CARDIO: Misc Flashcards
Pts being considered for noncardiac surgery should be assessed for cardiac risk using what?
Revised Cardiac Risk Index
What age related changes can you expect in pts w/advancing age?
aoritc stiffening, mild concentric LVH, conduction cell degeneration, reduced baroreceptor sensitivity and adrenergic responsiveness (leading to orthostatic hypotension!)
A woman with stroke like symptoms come into the ER. A CT angiogram of the head shows a thrombus in the left middle cerebral artery, and endovascular thrombectomy is performed. Microscopic examination of the retrieved thrombus shows mucoid, gelatinous material that is hypocellular. Where did this likely originate from?
A thrombus containing mucus and gelatinous material suggests that this patient’s thromboembolus occurred due to an underlying myxoma.
Cardiac myxomas are the most common cardiac tumor in adults, and over 75% of all myxomas originate in the left atrium.
Autoimmune granulomatous inflammation, presents w/ thickened superficial temporal artery often seen in pts w/ polymyalgia rheumatica?
Giant Cell Arteritis
Persons w/GCA are at in increased risk for what major cardiovascular complications?
Giant cell arteritis (GCA) causes chronic inflammation of large and medium-sized arteries, in particular the carotid arteries, its major branches, and the aorta. Approximately 10–20% of patients with giant cell arteritis (GCA) will have involvement of the thoracic aorta, which significantly increases the risk of thoracic artery aneurysms and dissections. The median time between the diagnosis of GCA and thoracic aortic aneurysm is around 10 years.
Viral illness in 40 yo man followed by signs of acute heart failure is seriously concerning for…
Viral myocarditis
You can also think about pericarditis but you may see less heart failure signs and more of a rub on ausc and signs of tamponade (Becks triad: muffled heart sounds, hypotension, venous distention)
When would the following tests be warranted:
-24 hr ECG monitoring
-Serum CK and troponin
-ECHO
-Cardiac Stress Test
-24 hr ECG monitoring=heart palpitations/suspicion of arrythmia
-Serum CK and troponin= suspicion of ACS
-ECHO= suspcion of valvular disease or HF
-Cardiac Stress Test= evaluation of angina pectoris
When do we determine ankle brachial indices?
When we suspect peripheral vascular disease, claudication is define by the onset of LE pain and cramping with exercise that impreoves with rest. It can indicated underlying arterial disease. ABI ratio of less than 0.9 is sensitive for detected PVD. ABI above 1.3 means likely calcified vessels. ABI 0.9-1.3 is normal.
How do addisons present differently from hyperaldosteronism?
Addisons= adrenal insufficiency (autoimmune), deficit in aldosterone and other adrenal homones like cortisol. Presents w/hypotension, hyponeutremia, hypoglycemia, and dark skin pigmenetation.
Hyperaldosteronism presents with hypertension, may present with hyperkalemia.
Young pt with new onset hypertension, what can you consider?
Pheochromocytoma (anxious symptoms)
Hyperaldosteronism like from adrenal adenoma or bilateral hyperplasia
