cardiac management

Question 1

SVR equation & normal

Answer 1

[ (MAP - CVP) / CO ] x 80

- 800 to 1200 (1000)

Question 2

MI door-to-needle

Answer 2

30 min

Question 3

MI door-to-cath

Answer 3

60 min

Question 4

MI elevations (CK-MB, Trop I & T) & note

Answer 4

CK-MB: gt 120 IU/L
Trop I: gt 0.35 mcg/L
Trop T: gt 0.2 mcg/L

note: repeat 8 hours later

Question 5

cardiac reserve

Answer 5

difference between the rate at which the heart pumps blood and its maximum capacity for pumping blood at any given time

Question 6

metabolic syndrome criteria

Answer 6

3 of 5

• waist 40 m/ 35 f
• hyperlipidemia
• hypertension
• ↑ CRP
• insulin resistance (FBG 110+)

Question 7

What precedes S1 and what is it?

Answer 7

Diastole precedes, S1 = closure of AV valves.

Question 8

What precedes S2 and what is it?

Answer 8

Systole precedes, S2 = closure of semilunar valves.

Question 9

dilated cardiomyopathy: pathophys

Answer 9

severe ventricular dilation + systolic dysfxn

causes: idiopathic, postpartum, EtOH, viral myocarditis, ischemic heart disease

Question 10

dilated cardiomyopathy: mgmt

Answer 10

↓ preload: restrict Na, fluid
↓ afterload: vasodilation
↓ workload: activity restriction
↑ contractility: digoxin, dobutamine

SAME TX AS HF D/T REMODEING

Question 11

hypertrophic cardiomyopathy: pathophys

Answer 11

aka idiopathic hypertrophic subaortic stenosis

increased muscle mass of septum obstructs LVOT

Question 12

hypertrophic cardiomyopathy: mgmt

Answer 12

max preload/more filling time: BB, CCB

control dysrhythmias: amiodarone (CCB)

reduce septum size: septal myectomy OR alcohol ablation

NOTE - AV node, Bundle of His in septal wall = conduction problems

Question 13

hypertrophic cardiomyopathy: dx

Answer 13

Echo: septal wall hypertrophy, increased pressure gradients between aorta & LV

12 lead: LV hypertrophy

PE: systolic murmur

Question 14

restrictive cardiomyopathy: pathophys

Answer 14

muscle becomes constricted & can’t fill/pump

causes: amyoidosis (produced in bone marrow, accumulates in organs) or collagen disorders

Question 15

ankle brachial index: calculation & purpose

Answer 15

highest dopplered –
SBP (PT or DP) / SBP (brachial)

screening for PAD severity

Question 16

ABI scoring

• no disease
• mild to mod
• severe
• rigid/calcified arteries

Answer 16

• rigid/calcified arteries: gt 1.3
  + ultrasound to evaluate!
• no disease: 0.91 - 1.3
  + no sx
• mild to mod: 0.41 - 0.90
  + intermittent claudication & visual signs
• severe: lt 0.40
  + sx @ rest

Question 17

gold standard diagnosis for PVD

Answer 17

ultrasound!

Question 18

PAD mgmt

Answer 18

pharm: PDE-3 inhibitor + antiplatelet + ACE-inhibitor
medical: risk factor reduction, tx comorbs, exercise 30-45 min walking/day, avoid restrictive clothes

endovascular mgmt: stent, bypass

Question 19

what is critical limb ischemia?

Answer 19

severe PAD complication (2-5% pts)

EMERGENCY! reperfusion needed.

Question 20

critical limb ischemia: s/s

Answer 20

pain
pulseless
paresthesia
paralysis
pallor

Question 21

carotid artery stenosis often asx until

Answer 21

severe - 50 to 60% occlusion

Question 22

most common presentation of carotid artery stenosis patient

Answer 22

TIA

Question 23

carotid artery stenosis gold standard diagnostic

Answer 23

suplex ultrasound

Question 24

carotid artery stenosis mgmt

Answer 24

asx + 30-50% stenosis: 
↓ risk factor
tx comorbs
antiplt rx
vascular surgery follow up

over 50% + sx OR over 80% w/o sx:
vasc surg consult: @ risk complications
- carotid endarterectomy, angioplasty, stent

Question 25

renal artery stenosis presentation

Answer 25

uncontrolled htn refractory to meds

Question 26

gold standard for renal artery stenosis diagnosis

Answer 26

renal angiography (beware contrast since renal problems!!!)

so doppler US is most common (initial catch)

Question 27

virchow’s triad: what are the s/s and purpose?

Answer 27

s/s VTE!

1. venous stasis
2. hypercoagulability
3. vascular endothelial injury

Question 28

thoracic vs abominal aortic aneurysm

Answer 28

AAA = past renal arteries

Question 29

aortic aneurysm s/s

Answer 29

usually asx, found incidentally 80 - 90%

chest, back pain
new/changing abdominal mass (80% are palp when gt 5.5 cm)

Question 30

what is an aortic dissection?

Answer 30

results from intimal layer tear (aorta)

occurs when blood = in between intima/media → false lumen

ruptured aneurysm without dissection possible

Question 31

best diagnosis tool for aortic dissection

Answer 31

CTA - visualize the intimal flap

Question 32

aortic dissection physical exam findings

Answer 32

new diastolic aortic valve murmur

unilateral: pulse deficit, cold/mottled extremity

BP discrepancy in extremities

abd pain on palpation

Question 33

how to tell compartment syndrome vs critical limb ischemia

Answer 33

HISTORY!

Question 34

intracompartmental pressure: normal vs compartment syndrome vs surgical intervention needed

Answer 34

normal: 10 - 12 mmHg
compartment: 25- 30 mmHg

fasciotomy time: ΔP = DBP - highest intracompartmental pressure = gt 30mmHg

Question 35

fasciotomy purpose

Answer 35

for compartment syndrome - prophylactic: prevents change from occurring, doesn’t reverse damage from initial injury

Question 36

AAA diagnostics

Answer 36

1. bedside ultrasound (stat)
2. CTA (time to eval if op appropriate)
3. angiogram (least sensitive)

Question 37

reperfusion injury

Answer 37

serious complication following reoxygenation of tissues after ischemia/hypoxia

highly reactive oxygen intermediates (oxidative stress) cause further membrane damage + mitochondrial Ca overload

WBC especially affected

Question 38

beck’s triad - what is it & purpose

Answer 38

muffled heart sounds
increased JVD
BP decreased 20 between S1 & S2 (pulsus paradoxus)

signs of cardiac tamponade

Question 39

pulsus paradoxus

Answer 39

BP decreased 20 between S1 & S2