Block 2 Lab And Review Flashcards
1
Q
Acute arterial occlusion presents with what type of disease and includes what symptoms
A
Chronic ATH disease
ATH plaque on the aorta- could break
6 P’s
[Poik. And pulseless = PE findings]
2
Q
1 emergent mgmt of Art Occlusive disease
A
CTANgio
Followed by intervention
3
Q
What is a good intervention to use after CTA in Art Occlusive Dsiease ACUTELY
A
Interv. Rad- Non invasive
Percutaneous Thromboectomy - balloon tug out proximal
Percutaneous POBA
Amputation if fail to intervene within 10H
4
Q
What is a good intervention to use after CTA in Art Occlusive Dsiease CHRONIC
A
Reverse underlying cause.
5
Q
What are the potential origin possibilities for acute arterial occlusion
A
Aortic- Atherosclerotic thromboembolic
Cardiac - LA myxoma , LA A Fib Thrombus
Venus - Paradoxical DVT thromboembolic cardiac shunt
6
Q
What condition would predispose you to LV thrombus
A
Large Anterior MI
7
Q
Best TXM for large ant MI w LV thrombus
A
Apixaban
Blood Thinner
8
Q
Inf Endo TXM is commonly
A
ABX for bacterial infection
> 1 cm = surgery
9
Q
No causes of Chronic PAD, echo is normal valvular vegetation’s = normal , shunt = normal , what is the most common cause of Paradoxical DVT
A
ATH with venous origin
10
Q
Best imaging study for DVT
A
Doppler U/S
11
Q
Paradoxical DVT is
A
Thromboemboli that comes from a DVT
People with a shunt that have venous thrombi
“Breaking off from a cardiac origin”
12
Q
PAD is similar to what type of disease
A
CAD
13
Q
Where is most common for PAD plaque to end up
A
Popliteal arteries
14
Q
What is the ABI finding in PAD
A
Less than 0.9
15
Q
Ominous sxs of CHRONIC PAD
A
Localized muscle fatigue
Rest Pain = ABI less than 0.4
Paresthesia weak erectile dysfunction
16
Q
What is the imaging study of choice to eval DVT
A
Doppler U/S
17
Q
Chronic Sxs of PAD
A
Diminished pulses Slow cap refill Hair Loss Hypertrophic nails Arterial bruits Pillow Wet vs Dry gangrene
18
Q
Wet gangrene vs dry gangrene
A
Dry = black and rubs off
Wet = looks like a wound
19
Q
What is the best way to map out intervention in PAD
A
Arterial duplex scanning
W/ invasive arteriography (peripheral)
20
Q
Diagnosis of chronic PAD is made by
A
Sxs + Radiographic Evidence
21
Q
Severe mgmt for PAD
ABI less than 0.4) (rest pain
A
Bypass graft surgery
POBA (plain old balloon angioplasty)
Percutaneous arterial stent
22
Q
What method of intervention lasts longer
Prosthetic or Native
A
Native tissue
23
Q
POBA can cause what with arterial sheering
A
Aortic Dissection
24
Q
Most is the most common cause of PAD and TXM
A
ATH
Cilostazol
With an Aspirin = Anti-platelet therapy
With a Statin (HIS)
HIS
Atorvastatin 20-40 mg
Ruvustatin 40-80 mg
25
What do you give a patient if they have ASA allergy
Clopidogrel
26
What is a good physical exam assessment for Art occlusion
Routine 6 minute walk test
Vascular assess and
Skin assess
27
What is the concept of the 6 minute walk test
Assess symptoms for PAD
Assess claudication with low ABI
Standardized MET EQUIV.
Fail test , Doppler study req’d
Assess need for cilaztasol + ASA + HIS
*can help with follow up to assess disease progression*
28
Low ABI req. what management and treatment
Doppler U/S
TXM =
Cilostazol
With an Aspirin = Anti-platelet therapy
With a Statin (HIS)
29
What 2 disease processes can cause ATH and PAD most commonly
DM
| CKD
30
Vasculitis is normally part of what?
A systemic condition
| Whole BODY ATTACK
31
Temporal Arteriritis Sxs
And is associated with what disease
Jaw Claudication
Vision- Blindess
Headache
Elevated CRP and ESR
Assoc- w/ Polymalgia Rhuematica (PMR)
32
Temporal arteritis can have what? Due to what?
