Cadiovasc NMBE Flashcards
What are the types of large vessel vasculitis?
-Giant cell (temporal) Arteritis
-Takayasu Arteritis
How can you distinguish between the different large vessel vasculitis?
Giant cell
-“old women with jaw pain and vision loss”
-Unilateral headache
- Inc. ESR associated with polymyalgia rheumatica (joint and muscle pain/stiffness)
- Granulomatous thickening of carotids
Takayasu
-“young asian women with WEAK PULSES”
-Pulseless disease
-Granulomatous thickening of aortic arch
What are the types of medium vessel vasculitis?
-Polyarteritis Nodosa
-Kawasaki disease
What are some ways to distinguish medium vessel vasculitis?
Polyarteritis Nodosa
-PAN = HepB + renal prob + neuro prob
- Hepatitis B patient with renal and neuro problems
- SPARES lungs
- Fibrinoid necrosis–> String of pearls
-corticosteroids, cyclophosphamide
Kawasaki Disease
-CRASH and Burn;
-Conjunctivitis, Rash, Adenopathy (cervical), Strawberry tongue, Hand/foot edema, Burn (fever)
- Coronary vasculitis–> risk of aneurysm
- Aspirin and IVIG treatment
What kind of vasculitis is Buerger disease?
Medium vasculitis
Whats another word for buerger disease?
Thromboangiitis Obliterans
What are the types of small vessel vasculitis?
-Granulomatosis with polyangiitis
-Microscopic polyangiitis
-Eosinophilic granulomatosis with polyangiitis
- Henoch- Schönlein Purpura
Whats another name for granulomatosis with polyangiitis?
Wegeners disease
Whats another name for eosinophilic granulomatosis with polyangiitis?
Churg- Strauss
Whats another name for Henoch-Schonlein Purpura?
IgA vasculitis
What are some ways I can distinguish small vessel vasculitis?
Wegeners
-C-shaped symptoms
-C-ANCA
-C- shaped organs; nasopharynx, lungs, kidneys
-Hemoptysis, hematuria
-Necrotizing granulomas
-cyclophosphamide and steriods
Microscopic Polyangiitis
- Like wegeners but no granulomas or NO upper airway involvement
-P-ANCA
-cyclophosphamide and steriods
Churg-Strauss
-P-ANCA + eosinophilia
- History of asthma/allergies
-necrotizing granulomas
- cyclophosphamide and steroids
IgA Vasculitis
- IgA= Skin, GI, Kidneys
-PALPABLE purpura, arthritis, abdominal pain
-IgA nephropathy (hematuria)
-Often follows URI
What type of vasculitis present with recurrent oral and genital ulcers, uveitis and POSITIVE pathergy test?
Behcets syndrome
What are the main 4 types of shock
Cardiogenic Shock
Distributive shock
Hypovolemic shock
Obstructive shock
What is the main cause of cardiogenic shock?
Heart failure due to MI, arrhythmias, cardiomyopathy, valvular diseases (mitral regurg)
What is the pathophys of cardiogenic shock?
-Decreased CO due to pump failure
-increased afterload due to body compensating (RAAS and SNS)
What clinical features are associated with cardiogenic shock?
-Hypotension, tachy, cool extremities, pul. edema (dyspnea, crackles)
-JVD due to increased CVP (right atrial pressure)
-Low CO w/ high PCWP (due sucky ass left ventricle)
-increased TPR (body compensation)
What are the main causes of hypovolemic shock?
Decreased blood volume due to hemorrhage, fluid loss (vomitting, diarrhea, burns), or dehydration
What is the pathophys for hypovolemic shock?
-Decreased preload, leads to low CO
-Body compensates by activating RAAS, SNS, ADH secretion to preserve blood volume
What are the clinical features of hypovolemic shock?
-hypotension, tachy, cool extremities, reduced urine output
-Dry mucous membranes (dehydration)
-Low central venous pressure (CVP)
-Low PCWP
What are the big causes of distributive shock?
Systemic vasodilation due to…
-sepsis
-anaphylaxis
- neurogenic shock (spinal cord injury–> less SNS input)
-toxic shock syndrome
What is the pathophysiology of distributive shock?
-MASSIVE vasodilation –> Decreased TPR—> shitty ass organ perfussion
-Decreased preload
-high/low CO depending on stage
What are the clinical features of distributive shock?
-Warm skin (in sepsis and anaphylactic shock), due to vasodilation
-Hypotension
-Hyperdynamic circulation with bounding pulses (due to compensation) in sepsis and anaphylaxis
- Tachy
-elevated lactate levels (in septic shock due to tissue hypoxia)
What are the main causes of obstructive shock?
Physical obstruction of blood flow due to PE, cardiac tamponade, tension pneumo
What is the pathophys of obstructive shock?
-Decreased CO due to impaired blood flow
-increased afterload or pressure overload on the heart due to obstruction
What are the clinical features of obstructive shock?
-hypotension, tachy, JVD (esp. in tamponade or tension pneumo)
-Sign of heart failure (dyspnea, pul. edema in tamponade)
-hypoxia, decreased breath sounds
Which arteriolosclerosis is due to benign hypertension
Hyaline arteriolosclerosis
Which arteriolosclerosis is due to malignant hypertension
Hyperplastic arteriolosclerosis
What is the difference between malignant and benign hypertension?
Malignant- acute onset, causes organ damage off rip, medical emergency
Benign- happens overtime, takes time to cause damage to organs
Pathophys for hyaline arteriolosclerosis
Benign hypertension and diabetes cause plasma proteins to leak into vessel wall causing narrowing of lumen and can cause renal failure
pathophys for hyperplastic arteriolosclerosis
Malignant hypertension or arterioles causes smooth muscle proliferation to sustain all the tension, this results in thickening of the vessel (onion skin), which can potentially lead to end organ damage
- renal failure, retinal hemorrhages, encephalopathy
What is CVI
Venous valves of the lower legs are fucked with lead to retrograde flow and decreased venous blood to the heart
this leads to venous hypertension due to blood stasis
can lead to DVT
What drugs are used for acute coronary syndrome
Anti-platelets
MOA of aspirin
inhibits Cox-1—> decreased TXA2—> decreased platelet aggregation
What is aspirin used for?
-Prevention of MI, stroke
-ACS
-Post stroke and MI
Side effects of aspirin
Gastric ulcers, tinnitus, allergic rxn, renal injury, reye syndrome
Which drugs have grel in their names
Clopidogrel
Ticagrelor
Prasugrel
MOA of the grel drugs
Binds to ADP receptor (P2Y12), thus preventing ADP binding which decreases expression of GPIIb/IIIa
What are the grel drugs used for
Combination with aspirin for ACU and PCI’s (stent placements)
What are the side affects of the grel drugs
Bleeding
What type of drug are the grel drugs
Anti-platelet drugs
MOA for Abciximab
GpIIb/IIIa receptor inhibitor—> decreased platelet aggregation
What is abciximab used for
ACS and during PCI
Side effect for Abciximab, tirofiban, eptifibatide
Bleeding, thrombocytopenia, hypotension
Which drugs block GpIIb/IIIa receptor?
abciximab, tirofiban, eptifibatide
Which antiplatelet drugs have ol in their name
Cilostazol, dipyridamole
MOA for dipyridamole, cilostazol
Blocks phosphodiesterase
–> increased cAMP
–> inhibition of platelet aggregation
side effects for ol drugs
cilostazol, dipyridamole
headaches, hypotension, dizziness, nausea, abdominal pain
what are cilostazol and dipyridamole used for
Claudication, stroke prevention, prevention of restenosis of stent
