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PANCE 2.0 > Cardiology #12 (GCA, Thrombophlebitis, DVT, Varicose Veins, Venous Insufficiency) > Flashcards

Cardiology #12 (GCA, Thrombophlebitis, DVT, Varicose Veins, Venous Insufficiency) Flashcards

1
Q

What are some risk factors for giant cell (temporal) arteritis?

A

-Women > 50 years old
-Northeastern Europeans

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2
Q

Symptoms of GCA

A

-Headache
-Jaw claudication with mastication
-Visual changes (monocular vision loss, amaurosis fugax, CRAO, anterior ischemic optic neuritis is MC)
-Scalp tenderness
-Temporal artery may be tender, pulseless, or normal.
-Fever, fatigue, weight loss, night sweats, malaise.

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3
Q

Although GCA is primarily a clinical diagnosis, what labs can be drawn for further evidence?

A

Increase ESR and CRP. Normocytic normochromic anemia.

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4
Q

What is the definitive diagnostic for GCA?

A

Temporal biopsy

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5
Q

What treatment should be started for GCA once suspected. Do not delay treatment to biopsy or while waiting for biopsy results.

A

High-dose corticosteroids

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6
Q

What is the MC complication of GCA

A

Blindness

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7
Q

What are other options for treatment for GCA if the patient cannot take steroids?

A

Methotrexate
Azathioprine
Low dose Aspirin

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8
Q

What is superficial thrombophlebitis?

A

Inflammation and/or thrombosis of a superficial vein

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9
Q

Etiologies of superficial thrombophlebitis

A

-Associated with IV catheterization, pregnancy, varicose veins, venous stasis

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10
Q

What is Trousseau Sign?

A

Migratory thrombophlebitis associated with malignancy (pancreatic cancer, etc.)

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11
Q

Symptoms of superficial thrombophlebitis

A

Pain, tenderness, induration, edema, and erythema along the course of the vein.
May feel a palpable cord

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12
Q

Although superficial thrombophlebitis is a clinical diagnosis, what can be done for further evaluation?

A

Venous Duplex US: noncompressible vein with clot and wall thickening

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13
Q

MCC of superficial thrombophlebitis

A

Factor V Leiden

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14
Q

Treatment for superficial thrombophlebitis

A

-Supportive is mainstay: NSAIDs, elevation, warm compresses
-Vein ligation/excision (phlebectomy)
-If septic (febrile), give IV ABX

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15
Q

Most DVT’s originate in

A

the calf

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16
Q

What are the risk factors (Virchow’s Triad) for a DVT?

A

-Venous stasis (immobilization or prolonged sitting)
-Hypercoagulability (Protein C or S deficiency, Factor V Leiden mutation, OCP, malignancy, pregnancy, smoking)
-Intimal Damage (trauma, infection, inflammation)

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17
Q

Symptoms of a DVT

A

-Unilateral swelling and edema of the lower extremity > 3 cm (MOST SPECIFIC SIGN)
-Calf pain and tenderness
-Warm to palpation
-Homan sign: deep calf pain with foot dorsiflexion while squeezing the calf (not reliable)

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18
Q

First-line imaging for a DVT

A

Venous Duplex US

19
Q

Explain a D-dimer and specificity for a DVT

A

-highly sensitive but not specific.

Negative D-dimer with low-risk for DVT can exclude DVT as diagnosis.
Positive D-dimer should be followed by ultrasound

20
Q

What is the gold standard diagnostic for DVT

A

Contrast venography

-However, it is invasive, difficult to perform, and rarely used.

21
Q

First-line treatment for patients with a DVT

A

Anticoagulation: LMWH + Warfarin, LMWH + either Dabigatran or Edoxaban, or mono therapy with Rivaroxaban or Apixaban

22
Q

When should an IVC filter be placed in a patient with DVT? 3 reasons

A

1) recurrent DVT/PE despite adequate anticoagulation
2) Stable patients in whom anticoagulation is contraindicated
3) Right ventricular dysfunction with an enlarged RV on echocardiogram

22
Q

When should an IVC filter be placed in a patient with DVT? 3 reasons

A

1) recurrent DVT/PE despite adequate anticoagulation
2) Stable patients in whom anticoagulation is contraindicated
3) Right ventricular dysfunction with an enlarged RV on echocardiogramWhen is

23
Q

When is thrombolectomy or thrombolysis considered in a patient with a DVT?