Whole body pain
Concurrent vasculitis
33
Takayasu does what
```
Low fever/ weight loss / fatigue
Limb claudication
Cardiac angina
Carotid pain
Vertigo / syncope
Elevated CRP and ESR
```
Impacts the aorta
Responds to high dose steroids
34
What treats vasculitis best
Steriods-prednisone
35
The temporal artery is what characteristic and what downrange
Hot / Inflamed
Then
Cold and causes the optic neuritis
36
What is the important lab finding in vasculitis
ESR and CRP elevated
37
Best study to eval vasculitis ( Takayasu and Temporal Arteritis )
MRAngio
38
Confirmatory test for Art occlusion PAD and Vasculitis
Invasive Angio
39
Best acute treatment of vasculitis
Prednisone!
40
Chronic treatment of vasculitis
Biological anti inflammatory to reverse underlying conditions
41
Most common type of aneurysm
AAA
42
CMD’s
Ehler danlers
Bicuspid Aorta
Marfans syndrome
43
End of result after ischemia and infarct
Aneurysm
44
Epidemiology risk factors for aortic anuerysm
Over 65 years old
45
Abd Aortic Anuerysm can show disease where
Kidneys
Ischemic bowel - Large Mesenteric Ischemia
Liver
46
AAA bu ASX you need to get what
CT of chest ABD pelvis with contrast
| To survey the entire aorta
47
ABD aorta greater than what gets screened when and how often
Greater 3 cm
| 1 a year
48
Sxs of a AAA
Pulsitile abdominal mass
| With PE Bruit
49
Indications for urgent aortic repair
AAA-EVAR
Any sxs
Greater than 5.5cm
Expanding .5 cm per year and greater 5 cm
50
Ascending Thoracic pain is where
Retrosternal chest pain
51
Proximal aorta ascending TAA is associated with what murmur
Aortic regurgitation - early diastolic best with expiration
52
Right sided vs left sided murmurs
Inspire and expire
53
Superior vena cava syndrome
Upper extremity edema
54
End organ ischemia affects what organs
Hands
| Hair / Head neuro sxs (from hypoperfusion)
55
Large medistinum could make you concerned for what
Aortic Dissection
| Aortic Aneurysm
56
Diagnosis of all anuerysm Stable =
Chest ABD Pelvis CTA
57
Unstable diagnosis for Ascend. Thoracic. AA
SBP less than 90
| TEE req’d
58
What is the only thing that improve mortality in AAA
Smoking cessation
59
Aortic Repair for Ascending Aorta
Open SURGERY
60
What med do you give after dx of ascending aortic anuerysm and descending
Beta blocker + Statin + ACEI
61
What is the only anuerysm that presents with back pain, left sternal pain laryngeal nerve hoarseness
Descending TAA
62
What defines unstable for Desc. TAA
SBP less than 90
63
Surveliience imaging for anuerysm
Ascending. - @3.5cm = annual ; 3.5-4.5 = biannual ; aortic root invol ->echo
Descending - @4.0cm = annual ; @5.0cm = biannual ; aortic root invol ->echo
Abdominal - @3.0 annual screening
64
Proximal Type A has what kind of mortality rate
Better prognosis with surgery
| Worse with medication mgmt
65
Most common type of dissection
Type A
66
Where can an aortic dissection occur
Medial Tear
Due to vascular pressure
Vaso Vasorum
67
CABG or PCI can cause what
Aortic Dissection
68
Proximal dissection presents with what type of pain
Sternal
69
What murmur is common in type a AD
Aortic regurge
70
What type of AD requires EMERGENT surgery
Aortic Dissection Type A
71
Type A AD can benefit from what med mgmt
Anti-impulse
| Vasodilator therapy
72
Exam findings for type A AD
Unequal pulses
| Ripping tearing pain
73
What med do you not give for ASX pulses
ASA
74
Sxs of Type B AD
Ripping scapular bac pain or abdominal pain
Hemothorax, hemoperitoenuem , Neuro deficits
75
What is the ASX pulse difference between Type a and Type B exam for AD
Variance between left arm and left leg is indicative of Type B
76
When do you surgically manage Type B AD
Limb ischemia
| Kidney function worse
77
What is the intervention for Type B AD
