Peripheral vascular disease: Clinical (To be retired)


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Peripheral vascular disease: Clinical (To be retired)

ETP Cardiovascular System


Introduction to the cardiovascular system

Anatomy of the heart

Anatomy of the coronary circulation

Anatomy clinical correlates: Heart

Anatomy of the superior mediastinum

Anatomy of the inferior mediastinum

Anatomy clinical correlates: Mediastinum

Development of the cardiovascular system

Fetal circulation

Cardiac muscle histology

Artery and vein histology

Arteriole, venule and capillary histology

Cardiovascular system anatomy and physiology

Lymphatic system anatomy and physiology

Coronary circulation

Blood pressure, blood flow, and resistance

Pressures in the cardiovascular system

Laminar flow and Reynolds number

Resistance to blood flow

Compliance of blood vessels

Control of blood flow circulation

Microcirculation and Starling forces

Measuring cardiac output (Fick principle)

Stroke volume, ejection fraction, and cardiac output

Cardiac contractility

Frank-Starling relationship

Cardiac preload

Cardiac afterload

Law of Laplace

Cardiac and vascular function curves

Altering cardiac and vascular function curves

Cardiac cycle

Cardiac work

Pressure-volume loops

Changes in pressure-volume loops

Physiological changes during exercise

Cardiovascular changes during hemorrhage

Cardiovascular changes during postural change

Normal heart sounds

Abnormal heart sounds

Action potentials in myocytes

Action potentials in pacemaker cells

Excitability and refractory periods

Cardiac excitation-contraction coupling

Electrical conduction in the heart

Cardiac conduction velocity

ECG basics

ECG rate and rhythm

ECG intervals

ECG QRS transition

ECG axis

ECG normal sinus rhythm

ECG cardiac infarction and ischemia

ECG cardiac hypertrophy and enlargement



Renin-angiotensin-aldosterone system

Arterial disease

Angina pectoris

Stable angina

Unstable angina

Myocardial infarction

Prinzmetal angina

Coronary steal syndrome

Peripheral artery disease

Subclavian steal syndrome


Aortic dissection


Behcet's disease

Kawasaki disease


Hypertensive emergency

Renal artery stenosis

Coarctation of the aorta

Cushing syndrome

Conn syndrome


Polycystic kidney disease


Orthostatic hypotension


Familial hypercholesterolemia



Chronic venous insufficiency


Deep vein thrombosis




Vascular tumors

Human herpesvirus 8 (Kaposi sarcoma)


Truncus arteriosus

Transposition of the great vessels

Total anomalous pulmonary venous return

Tetralogy of Fallot

Hypoplastic left heart syndrome

Patent ductus arteriosus

Ventricular septal defect

Atrial septal defect

Atrial flutter

Atrial fibrillation

Premature atrial contraction

Atrioventricular nodal reentrant tachycardia (AVNRT)

Wolff-Parkinson-White syndrome

Ventricular tachycardia

Brugada syndrome

Premature ventricular contraction

Long QT syndrome and Torsade de pointes

Ventricular fibrillation

Atrioventricular block

Bundle branch block

Pulseless electrical activity

Tricuspid valve disease

Pulmonary valve disease

Mitral valve disease

Aortic valve disease

Dilated cardiomyopathy

Restrictive cardiomyopathy

Hypertrophic cardiomyopathy

Heart failure

Cor pulmonale



Rheumatic heart disease

Pericarditis and pericardial effusion

Cardiac tamponade

Dressler syndrome

Cardiac tumors

Acyanotic congenital heart defects: Pathology review

Cyanotic congenital heart defects: Pathology review

Atherosclerosis and arteriosclerosis: Pathology review

Coronary artery disease: Pathology review

Peripheral artery disease: Pathology review

Valvular heart disease: Pathology review

Cardiomyopathies: Pathology review

Heart failure: Pathology review

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Aortic dissections and aneurysms: Pathology review

Pericardial disease: Pathology review

Endocarditis: Pathology review

Hypertension: Pathology review

Shock: Pathology review

Vasculitis: Pathology review

Cardiac and vascular tumors: Pathology review

Dyslipidemias: Pathology review

Sympatholytics: Alpha-2 agonists

Adrenergic antagonists: Presynaptic

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Thiazide and thiazide-like diuretics

