4.2.5 Family history
1.1.4.2.5.1 High cholesterol
1.1.4.2.5.2 High blood pressure
1.1.4.2.5.3 Peripheral vascular disease
1.1.5 Complications
1.1.5.1 Due to decreased or absent blood flow
1.1.5.1.1 Amputation
1.1.5.1.2 Poor wound healing
1.1.5.1.3 Restricted mobility
1.1.5.1.4 Severe pain
1.1.5.1.5 Stroke
1.1.6 Investigations
1.1.6.1 Imaging
1.1.6.1.1 ABI
1.1.6.1.2 Duplex ultrasonography
1.1.6.1.2.1 Anatomic information
1.1.6.1.2.2 Hemodynamic information
1.1.6.1.2.3
1.1.6.1.3 MRA
1.1.6.1.3.1 Angiography
1.1.6.1.3.1.1
1.1.6.1.4 CT
1.1.6.1.5 DSA
1.1.6.2 Physical exam
1.1.6.2.1 Ankle-Brachial Index
1.1.6.2.1.1
1.1.6.3 Blood tests
1.1.6.3.1 CBC
1.1.6.3.2 Blood urea / Nitrogen / Creatinine / Electrolyte
1.1.6.3.3 Lipid profile
1.1.6.3.4 Coagulation tests
1.1.7 Management
1.1.7.1 Drugs
1.1.7.1.1 Cilostazol
1.1.7.1.1.1 MOA
1.1.7.1.1.1.1 Phosphodiestrase 3 inhibitors
1.1.7.1.1.2 AE
1.1.7.1.1.2.1 Headache / Diarrhea / heat intolerance / Abnormal stool / Increased heart rate / Palpitations
1.1.7.1.2 Dipyridamole
1.1.7.1.2.1 MOA
1.1.7.1.2.1.1 Inhibit the cellular re-uptake of adenosine into platelets phosphpdiesterase enzymes
1.1.7.1.2.2 AE
1.1.7.1.2.2.1 Bleeding
1.1.7.1.3 Pentoxifylline
1.1.7.1.3.1 MOA
1.1.7.1.3.1.1 Competitive nonselective phosphodiesterase inhibitor
1.1.7.1.3.2 AE
1.1.7.1.3.2.1 Belching / Bloating / Stomach discomfort or upset / N&V
1.1.7.1.4 Aspirin
1.1.7.1.4.1 MOA
1.1.7.1.4.1.1 Cox 2 inhibitor
1.1.7.1.4.2 AE
1.1.7.1.4.2.1 GIT bleeding
1.1.7.1.5 Clopidogrel / Ticlopidine
1.1.7.1.5.1 MOA
1.1.7.1.5.1.1 Inhibit ADP
1.1.7.1.5.2 AE
1.1.7.1.5.2.1 Bleeding
1.1.7.1.6 Statin
1.1.7.1.6.1 MOA
1.1.7.1.6.1.1 Competitively inhibiting HMC-CoA reductase
1.1.7.1.6.2 AE
1.1.7.1.6.2.1 Hepatotoxicity / Myopathy / Gi upset / Cataracts
1.1.7.2 Interventional procedures
1.1.7.2.1 Angioplasty
1.1.7.2.2 Stenting
1.1.7.2.3 Atherectomy
1.1.7.3 Surgical procedures
1.1.7.3.1 Peripheral artery bypass surgery
1.1.7.3.2 Atherosclerosis endarterectomy
2
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