Medical mgmt
| EVAR
78
Primary treatment for Type B
Propranolol
79
What is the goal BPM during anti impulse therapy
Less than 60 BPM
80
Pericarditis 4 characteristics
Friction Rub
ECG changes
Pleuritic Chest pain
Effusion
81
Myopericarditis =
Pericarditis
| + Positive Troponin = Myocardial Injury
82
What are the most common among known viral causes of Pericarditis
And med cause
TB
Cocksackie
Doxorubicin -chemo med
83
Best medication mgmt for myopericarditis
ASA + Colchicine
ASA due to concurrent heart disease (don’t give other NSAID’s) wont help heart and prevent heart attack
84
CKD with uremia what would be the 1st txt of pericarditis
Hemodialysis
85
What treats only acute pericarditis
Ibuprofen or indomethacin (NSAIDS) x2weeks then +Colchicine (3months initial) and (6months recurrent)
*use ASA if post MI* *use high dose steroids if Preg Or CKD*
86
Telemetry is = to
Continuous heart monitoring
87
What is the best way to ID Hemodynamic stability
Vital signs
88
Hx of bleeding issues or prior would require what kind of mgmt
ICU
89
Recommended physical activity for myopericarditis TXM
After 6 months no sxs with normal CRP
90
Physical activity mgmt for pericarditis non athlete
No sxs with normal CRP
91
Athlete (Military soldier) pericarditis physical activity return
3 months No sxs with normal CRP
92
If sxs do not improve after ASA (2 weeks) therapy what is the best mgmt
ASA taper is recommended
93
Cardiac Tamponade evidence
Obstructive shock sxs
—-
Repeat echo
94
Kussmauls sign req what ddx
Constrictive pericarditis
Or
Restrictive cardiomyopathy
95
What is a sxs of cardiac Tamponade and how can it present
Ripping anterior chest pain
W/ bicuspid aortic valve
Electrical alternans on ECG
96
Dissection can lead to what?
Active bleed which can cause Cardiac Tamponade
97
Cardiac Tamponade classic sxs presentation
Becks triad
JV/Hypotension
Distant heart sounds
Ewart sign
Possible = pulses paradoxes
98
When do you give ASA
Myocardial involvement
99
Pericardiocentesis can do what for dissection
Make it worse because you relieve the pressure around the bleed
100
What would be seen on a cardiac Tamponade echo
Pericardial effusion
| Diastolic collapse of all 4 cardiac chambers
101
Cardiac Tamponade needs what type of admit
ICU
102
Constrictive pericarditis sxs presentation
Kussmals sign
Pericardial knock
Chest pain that radiates to back on inspiration
Hepatomegaly
103
Sxs resolve for constrictive pericarditis
Pericaridiocentesis
104
What wave is present with constrictive pericarditis
V wave, persistent with right atrial pressure
105
Restrictive cardiomyopathy has what type of fibrosis
Myocardial
*constrictive pericarditis = pericardial fibrosis*
106
New exertional dyspnea with chest pain relived by nitro
| STE gets what txm?
Goal : Gets cath lab in 90 min
107
What SBP below makes you want to stop giving nitro
90-100
108
ECG LEADS
Know the locations and blood supply
109
How often should you repeat ECGS vs Troponin
15 mins
Hourly
110
Elevated V2 more than the other leads is indicative of what
Scarbossa validated MI
Do what?
*repeat in 15-30 mins*
111
Wellenoid ekg findings
Are indicative of early MI
112
New LBBB that meets scarbosa criteria should get what
Cath Lab activated
113
Low heart rate means the pt may not need what three things
Morphine
Nitro
Too many fluids
114
What types of disease have chest pain relieved with rest
Wellens syndrome
Right vent infarct
Could be Left main disease
115
What ecg finding is indicative of right vent. Heart failure
23AVF
With 3 being the largest
116
AVR elevation only with global depression =
Left main coronary artery disease
117
Risk factors for heart score
List ‘em
118
How does phlegmasia alba dolens present?