A

Massive DVT or severe cases

24
Q

If the patient has a DVT, is is their first DVT and they have a modifiable risk factor, what is the time frame in which they should stay on treatment?

A

at least 3 months

-Modifiable risk factor: OCP, surgery, trauma, etc

25
Q

If the patient is pregnant and gets a DVT, what is the preferred treatment?

A

LMWH

26
Q

If the patient has malignancy, what is the medical therapy for DVT?

A

LMWH

Warfarin or direct oral anticoagulants are alternatives but LMWH is the preferred method

27
Q

According to the 2016 ACCP guidelines, what is preferred over Warfarin therapy as the management of DVT/PE if the patient does not have cancer?

A

Novel oral anticoagulants (Apixaban, Dabigatran, Edoxaban, Rivaroxaban)

28
Q

What is the mechanism of action of LMWH?

A

Potentiates antithrombin III (works more on factor Xa than thrombin (Factor IIa)

29
Q

What is the antidote to LMWH?

A

Protamine Sulfate

30
Q

What is one major contraindication to use of LMWH?

A

Renal failure because LMWH is excreted by the kidneys

31
Q

Regarding the Well’s Criteria for DVT, what score is associated with low probability of DVT? Moderate probability? High probability?

A

Low: -2 to 0
Moderate: 1-2
High: 3-8

32
Q

Explain what some of the points are that are given for Well’s Criteria for a DVT

A

Active cancer or treatment within last 6 months : 1 point
Paralysis or immobilization of lower extremity: 1 point
Bedridden for more than 3 days due to surgery (within 4 weeks) : 1 point
Localized tenderness along deep veins: 1 point
Swelling of entire leg: 1 point
Unilateral calf swelling of greater than 3 cm: 1 point
Collateral superficial veins: 1 point
Unilateral pitting edema: 1 point
Another diagnosis more likely than DVT: -2 points

33
Q

Explain the pathophysiology of varicose veins

A

Dilation of superficial veins due to failure of the venous valves in the saphenous veins, leading to retrograde flow, venous stasis, and pooling of blood

34
Q

Risk factors for varicose veins

A

Family history
Female gender
Increased age
Standing for long periods
Obesity
Increased estrogen (OCP use, pregnancy)
Chronic venous insufficiency

35
Q

Symptoms of varicose veins

A

Most are asymptomatic but may present due to cosmetic issues
-Dull ache or pressure sensation
-Pain is worse with prolonged standing or sitting with the leg flexed. Relieved with elevation.
-Dilated visible veins
-Telangiectasias
-Swelling, discoloration
-Mild ankle edema

36
Q

Treatment for varicose veins

A

Conservative: compression stockings, leg elevation, pain control
-Ablation: laser or radiofrequency
-Ligation and stripping
-Sclerotherapy

37
Q

When does chronic venous insufficiency occur and what is it?

A

Changes due to venous hypertension of the lower extremities as a result of venous vavular incompetency

Occurs after superficial thrombophlebitis, DVT, or trauma to the leg

38
Q

Explain the pain associated with chronic venous insufficiency

A

-Worse with prolonged standing or sitting with the feet dependent
-Better with ambulation and leg elevation

-Burning, aching, throbbing, cramping, or “heavy leg”

39
Q

What does the skin look like on the associated leg with chronic venous insufficiency?

A

-Stasis Dermatitis: itchy eczematous rash, excoriations, brownish or dark purple hyperpigmentation of the skin
-Venous stasis ulcers: at medial malleolus
-Dependent pitting leg edema
-Increased leg circumference
-Normal pulse and temperature
-Atrophie blanche: hypo pigmented areas with punctuate red dots

40
Q

Where are ulcers associated in chronic venous insufficiency?

A

Most times at the medial malleolus

41
Q

Treatment for chronic venous insufficiency

A

-Conservative: initial management. Leg elevation, compression stockings, exercise and weight management
-Surgical intervention only for non-response to conservative therapy
-Ulcer management: Zinc impregnated gauze, wound debridement, Aspirin

42
Q

Why give aspirin for an ulcer associated with chronic venous insufficiency?

A

It accelerates the healing process of the ulcer

PANCE 2.0 (62 decks)

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