Cardio Block 3 Flashcards
What are the RFs for DVT?
What are the most common findings?
Hx of DVT Current CA Stasis x 6hrs Endothelium injury Thrombophilia
Calf pain, Edema, Warmth, Palpable cord
What two tests are sufficient to positively Dx DVT?
When can a DVT be ruled in/out?
D-Dimer
Compression US
In: Mod/High probability, Pos compression US
Out: Low probability, Neg D-Dimer
What are the acquired/inherited risk factors of DVTs?
Persistent: age, CA, antiphosphoidal Abs, Hx of DVT/PE
Transient: recent surgery/trauma, pregnant, OCP/Hormones, imobile
Inherited: antithrombin 3 deficiency, Protein C/S
Factor 5 Leiden
Prothrombin gene mutaiton
When is a D-Dimer for DVT not recommended?
What blood work up result is considered after a DVT has been Dx’d?
Pretest probability is intermediate/high
Factor 5 levels
What is the gray zone of DVT Dx?
What is done to finalize the Dx?
Neg US
High probability
CT/MR venography w/ repeat US when D-Dimer is 500ng or higher
What are 5 thrombophilic disorders?
What PE finding is indicative of DVT but unreliable?
OCPs Hormone replacement Antiphospholpid Ab syndrome Protein C/S deficiency Hyperhormocysteinemia Factor 5 Leiden
Homan Sign- pain w/ foot dorsiflexion
What is the Gold Standard of DVT Dx?
What are the 3 parts of Virchows triad
US
Stasis
Hypercoagulability
Trauma
What Tx med can’t be used in pregnant PTs w/ DVTs?
Define AAA
Warfarin, LMWH (Enoxaparin) is preferred
Infrarenal aortic diameter of 3cm or more
What are the RFs for AAA?
What is the underlying pathology?
FamHx Syphillis Men (Caucasian) Atherosclerosis Smoking HTN
Oxidative stress
Aortic wall inflammation
Proteolytic degradation of elastin/collagen
When is US screening for AAA conducted?
When are they surgical?
Men 65-75 w/ smoking Hx of at least 100 cigarettes
5.5cm or more
Growth of 0.6-0.8cm over 6mon
When are AAAs monitored for growth?
What are they monitored w/?
<5.5cm or growth 0.6cm or less per year
Cereal US
What size of AAAs don’t/need screening?
When do these PT need to be referred to vascular specialist?
<3cm, no testing
3-4: Q12mon
4-4.5: Q6mon
> 4.5cm
What can be done for PTs w/ AAAs in attempt to reduce their rupture/surgery likelihood?
Aortic dissection involves what 2 events?
Tobacco cessation
BP control
LDL <70
PO BB
Intimal tear
Hemorrhagic extravasation into intima-media space
Aortic dissections are characterized by ? pain and the development of ?
What is the first and second line medical therapy given to these PTs after rupture?
Ripping/tearing
AI murmur
IV Labetolol, Esmolol
Nitroprusside
What are three genetic d/os that can cause protein abnormalities leading to aortic dissection?
How can dissections be viewed for Dx?
Polycystic kidney- polycystin
Marfans- fibrillin
Ehlers- type 3 procollagen
CT- stable
TEE- unstable
What type of shunt is an ASD?
When are most of these Dx’d?
L to R
5th decade
Over time, a large enough ASD can lead to what five issues
What is the classic findings of these w/ auscultation?
Pulmonary overcirculation PHTN Eisenmenger R to L shunting Cyanosis
Wide fixed, split S2
ASDs done affect ? heart structure?
What is the most common and 3 other types of ASD?
Coronary artery
Ostium secundum- incomplete adhesion of flap and septum
Ostium primum
Sinus venosus
Coronary sinus septal defect
What is the most common cyanotic congenital heart dz in childhood?
What are the four parts of this d/o?
Tetrology of Fallot
PV stenosis- ejection murmur
RVH
VSD, no change w/ respiration
Over riding aorta
What PE finding is characteristic of Tetrology of Fallot?
What makes the Tet spells worse or better?
Loud systolic ejection murmur
CXR of boot shaped heart
R sided aortic arch
Worse: worsened pulmonary outflow obstruction
Better: inc systemic vascular resistance
Where does coarctation of the aorta occur?
How can this be identified on PE?
Acyanotic narrowing of descending aorta at origin of ductus arteriosus
Dec femoral pulse
Brachial HTN
Systolic ejection at apex
“3 sign” aortic knob on CXR
What does a VSD sound like?
This is considered acyanotic alone but can be seen in ?
Harsh murmur louder w/ smaller defects
Tetrology
Transportation of arteries
What causes a PT to become cyanotic from a VSD?
What syndrome is defined by PHTN and cyanosis from pulmonary vascular obstruction secondary to large R to L shunt?
R to L shunt
PHTN
Dyspnea
Eisenmenger syndrome (irreversible)
Peripheral artery dz can represent atheroscletoic disease w/in the aortoilliac system and is then called?
How does classic claudicaton present?
Leriche syndrome- thigh, butt, hip pain w/ ED
Replicated w/ exercise
Relieved w/ rest