Pale
Pain
With different red marks due to sup. Vein still draining
+ WITH A PULSE
119
How does phelgmasia cerulean dolens present
Red all over
DrEP - dependent rubor
- NEG / NO PULSE
120
If pt is not high risk for ASCVD event and you have already used adjunct with ezetimibe (above 70mg/dL LDL) what do you do
Optimize diet and lifestyle
121
Acute arterial occlusion sources (3)
Aortic
Cardiac
Venous
122
6 P’s of compartment syndrome
```
Pain
Pale
Pallor
Paresthesias
Pulselessness
Poikilothermic
```
123
What is the #1 study to eval Acute Art Occlusion
CTA
Then -> Thromboectomy
124
Wha two conditions, when present with acute arterial occlusion, can be treated with a blood thinner
A-Fib
| L thrombo emboli
125
What type of sxs are present with PAD
```
ATH sxs
Claudication
Rest pain
Unstable angina
Dry to Wet gangrene
```
126
What is the #1 study to eval PAD
Art Duplex
Then, Inv. Angio—>Bypass Graft / Stent
ABI
127
What is the best treatment for an ABI less than 0.9
Cilostazol + Statin + ASA
128
Two types of vasculitis discussed and the best TXM
Takayasu
Temp Arteritis
Steroids = prednisone
129
Acute pericarditis sxs and presentation
Sharp pleuritic pain
Friction Rub
Kussmaul breathing
130
4 most common causes of pericarditis
Post viral = #1 (coxsackie b)
TB
Lymph
Uremia
131
Best treatment for viral pericarditis
NSAIDs + Colchicine
132
Best TXM for Pregnant pericarditis
Prednisone
133
Best TXM for uremic pericarditis
Hemodialysis
134
What does myopericarditis have on echo findings and how is it different from pericarditis
Echo = global hypokinesis
+ Troponins = myo damage
135
Modified wells criteria greater than 4 gets what type of study (if pt has a lung condition)
CTA
136
A MWC of less than 3 and a D-Dimer of what value is good to discharge the patient?
500
137
Myopericarditis and vascular disease has what main TXM protocol
ASA
138
HFrEF pt that is young and has exacerbated all meds gets what type of treatment?
LVAD
| Set up for heart transplant
139
Older terminal cancer pt has HFrEF, best treatment?
Palliative ; laxatives ; pain mgmt
140
How does Cardiac Tamponade present
Becks triad
Ewarts sign
Kussmaul breathing
ECG :Electrical Alternans
*pressures will normalize*
141
Best TXM for cardiac Tamponade
Drain until fluid is less than 25 ml a day
142
Constrictive pericarditis sxs and presentation
Rt Sided HF signs
Acute pericarditis chest pain
Friction KNOCK
Kussmauls
143
What is different about constrictive pericarditis
Pericardiocentesis fails to drop RA pressure below 10 mmHg
While Tamponade centesis will drop the RA pressure below 10mmHg
144
TXM for constrictive pericarditis
1st - DRAIN
| 2nd - pericardiectomy
145
Ascending TAA has what type of chest pain
Anterior
146
Restrictive cardiomyopathy is seen best on what study
MRA
147
Descending TAA has chest pain where
Scapula and
| Back Pain
148
Type A dissection is where?
Proximal
149
Type B dissection is where
Distal
150
Type A dissection presents with what
Aortic Regurge
Unequal pulses b/w right arm and left arm
Anterior chest pain
151
Presentation of type b dissection
Back or abdominal pain
Arms and legs diffferent pressures
W/ Ischemia :
pallor, kidneys issues, lactate HIGH, abd pain after eating
152
Mgmt and TXM of type B dissection
Propanolol
TXM = URGENT EVAR
153
Hx of stable angina w/ AS has what effect on oxygen , due to what?
Demand increase
| Increases wall stress and resistance
154
Hx of stable angina w Aortic Regurge has what effect on oxygen, due to what?
Increased demand
| Increased wall stress and radius
155
What are our anti anginal drugs
```
BB
ACEI
NTG prn
CCB
Ranolizine
```
156
Oxygen demand is controlled by what 3 things
Wall stress
Heart rate
Contractility
157
Oxygen supply is controlled by what 3 things
Resistance
Hemoglobin concentration
Coronary perfusion
158
Stunned vs Hibernating myocardium
Stunned = blood flow low with no fxn
Hybernating = chronic stable angina overusing NTG
159
How can hibernating heart be definitively treated
Revascularization
160
An NSTEMI with chest pain is caused by what?
