Cardio problems PII Flashcards
Occulsive peripheral vascular disease ( including diabetic vascular disease)
Hypertensive smoker comes in either a) acute vascular occlusion = severe ischemic pain, or b) chronic occulsion = claudication of thigh/buttock/calf/foot +- ulcers
- px: lift foot- should stay pink ( buergers test), ABI, skin color/temperature. This is a clinical diagnosis, but they might need vascular to come help remove the atherosclerosis/ put them on anti-clotting things ( aspirin/clopidogrel, exercise therapy to improve endothelial function). Tell them the exercise is worth it 85% will get better if exercise.
extracranial carotid occlusive disease ( carotid stenosis)
person comes in with “shade over eye”, TIAs, bruits, and you know its because their carotid artery is shooting plaques up. You do a cerebral angiography ( to look at the blood vessels) and then follow with carotid endarterectomy (CEA) to cut it out. You also stop them from clotting : statins, aspirin, reduce risks like HTN, DM, dyslipidemia
where do you usually find atherosclerosis in the carotid arteries?
its predominantly in the posterior wall of the carotid artery, 2cm before it bifurcates ( common carotid becomes internal and external carotids. Internal goes on to give off the opthalmic artery and ten continues to the circle of willis)
coronary artery disease
dude with clogged coronary arteries ( arteries that feed the heart) has heavy chest pressure/ pain radiating to arm with nausea and vomiting - this is because 02 demand is determiend by contractility, wall stress, and HR. You think his coronaries are blocked, but you dont know to what extent so you get an ECG, stress test, and coronary angiography to take a final look. if hes not too bad, medical mgmt with asa, 02, morphine, Nitro, bblockers, statins. Surgery is CABG
CHF - acute decompensated - symptoms only, not the whole story ( hint there are 10++ points here)
dilated pupils ( sympathetic system is on), skin pale gray/cyanotic, Orthopnea ( cant breathe unless sitting up because there is water in the lungs), crackles/wheeze ( lungs working hard), cough ( frothy sputum), decreased B ( heart not working), ascites ( there is fluid everywhere!), dependent pitting edema in the sacrum/ legs. Confusion ( decreased 02 to the brain), jugular venous distention, fatigue, HSM, decreased urine outpt
rest of the story in CHF
this patient cant sleep flat, and wakes up at night gasping, has crackles in the lungs, ascites and an S3 with elevated JVP. make sure they dont just have asthma, penumonia, or pulm edema, and then get htem an ECG, CXR, BNP, echo +- angiography if worried about vessels. the pathophys: decreased LV means sympathetic system turns on, your arteries constrict to move the blood, but also activates RAS = more fluid retained. tx: lasix/furosemide, nitro, seated posture,pulse oximetry, ACEs ARBs, sodium and fluid restriction
Aortic stenosis
aortic valve is tight, so it can close fine but it cant open, so during systole you get a crescendo-decrescendo murmur. pulsus parvus and tardus. surgically can replace valve, or do baloon valvuloplasty ( in very young pts). There is no medical treatment!
mitral stenosis
palpable diastolic thrill with opening snap before a diastolic decresendo murmur. usually due to rheumatic heart disease. Hx: wide split S2. Needs percutanous balloon valvuloplasty, meds = ACEi to decrease afterload.
acute superior venal caval syndrome
dyspnea, facial swelling, arm swelling. You do CXR and duplex U/S and find that the superior vena cava is being blocked by something, so you usually need to treat the obstruction ( usually cancer)
DVT
patient with unilateral leg edema/ swelling/warmth has a DVT from virchows triad ( hypercoag, stasis, endothelial damage). You make sure its not cellulitis, or calm muscle tear/pull, superficial thrombophlebitis, and order Ddimer/ Doppler. Venogram is the gold standard but is expensive.
Then anticoagulate them initiall on LMWH, later on warfarin/ IVC filter. read later on well criteria for PE, and for risk factors.
what are the 5p’s of vascular limb problems?
pulseless, parasthesias, with pain, pallor Phrigidity, and paralysis. The most important is paralysis because it means you have little time to revascularize.
what are the complications of doing surgery on someone with claudication type symptoms?
compartment syndrome- when the tissue dies ( is ischemic) but then is reperfused, there is free radical formation which is damaging. Dx clinically, based on pain response to passive movement. Tx fasciotomy, open fascia so muscle can swell properly. Pt may get lactic acidosis - hyperventilate them to get rid of the c02. They may hget high K from the dead muscle tiuue - do CBIG K. Pt may get excess myoglobin - red urine- give them fluids to help them pee it out
what is chronic venous disease, who does it affect and how do we fix it?
older latino man with job as security guard( prolonged standing) and or pregnant/obese lady have aching and swelling of legs with pressure. Px: see varicose veins, leg edema, skin ulcers/ changes from low perfusion. Clinical diagnosis, tx: 1) lifestyle. 2) stockings 3) endothermal ablation ( heat inside of the vein so it clamps down and you have decreasd flow), 4) sclerotherapy ( just prothrombic agents in the veins to get thrombosis, close the veins together
if someone complains of having an ache in their legs, what is one common and one fatal cause you should look into?
1) common = varicose veins
2) fatal = DVT- check if one leg is larger than the other, warmer, swollen, DDimer, CT PE.
you think someone has an embolism because they are SOB with afib. What do you do?
ABCs, vitals, heparin. Diagnose - CT angiogram. Treatment : embolectomy surgery.
