Cardiology Flashcards
What is 1st line mgmt of orthostatic hypotension?
Remove medications that cause it
Ex: Doxazosin (BPH med): alpha adrenergic antagonist
anti-HTN meds, nitrates, antidepressants
What are some additional things to know about medications regarding Orthostatic hypotension?
- In patients that continue to be symptomatic despite non-pharmacologic measures, fludrocortisone can be used as monotherapy.
- Patients with both anemia and orthostatic hypotension should begin a trial of erythropoietin.
What confirms orthostatic hypotension?
Decrease in systolic BP 20
Decrease in diastolic BP 10
What are the 6 Ps of Acute Arterial Occlusion?
- Paresthesia
- Pallor
- Pulselessness
- Poikilothermia (unable to regulate body temperature)
- Paralysis
- Pain out of proportion to exam
What is the recommended imaging modality for Acute Arterial Occlusion?
CTA of the pelvis with runoff
What are late findings of acute arterial occlusion?
paralysis
gangrene
loss of sensation
What is the primary risk associated with CTA?
contrast nephropathy
What is the gold standard of diagnosing arterial occlusion?
Digital subtraction angiography because has the additional benefit of potential treatment at the time of assessment
What is the most common limb artery to be affected by acute arterial occlusion?
The superficial femoral artery
What PMH will you see in pt who presents with thromboembolsim?
hx of recent MI or a-fib
What is the MC sirte of an acute arterial occlusion?
femoral artery bifurcation
What are treatments for acute arterial occlusion/thromboembolism?
thrombolysis
stenting
thrombectomy
surgery (bypass)
What is 1st line treatment for varicose veins?
Conservative measures: leg elevation, compression stockings, and exercise
If conservative measures faily to treat varicose veins, what is the next step?
vein ablation:
- sclerotherapy
- laser therapy
Subcutaneous dilated, tortuous veins
varicose veins
Pt is complaining of a dull ache in her legs after prolonged standing.
What dz?
varicose veins
Will pt with gastric cancer present with dysphagia?
They can if the cancer is at the proximal stomach
What are signs of metastatic disease in gastric cancer?
left supraclavicular node (Virchow’s node)
left axillary node (Irish node)
periumbilical node (Sister Mary Joseph’s node)
What is the diagnostic test of choice in patients with suspected deep vein thrombosis?
Doppler US
What will PE for DVT show?
dilated superficial veins, with unilateral edema, warmth, tenderness, and erythema
+ Homan sign (
What will Doppler US show for DVT?
Demonstrates noncompressibility of imaged vein, indicating a thrombus.
What is the gold standard for DVT?
venography
What is the triad that causes DVT?
Virchow triad
- stasis
- hypercoaguable state
- trauma
What will PE for PAD show?
loss of hair
skin atrophy/shiny skin
cool temperature
pale color
ulceration
weal lower extremity pulses
decreased sensation
How is dx of PAD made?
ankle-brachial index (ABI) value of ≤0.9
systolic BP of ankle/systolic BP of brachial artery
1st line tx of PAD
anti-platelet agents such as aspirin or clopidogrel (use for all patients)
aggresive risk factor modifications: complete tobacco cessation, exercise, antihypertensives, statin, and diabetes management
When is carotid endarterectomy recommended?
If pt has symptomatic carotid artery disease and >70 occlusion whose perioperative morbidity and mortality risk is < 6%
How can symptomatic carotid artery disease manifest?
transient ischemic attacks
cerebrovascular accidents
What is the gold standard dx for carotid artery disease?
cerebral angiography
What medical mgmt should be started following a carotid endarterectomy?
antiplatelet therapy and statin therapy
Cardiac Functional Status Level 1
Can take care of self, such as eat, dress or use toilet
Cardiac Functional Level Status 3-4
can walk up a flight of steps or a hill or walk on ground level at 3-4 mph
Cardiac Functional Status 4-10
can do heavy work around the house, such as scrubbing floors or lifting or moving heavy furniture, or climb 2 flights of stairs
Cardiac Functional Status > 10
can participate in strenuous sports such as swimming, singles tennis, football, basketball and skiing
What is bilirubin?
Bilirubin is a byproduct of heme metabolism, which occurs in three phases: prehepatic, intrahepatic, and posthepatic.
Prehepatic processes result in what form of bilirubin?
Prehepatic processes, such as red cell breakdown, hemolysis, erythropoiesis, hematoma resorption, and myoglobin breakdown, often result in unconjugated bilirubin or indirect bilirubin
What is unconjugated bilirubin?
Unconjugated bilirubin is fat soluble, however, the majority is bound to albumin in plasma, which prevents diffusion across the blood-brain barrier and kernicterus (bilirubin encephalopathy) in newborns.
In what phase is direct bilirubin formed?
In the hepatic phase of bilirubin metabolism, conjugated bilirubin, or direct bilirubin, is formed by enzymatic binding to a sugar making it water soluble.
Another word for direct bilirubin is?
conjugated bilirubin
What are common intrahepatic causes of hyperbilirubinemia?
autoimmune, infectious (hepatitis), genetic defects involving conjugation (Gilbert syndrome, Crigler-Najjar syndrome), or pharmacologic
What happens during the posthepatic phase of bilirubin?
The posthepatic phase involves excretion of conjugated bilirubin into bile.
What are posthepatic causes of hyperbilirubinemia related to?
biliary obstruction (cholelithiasis, choledocholithiasis, Mirizzi syndrome)
infectious (cholecystitis, cholangitis)
secondary to neoplasm in or around the biliary tract