Mismatch
| Perfusion vs viability
161
Irreversible necrotic disease presents how on PET scan?
Perfusion match
162
Best way to treat irreversible necrotic disease
Max medical management
163
2 treatment protocols for after unstable angina / NSTEMI / and STEMI
DAPT ( ASA and Clopidogrel )
| And Anticoag therapy (UFH or Enoxparin)
164
Providers continue to increase BB to treat angina unless the Bp = what?
Less than 60 Bpm
165
2nd and 3rd line medical TXM of angina
CCB
Ranolazine
166
Systolic Bp less than 90 is indicative of what?
Cardiogenic Shock
HIGH RISK
Inv Angio in 2 hours
167
ECG findings of LM dz and management
Global STD’s w STE’s in AVR
12 hr CABG mgmt
168
Patient presents with welllens criteria ECG but no chest pain best management?
Inv Angio
| 12 hours
169
Prinzmetals acute TXM vs chronic TXM
Acute = Nitro
Chronic = Amlodipine
Dilitiazem (CCB’s)
170
Accepted BB for coronary artery disease management
Metoprolol
Bisporolol
Carvedilol
171
Heart score greater than 3 gets what medical management?
ASA , Ticagrelor , UFH or LMWH (Enoxaparin)
Then BB within first 24 hours
172
Type B dissection treatment =
Bp control
173
Esophagitis chest pain differential and TXM
PIECE
P. ill I. nfxn E. osinophilic C. austic E. verthing else
Treat cause + PPI
174
Hyperthyroid sxs and txm
```
Tachycardia
Palpitations
Dyspnea
Chest pain
Systolic arterial HTN
```
B1 Selective B blocker
175
Warm and Dry TXM
Outpatient
| Diuretics
176
Warm and wet txm
Inpatient
| Diuretics
177
Cold and dry txm
ICU Inotropes
178
Cold and wet txm
ICU Diuertics
Inotropes
Vasodilators
179
Most common arteries affected by ATH (4)
Abd Aorta
Coronary
Popliteal
Carotid
180
Clinical finding associated 100% with ATH
Xanthomas
181
High risk conditions in secondary prevention
```
Age (over 65yrs old)
Familial hypercholesterolemia
Hx of CABG or PCI (outside of a major ASCVD event)
DM
HTN
CKD
Smoker
LDL over 100 despite max statin therapy and ezetimibe
Hx of CHF
```
182
Major ASCVD events
Recent ACS
Hx of MI
Hx of ischemic stroke
Sxs PAD = claudication or prev revanchist/amputation
183
Very high risk goal of txm for secondary prevention
Reduce LDL to less than 70
184
Not very high risk goal of secondary prevention
Goal is a 50% decrease in LDL
185
Risk enhancing factors for primary prevention of ASCVD
Fam Hx of ASVD
[Males over 55, Females over 65]
[ApoB over 130]
Metabolic syndrome
Chronic inflamm disorder [HIV/RA/psoriasis/Lupus/HIV/ART]
CKD
LDL over 160
South Asian
Trig. Over 175
ABI less than 0.9 when DIABETIC
186
Considerations for primary prevention
Diabetes
cholesterol level
Age [Males over 45/ Females over 55]
187
5 factors for Metabolic Syndrome
Waist circumference
Trig.
HDL
Bp
Fasting Glucose
188
Waist circumference of what is concern for Met.Syndrome.
Men over 40 inches
| Women over 35 inches
189
Trig. Over what is concern for Met.Synd.
175 mg/dL
190
HDL for men and women of what is concern for Met.Syndome
Men = under 40
Women = under 50
191
Bp of what is concern for met. Syndrome.
Over 130/85 or Bp MEDS
192
Fasting glucose over what = met. syndrome.
100
193
Age over 75 with a CAC of 0 can do what?
