1 Peripheral Artery Disease Tony Berardi 1 What is the pathophysiology Think coronary artery disease This is the same concept atherosclerosis or plague build up accumulates in the peripheral arteries The legs are usually affected The thrombus occlusion will severe the blood flow to the legs and this will lead to decreased functional capacity decreased QOL and limb dysfunction obviously So it starts with the normal process of atherosclerosis with damage to the endothelium This is called endothelium dysfunction The rate of damage depends on the percentage of stenosis present how much the arteries narrow and the effect on the flow velocity of the blood The biggest symptom is called intermittent claudications and this is pain in the legs upon exercise and is caused by the ischemia from the plague buildup This is a late stage of the process so if you have this its pretty advanced 2 What are the risk factors for PAD Smoking is the biggest modifiable risk factor for PAD or most cardiovascular and pulmonary diseases actually Dylipidemia is one because of this is just atherosclerosis in the legs instead of the heart like we have learned last exam Type two diabetes and hypertension also raise ones risk Age gender and race also predispose one To go into more detail about why you should never smoke or stop smoking it basically kills you slowly It is a vasoconstrictor increases platelet aggregation promotes oxidation of LDL and CHL and lowers lung function All of these minus the lung increase risk for atherosclerosis And lower lung function also sucks 3 What are the signs symptoms and how do you make the diagnosis for PAD To spot an individual with PAD you have to look for obviously discomfort but early fatigue with walking and the absence of a pulse in the femoral or popletal artery There will be an absence of a pulse because the plague will occlude the artery There are 4 possible grades of the disease Grade 0 is asymptomatic Grade 1 is when the intermittent claudications start Grade 2 is ischemia at rest also Grade 3 is minor or major foot pain tissue loss To make the diagnose one has to look at a clients ankle to brachial index This is the ratio between ankle pulse and the branchiel pulse Normally this value will be high and it will decrease with the severity of the blockage Less than 95 means there is narrowing of at least one vessel in the leg Less than 8 signifies pain in leg with exercise intermittent claudications Tony Berardi 2 Less than 4 means that the claudication can happen at rest Less than 25 means you are fucked Amputation is possible 4 What are the management and medication It is treated essentially the same as CAD because it is the same pathology Statins to lower CHL Anti platelets to prevent platelet aggregation Hypertensive agent ACE inhibitors Diuretics beta blockers And possible medication for other symptoms they may have If severe enough surgery is an option Revascularzation to move the arteries to bypass the buildup site Laser assisted angioplasty Angioplasty means to fix remove the plague STOP SMOKING Control diet and lipid level 5 What is the protocol for exercise testing First you have to determine the time when the claudication starts and you want to obtain the ankle to brachial measurement before and after exercise so you can see the affects For aerobic the treadmill is the preferred test because PAD affects walking capacity You have to realize that they probably will not achieve their maximum level because their PAD symptoms will force them to stop Don t let them hold on to the rail either since this relives the pain a little You want to see how much they can do and how much their PAD limits them If you want to use a subjective scale to determine their pain they should go to a 3 on the pain scale With muscular strength you could use an isokinetic expensive machine or isotonic same tension so free weights are a perfect example exercises You don t want to get a 1 RM 6 What are the prescriptions For aerobic you want them at 3 5 days 40 60 HRR and greater than 15 min You should increase the duration 5 min every four weeks As you can tell their symptoms can severely limit their exercise duration For resistance you want 2 3 days at 50 60 of their 1 RM at 1 2 sets of 10 12 reps 7 What are some special considerations of PAD patients The point of exercise for them is to relieve their pain and claudications Of course there is no cure for atherosclerosis but you can slow it down So as their capacity improves their ischemia will lessen One important thing to realize is that the plague is aggravated in cold weather so you need a longer warm up for exercising in the cold HIV AIDS 1 Give an overview of the immune system This a short review of how our body protects itself against any bacteria or viruses There are two main defenses that the body has the innate system and the adaptive system Tony Berardi 3 The innate is the first line of defense against pathogens This includes the skin mucous inflammatory responses and mast cells This defense is non specific to the pathogen and always happens The adaptive is specific to the pathogen and has a memory to the antigen so one will not keep getting infected The cells involved are called lymphocytes and the two are the B and T cells The B cells are the memory cells that activate more defenses to attack the antigen The T cells are the Killer cells that attack the antigens and there are CD8 and CD4 cells The CD8 are the actual killer cells and the CD4 help activate the CD8 and help proliferate cells to kill the antigen HIV attacks the CD4 cells and without them the CD8 cells cannot be called on leading to an individual getting infections from pathogens that a healthy person would never get These are called opportunistic diseases and are what kills the patient Not the actual HIV virus 2 What is the pathopshyology of HIV HIV is known as a retrograde virus meaning it contains RNA and it then converts it to viral DNA with an enzyme that the virus contains once it infects a host That DNA is then incorporated in the cell s DNA and hijacks the cell to duplicate more and more of the viral DNA As said before its target is the CD4 cells of the immune system and incorporates its DNA into these cells HIV goes though a lysogenic cycle don t need to know just explaining the term meaning it infects the cell s DNA but it lays dormant for a while up to years before it decides to divide and attack This is why people can have it for years before they get