acute arterial embolism in the elderly
Introduction
Introduction to acute arterial embolism in the elderly Acute arterial embolism: a atherosclerotic plaque from the heart or a atherosclerotic plaque from the arterial wall. A large or small peripheral artery that blocks the blood flow is called an acute arterial embolism. Only the extremity arterial embolism is discussed here. basic knowledge The proportion of illness: 0.002% Susceptible people: the elderly Mode of infection: non-infectious Complications: shock
Cause
Causes of acute arterial embolism in the elderly
(1) Causes of the disease
Most of the emboli are from the left atrium, the left ventricular wall thrombus or valve thrombus, a small part of the aortic or peripheral vascular atherosclerotic plaque, the cause is more common in myocardial infarction, coronary heart disease and rheumatic heart disease have atrial Patients with fibrillation and endocarditis.
(two) pathogenesis
The disease and occlusive atherosclerosis are more common in the lower aortic aorta, radial and femoral arteries, upper extremity arteries are less affected, occasionally in the proximal and ulnar arteries of the subclavian artery, some elderly or patients with diabetes, Lesions can occur in smaller arteries, such as the anterior and posterior tibial arteries. The arteries often expand and become harder, with a cord-like or irregular twist.
Changes in the arterial wall are referred to the "atherosclerosis" section, and a few can cause arterial dilation to form an aneurysm.
The degree of ischemia in the affected limb depends on the location, extent, extent of occlusion, and the degree of compensatory collateral circulation. When the arterial circulation is blocked, the neck, shoulder strap and elbow are abundant. The collateral net may be sufficient to prevent ischemic symptoms, which are usually caused by obstructive lesions of the subclavian and brachial arteries near the aortic arch. Less than 75% of vascular stenosis usually does not affect blood flow at rest. Vascular stenosis 60% can cause limb ischemia during exercise, skin atrophy and thinning after ischemia of the affected limb tissue, subcutaneous fat disappears and is replaced by fiber and connective tissue, bone is sparse, muscle atrophy, and ischemia Sexual neuritis, gangrene can occur in the later stage, gangrene often starts from the end of the affected limb, can be confined to the toe, can also extend to the foot or calf, but rarely exceeds the knee joint, diabetic patients are prone to gangrene and tissue infection.
Prevention
Elderly acute arterial embolism prevention
1. Patients should avoid cold, do not bathe or swim in cold water.
2. Wear warm clothes in winter and walk often to promote blood circulation.
3. Never heat the feet, avoid sun exposure on the feet and calves, wash your feet with warm water (close to body temperature), and dry thoroughly.
4. Avoid foot injury, shoes and socks should be clean and comfortable, do not walk barefoot, if you find that the foot has skin cracking, injury or color change with or without pain, you should see a doctor.
Complication
Elderly acute arterial embolization complications Complications
Severe acute arterial embolization can be complicated by shock and punctate necrosis.
Symptom
Symptoms of acute arterial embolism in the elderly Common symptoms Hairy skin pale muscle tenderness Nausea abdominal pain Atherosclerosis "5P" sign sensory disorder Dizziness Muscle necrosis
About half of the patients had a rapid onset, and the rest gradually occurred within a few hours. The limbs below the embolization site suddenly suffered from pain. The initial stage was pale skin, followed by cyanosis, superficial vein depression, arterial pulsation weakened or disappeared, and the lower extremities gradually swelled. The collateral circulation is established rapidly, and the skin color and temperature are improved after several hours. However, there are still muscle tenderness and swelling in the affected part. If the collateral circulation is poor, skin blisters and gangrene may occur.
The clinical feature is the limb "5P" sign:
1 pain (pain): begins at the embolization site, gradually extending distally, and can move with the embolus.
2 paresthesia: sock-shaped sensory disturbance.
3 paralysis: muscle necrosis paralysis.
4 pulselessness.
5 pale (pallor), when the abdominal aortic bifurcation produces a saddle-like embolism embolism, the symptoms are more serious, in addition to the lower extremity arterial obstructive symptoms, often have systemic reactions such as dizziness, nausea, vomiting and abdominal pain, Old people even have a shock.
In elderly people with atherosclerosis, myocardial infarction, atrial fibrillation, rheumatic heart disease and infectious meningitis, acute arterial embolism should be suspected in patients with acute lower extremity pain and limb ischemia.
Examine
Elderly acute arterial embolism
Coronary patients are often associated with dyslipidemia.
Doppler ultrasound, infrared imaging and limb plethysmography can clarify the embolization site in a short time.
Diagnosis
Diagnosis and diagnosis of acute arterial embolism in the elderly
In the elderly, attention should be paid to the identification of obliterative atherosclerosis. Thromboangiitis obliterans and multiple arteritis are common in young people, and there is no difficulty in identification.