Calcium channel blockers

cGMP mediated smooth muscle vasodilators

Class I antiarrhythmics: Sodium channel blockers

Class II antiarrhythmics: Beta blockers

Class III antiarrhythmics: Potassium channel blockers

Class IV antiarrhythmics: Calcium channel blockers and others

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Positive inotropic medications

Cardiomyopathies: Clinical (To be retired)

Congenital heart defects: Clinical (To be retired)

Valvular heart disease: Clinical (To be retired)

Infective endocarditis: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Hypertension: Clinical (To be retired)

Pulmonary hypertension

Aortic aneurysms and dissections: Clinical (To be retired)

Raynaud phenomenon

Peripheral vascular disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Coronary artery disease: Clinical (To be retired)

Deep vein thrombosis and pulmonary embolism: Pathology review

Fascia, vessels and nerves of the upper limb

Vessels and nerves of the forearm

Blood vessels and nerves of the hand

Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut

Fascia, vessels, and nerves of the lower limb

Vessels and nerves of the gluteal region and posterior thigh

Anatomy of the popliteal fossa


Ventilation-perfusion ratios and V/Q mismatch

Gas exchange in the lungs, blood and tissues

Oxygen binding capacity and oxygen content

Oxygen-hemoglobin dissociation curve

Carbon dioxide transport in blood

Trypanosoma cruzi (Chagas disease)

Yellow fever virus

Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species

Arteriovenous malformation

Cerebral circulation


Peripheral vascular disease: Clinical (To be retired)

USMLE® Step 2 questions

0 / 7 complete


USMLE® Step 2 style questions USMLE

of complete

A 75-year-old man comes to the clinic with persistent leg pain with exertion. Three months ago, the patient was found to have an ankle-brachial index of 0.6, and he was started on atorvastatin, chlorthalidone, and aspirin. Since then, the patient has successfully quit smoking and has participated in a supervised exercise therapy program where he has achieved a 10 lb (4.5 kg) weight loss. The pain, characterized by aching in the right thigh and buttock after walking more than 3 blocks, has not improved. The patient’s temperature is 37.0°C (98.6°F), pulse is 80/min and regular, respirations are 20/min, blood pressure is 130/75 mmHg, and BMI is 32 kg/m2. Pulses in the right femoral artery are diminished compared to the left. Which of the following therapies is most appropriate for this patient?  


Content Reviewers

Rishi Desai, MD, MPH


Antonella Melani, MD

Evan Debevec-McKenney

Peripheral vascular disease is an abnormal narrowing of arteries other than the ones that supply the heart or brain, and it most often affects the ones in the legs.

Risk factors include being older than 60 years, smoking, hypertension, hyperlipidemia, diabetes, and metabolic syndrome.

The most common underlying mechanism of peripheral artery disease is atherosclerosis, which results in the accumulation of lipid and fibrous material between the layers of the arterial wall.

Eventually, the affected artery becomes progressively narrower, and this may lead to pain, ulceration, and even gangrene.

Now, most people with peripheral vascular disease actually don’t have symptoms until occlusion becomes significant, which is when 70% of the vessel lumen is obstructed.

Symptoms include intermittent claudication, which includes pain, numbness, or tiredness in the legs during walking or standing, and is relieved by rest.

This is because the blood supply may be enough to meet the muscle needs at rest, but not the increased needs during activity, leading to ischemia – so basically, occurs when oxygen demand is greater than oxygen supply.

The perceived level of symptoms from intermittent claudication can be mild to extremely severe depending on the degree of blood supply.

Intermittent claudication can present unilaterally or bilaterally, as buttock and hip, thigh, calf, or foot pain, singly or in combination.

In addition, pulses in one or both groins are diminished, and bilateral aortoiliac disease that is severe enough almost always causes erectile dysfunction.

The triad of intermittent claudication, absent or diminished femoral pulses, and erectile dysfunction is known as Leriche syndrome.

Location of pain depends upon the artery involved. Lower aorta or iliac artery involvement causes pain in the hips and buttocks.

Iliac or common femoral artery involvement causes pain in the thigh.


Peripheral vascular disease (PVD) is a group of diseases that affect the circulation in the blood vessels outside of the heart and brain. PVD can cause the blood vessels to get narrowed or blocked, leading to poor circulation and possible ischemia of the affected body parts. Symptoms depend on the affected organ and may include leg pain, cramping, and fatigue. It is commonly associated with smoking, high blood pressure, diabetes, and high cholesterol. Treatment options for PVD include lifestyle changes, medications, and surgery.


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