CAD and Vascular Disease Flashcards
What is vasospastic angina?
Episodes of rest angina from vasospasm of coronary arteries that are relieved quickly by short acting nitrates.
Why do vasospasms of the coronary arteries cause chest pain?
Spasms cause the lumen of the vessel to become smaller, leading to ischemia and infarction if the spasms are persistent.
Risk factors for vasospastic angina.
Smoking, drugs, guide wire or balloon dilatation during PCI, botulism, magnesium deficiency, JAPANSESE DESCENT and age less than 50.
What are some differences between MI chest pain and vasospastic angina pain?
Described as discomfort rather than pain, gradual onset and stop.
Do you see EKG changes with vasospastic angina?
Yes, you can see transient elevation or depression in multiple leads.
How do you diagnose vasospastic angina?
Multiple episodes of angina type chest pain at rest and transient ST changes during an episode, without findings of coronary stenosis in coronary arteriography.
What is the first line treatment in preventing vasospastic angina?
Calcium channel blockers: nifedipine, diltiazem, verapamil, or amlodipine.
Work by preventing vasoconstriction and promoting vasodilation in coronary vasculature.
What medication can help terminate an episode of vasospastic angina?
Nitroglycerin
What medication can be added if a patient with vasospastic angina still need symptom control after using a CCB?
Long acting nitrates, such as isosobide mononitrate (Imdur)
T/F? There are no life threatening complications of vasospastic angina.
False, 25% of untreated patients can develop life threatening arrhythmia or MI. Treatment reduces life threatening events.
Stable angina is \_\_\_\_\_\_? A. Predictable and reproducible B. Relieved with rest C. Relieved with nitroglycerin D. All of the above
D. All of the above
What is one major difference between vasospastic angina and stable angina?
Vasospastic angina occurs at rest. Stable angina is relieved by rest.
What is a medication you would use in stable angina that is not indicated in vasospastic angina?
Beta blockers
CCB’s and nitrates are also used in stable angina.
When would angiography and revascularization be indicated in a stable angina patient who takes a CCB?
A. Significant interference in a patient’s lifestyle
B. Occurrence more than 2 times each week
C. It is never indicated for a stable angina patient
D. None of the above
D. None of the above
Angiography and revascularization is only indicated if symptoms interfere with a patient’s lifestyle despite maximal medical therapy
What is the difference between primary prevention and secondary prevention of an MI?
Primary is to prevent a first MI.
Secondary is to prevent another MI.
T/F. Aspirin is not used for primary prevention of MI’s.
True! No longer recommended for primary prevention.
What is the first line medical therapy for primary prevention of an MI?
Statin therapy if:
LDL >190
DM
40-75 years of age with sufficient ASCVD risk
What are secondary prevention options?
Treatment of risk factors ASA therapy High intensity stain beta block (after acute MI or HFrEF) ACEI/ARB especially in those with DM, CKD, HFrEF
Which of the following are true about PAD?
A. It is a disease of the venous system
B. It is most commonly from atherosclerosis
C. It a disease of the vascular system effects the coronary arteries
D. It is most commonly caused by emboli.
B. It is most commonly from atherosclerosis
Risk factors for PAD include all of the following except? A. Smoking B. Age > 65 C. Caucasian D. DM E. HTN D. Dyslipidemia
C. Caucasian
People of color are at higher risk of PAD
What are common symptoms of PAD?
Claudication, pain at rest, nonhealing wounds, ulceration, gangrene
What is the cause of blue toe syndrome?
Embolic occlusion of digital arteries with atheroembolic materiel from a proximal arterial source.
What is caudication?
Exertional leg pain
What is the likely area of disease for buttock and hip claudication?
Aortoilliac disease
What is the likely area of disease for thigh claudication?
Common femoral artery
What is the likely area of disease for calf claudication?
Upper 2/3 is superficial femoral artery
Lower 2/3 is popliteal artery
What is the likely area of disease for foot claudication?
Tibial and peroneal artery
What is Leriche syndrome (triad)?
Claudication, absent or diminished femoral pulses, ED
What is the Buerger test?
What is normal vs abnormal?
Elevate foot while patient is supine, then put the foot in a dependent position.
Normal is when the leg remains pink with elevation
Abnormal is foot pallor with elevation and dusky flush in dependent position.
Common physical exam findings of the skin with PAD?
Dry, shiny, hairless skin.
Cool temperature
Ulcerations or gangrene
Brittle or thickened nails
Signs of acute limb ischemia?
Extremity becomes suddenly and severely painful, cold, pale, pulseless, and immobile, without sensation or paresthesias.
What is an normal ABI?
between .91 and 1.29
What ABI is diagnostic of PAD?
less than or equal to .9
What does ABI >1.29 suggest?
Calcified vessels
T/F? All patients with suspicion for PAD should have exercise testing.
False, only patients with atypical pain and a normal ABI need exercise testing.
What exercise testing result is diagnostic of arterial obstruction?
ABI decreases by 20% or more after exercise.
When should vascular imaging be done for PAD?
When planning intervention.
What is the initial and gold standard of imaging for PAD?
Initial: CT angiography
Gold standard: Conventional angiography
Treatment for PAD includes which of the following? A. Antithrombotic therapy B. Anticoag therapy C Lipid lowering therapy D. Two of the above
D. Answers A and C are correct
Tx also includes risk factor modification
Medication used for symptoms of claudication is?
Cilostazol
Contraindication of Cilostazol?
Any pt with CHF.
Increases risk of angia and MI in patients with CAD
What is worse? Category II or category I acute limb ischemia?
Category II is more emergent. Limb survival is immediately threatened.
It is within 6 hours to be category II.
T/F? Risk of amputation is increased in patients with PAD
True
T/F? Upper extremity PAD is less common than lower extremity PAD
True, UE PAD is much less common.
MATCHING :)
Phlebitis
Vein Thrombosis
Thrombophlebitis
A. a clot within the vein
B. Inflammation within a vein
C. Thrombosis within a vein associated with inflammation
Phlebitis = B, inflammation within a vein
Vein thrombosis = A, a clot within the vein
Thrombophlebitis = C, thrombosis within a vein associated with inflammation
What is the greatest risk factor for phlebitis/thrombophlebitis?
varicose veins - 90% of cases
Clinical presentation of phlebitis/thrombophlebitis includes all of the following except? A. Tenderness B. Induration C. Cyanosis D. Pain E. Erythema
C. Cyanosis
Phlebitis/thrombophlebitis presents with tenderness, induration, pain, and erythema
Migratory thrombophlebitis should make you think of what condition?
Malignancy, especially pancreatic cancer
What is suppurative thrombophlebitis?
Infection within the vein, usually from cannulation. Causes high fever, fluctuance, purulent drainage, and erythema significantly past the margin of the vein
How is thrombophlebitis diagnoses? A. Ultrasound B. Clinical diagnosis C. Blood cultures D. CT scan
B. Clinical diagnosis
although you might rule out a DVT with ultrasound
Improperly function valves in the venous system leads to \_\_\_\_\_\_\_\_\_\_. A. Varicose veins B. Venous stasis C. Venous insufficiency D. Veins do not have valves E. A, B, and C
E.
venous insufficiency is AKA varicose veins and venous stasis
Risk factors for venous insufficiency include?
Female gender, age, obesity, prolonged standing, DVT, estrogen increase
Clinical manifestations of venous insufficiency
Telangiectasias, varicose veins, edema, blue-gray hyperpigmentation of anterior leg, stasis dermatitis, ulceration
Treatment for stasis dermatitis?
Topic mid to high potency corticosteroids once to twice daily x 2 weeks