Have no stating therapy
194
Age 20 - 39 with lifetime risk fam Hx of premature ASCVD or LDL over 160
MIS
195
Age 40-75 yrs old with LDL 70 to 190 WITH NO DM and risk less 5% ;;; 5%-7.5% ;;; 7.5%-20% ;;; 20%
Less 5% = no statin
5%-7.5% = MIS
7.5% - 20% = MIS ; goal = 30% reduction
20% = HIS ; goal l= 50% reduction
196
LDL over 190 gets what primary prevention
HIS
197
DM LDL 70-190 gets what primary prevention
MIS.
198
DM LDL 70-190 with 2 risk enhancers gets what therapy
HIS ; goal = 50% reduction in LDL
199
High Int Statin meds
Atorvastatin 40-80
| Ross a statin 20 -40
200
Mod intensity Statin meds
Atorvastatin 10 -20
Rosuvastatin 5-10
Simvastatin 20-40
Pravastatin 40-80
201
Monitoring parameters for stain therapy
Baseline
FASTING LIPID/ HEPATIC FXN/ CREATINE KINASE
4 AND 12 WEEK FOLLOW UP
EVERY 12 MONTHS
202
Statin therapy has increased risk of what two things
Myopathy
| Myopathy and rhabdomyolysis
203
MOA of statin
HMG COA Reductase INHB
204
Statins have a drug interaction with what drink
Grapefruit juice
Red yeast rice
205
High risk conditions that need 2 hour Inv Angio
Hemodynamic ally unstable
Left ventricle dysfunction
New or worse MR
New VSD
Vtach
Ventricular arrhythmias
206
LV ejection fraction less than 50% gets what
CABG
207
PCI due to ACS gets what follow up txm after DES
12 months ASA Clopidogrel or ticagrecalor or prasugrel
208
Stable Isch. Heart dz gets what follow up txm if used a Drug eluding stent
6 months ASA plus Clopidogrel
209
Stable isch. Heart dz gets what follow up txm after BMS
1 moth of ASA plus Clopidogrel
210
Lateral leads and blood supply
1 , AVL, V5 , V6
| LCx Diag LAD
211
Inferior leads and blood supply
2,3,AVF
RCA and or LCx
212
Anterior septal leads and blood supply
V1,V2,V4,V4
LAD
213
If HIT occurs use what?
Bivalirudin
214
An obstruction of lymph drainage results in what and what is the associated finding
Lymphedema
Non pitting edema
215
Primary lymphedema is associated with ?
Hereditary congenital lymphedema
216
What is the most common cause worldwide of secondary lymphedema
Filariasis
217
What are other causes of secondary lymphedema
Post op -mastectomy
Radiation surgery lymph node removal
218
What is the most common cause of lymphedema in the US
Radiation surgery axillary or groin lymph node removal
219
What is the murmur of AR
Early diastolic decrescendo crescendo murmur heard best at Erbs point while sitting up and leaning forward
220
What is a left atrial myxoma murmur
Diastolic murmur of an valve obstruction
| Heard best at mitral point with patient sitting up and leaning forward
221
Mitral stenosis murmur
A pre-systolic rumble heard best at the mitral valve positing laying LLDC
222
What are the holosystolic murmurs
Mitral regurge
Tricuspid regurge
VSD
223
What is a VSD murmur
Handgrip increases the strength of the murmur
Heard at the LSB through systole
L to R shunt
224
LBBB ECG
V1 = deep down wave
V6 = deep up wave , with notching
*lead 1 can also have notching*
225
What supplies the right coronary artery
PDA
226
LAD supplies what
```
Anterior wall
Anterior 2/3 IVS
Anterior Lateral Papillary Muscle
Left and Right BB
MV valve
```
227
LCx supplies?
Left Atrium
| Left ventricular lateral wall
228
RCA supplies?
```
SA node
AV node
Right Ventricle
Right Atrium
Left Ventricle
T/P Valves
Inferior / Posterior Wall
Medial Papillary muscle
```
229
PDA supplies?
Posterior 1/3 of the IVS
230
If a valve infarcts
Rupture and regurgitation results
231
If the Inv septum infarcts
VSD with murmur results
232
If anterior or lateral wall infarcts
Free wall rupture
| Tamponade results
233
If RB infarct what happens
RV failure
| Preload dependent and [would decomp with NITRO]
234
Inf INF STEMI
Possible junction Al rhythm or AV block results
235
If ANT SEPTAL STEMI
Possible LBBB or RBBB
