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Related Concept Videos

Peripheral Artery Disease I: Introduction01:30

Peripheral Artery Disease I: Introduction

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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
549
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Atherosclerosis II: Clinical Manifestations and Diagnostic Tests01:27

Atherosclerosis II: Clinical Manifestations and Diagnostic Tests

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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Peripheral Artery Disease IV: Nursing Management01:26

Peripheral Artery Disease IV: Nursing Management

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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Peripheral Artery Disease and Aortic Disease.

Michael H Criqui1, Victor Aboyans2, Matthew A Allison3

  • 1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, University of California, San Diego, La Jolla, CA, USA.

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Summary

The Multi-Ethnic Study of Atherosclerosis found ethnic variations in peripheral arterial disease and subclavian stenosis. Abnormal ankle-brachial index and aortic calcifications predict cardiovascular events and mortality.

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Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Medical Imaging

Background:

  • Peripheral arterial disease (PAD) and aortic calcifications are indicators of subclinical cardiovascular disease (CVD).
  • Ethnic variations in CVD prevalence and risk factors are well-documented.
  • The Multi-Ethnic Study of Atherosclerosis (MESA) provides a valuable dataset for investigating these disparities.

Purpose of the Study:

  • To review MESA study findings on peripheral arterial disease, subclavian stenosis (SS), abdominal aortic calcium (AAC), and thoracic artery calcium (TAC).
  • To examine ethnic differences in these cardiovascular measures.
  • To assess the association of these measures with subclinical CVD and overall mortality.

Main Methods:

  • Systematic review of published MESA articles focusing on PAD, SS, AAC, and TAC.
  • Analysis of ankle-brachial index (ABI) and brachial pressure differences across ethnic groups.
  • Evaluation of associations between aortic calcifications (AAC, TAC) and other CVD measures.

Main Results:

  • African Americans exhibited lower ABI and higher SS compared to non-Hispanic whites; Hispanic and Chinese Americans showed higher ABI and less SS.
  • Abnormal ABI and brachial pressure differences correlated with other subclinical CVD indicators.
  • Both very high and low ABI independently predicted increased CVD events.
  • TAC and AAC were associated with other subclinical CVD measures.
  • AAC and CAC were less prevalent in ethnic minorities, but AAC showed no significant sex difference, unlike CAC.
  • AAC demonstrated a stronger association with CVD and total mortality than CAC when mutually adjusted.

Conclusions:

  • Ethnic disparities exist in peripheral arterial disease and subclavian stenosis prevalence.
  • Ankle-brachial index and aortic calcifications are significant predictors of cardiovascular events and mortality.
  • Abdominal aortic calcium may be a stronger predictor of mortality than coronary artery calcium, independent of sex and other risk factors.