Cardiology - 9% Flashcards
Abdominal Aortic Dissection/Aneurysm
- Fusiform - all arterial walls enlarged symmetrically vs
- Saccular - asymmetric = 1 pt of wall weakened through trauma or infx
MC type = infrarenal AA d/t atherosclerotic dz
Older, hx of HTN, smoking, Marfan’s syndrome
Sxs:
- sudden, “ripping” or “tearing” CP radiating to back (DISSECTION)
- Flank pain, hypotension, pulsatile abd mass (ANEURYSM)
Dx:
- PE - asymmetric pulses/BP in UE
- CXR, TEE
- CT or Angiography* = gold
- US - aneurysm
Tx
- Reduce BP
- Surgery
- >5.5cm or > 0.6cm growth per year = immediate repair
- Monitor if > 3cm
- Monitor q 6 mos if > 4 mos
Arterial Embolism/Thrombosis
Caused by sudden Arterial occlusion
- Pain
- Pallor
- Pulselessness
- Paresthesia
- Poikilothermia
- Paralysis
Dx - Angiography - gold std
Tx
- IV heparin - if not limb threatening
- Angioplasty, graft or endarterectomy
Arterial Ulcer Disease
a/w PAD
leg pain better w/ rest; worse with walking, elevation of leg, cold
Redness w/ dependency - cyanotic leg w/ elevation
Sxs:
- ULCERS on lateral malleolus*, clean margins
- atrophic skin findings thin, shiny skin, loss of hair, muscle atrophy, pallor, thick nails
- Livedo reticularis - mottled appearance
- Decr pulses and cool tempt
Dx - ABI, US, CT
Tx - as PAD
Chest Pain; history of angina
Stable angina - predictable, relieved by rest and/or nitroglycerine
Unstable angina - Previously stable and predictable symptoms of angina - more frequent, increasing or present at rest
Prinzmetal variant angina - Coronary artery vasospasms, causing transient ST seg elevations, not aw clots
STEMI
NSTEMI
Claudication
reduction in blood flow to leg muscles d/t atherosclerotic plaque
Sxs
- pain w/ walking
- relieved with rest
- reproducible walking same distance q time
Dx:
- ABI < 0.9
- mild 0.9-0.7
- mod 0.7-0.4
- severe/pain at rest 0.4
- Angiography** - gold standard
Tx
- Plt Inhibitors - cilostazol, asp, clopidogrel
- Tx lipids = statins
- Revasc = PTA, bypass grafts, stenting
- exercise = to point of claudication
- BB’s are c/i in isolated PAD = worsens claudication
DOE
Arrhythmias - AFib, Sinus tachy, SSS/bradycardia
- Hx - palps, syncope
- PE - irreg rhythm, pauses
- dx - ECG, event recorder, holter, stress
Myocardial - CMOs, coronary ischemia
- Hx - DOE, PND, orthopnea, CP, px CAD or afib
- PE - edema, JVD, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, carckles, wheezing, tachycardia, S4
- Dx - ECG, BNP, echocardiography, stress testing, coronary angiography
Restrictive - constrictive pericarditis, pericardial effusion/tamponade
- Hx - CP, dyspnea
- PE - paradoxical pulse - exaggerated variation in BP w/ respiration
- Dx - EKG low voltage QRS w/ electrical alternans, echo w/ pericardial fluid, water bottle heart
Valvular - Aortic insufficiency/stenosis, CHD, mitral valve insufficiency/stenosis
- Hx - DOE
- PE - murmur, JVD
- Dx - echo
Peripheral Arterial Disease
MCC Atherosclertoic Dz - important risk factor for CV and cerebrovascular M&M
Sxs:
- intermittent claudication - foot or lower leg pain - relieved by rest
- As condition develops, pain at rest develops
- Femoral or distal pulses weak or absent
- Aortic, iliac or femora bruit may be present
- Skin changes - loss of hair, shiny atrophic skin, pallor w/ dependent rubor
- Severe, chronic = numbness, tingling, ischemic ulceration
Don’t miss - Acute Arterial Occlusion
- Pain
- Pallor
- Poikilothermia
- Pulselessness
- Paresthesias
- Paralysis
Dx:
- ABI - upper and lower extremities
- 0.9-1.2 = normal
- <0.9 = PAD
- <0.4 = severe disease
- Arteriography- gold std - occlusion
Tx:
- Stop smoking
- Stent - only if short and proximal (femoral and < 0.3 cm); never stent otherwise
- Everything else = BYPASS
- Meds
- ASA
- ACE-I
- Statin
- BB
- Exercise regimen
Syncope ddx
Cardiopulmonary
- Aortic stenosis - angina, syncope, CHF = 3 years life expectancy if not treated
- CMO - HOCM - young athlete
- Pulm htn
- acute MI
- Pericarditis
Orthostatic Hypotension
- Drug induced, volume depletion, cardiogenic shock
Cardiac arrhythmia
- brady (sick sinus, AV block), tachy (SVT, VT), prolonged QT
Vasovagal
- drop in P w. sudden slowing of heart - triggered by pain or emotional shock
Subclavian steal syndrome
- arm pain and syncope w/ use of L arm
Varicose Vein
Dilated, tortuous superficial veins 2/2 defective valve structures; weak vein wall = incr intraluminal pressures, rev of venous flow (pooling)
Eti: Incr Estrogen = preg, stress of legs, prolonged standing, obesity
Sxs:
- Dilated, tortuous superficial veins
- dull ache or pressure w/ prolonged standing, relieved w/ elevation
Dx - clinical
Tx:
- Conservative - leg elevation, compression stockings, avoid prolonged standing
- Sclerotherapy, radiofreq or laser ablation
Venous Ulcer Disease
Leg pain worse w/ dependency, standing/prolonged sitting
Improves w/ walking, elevation of leg; Cyanotic leg w/ dependency
Sxs:
- ULCERS over medial malleolus*
- uneven ulcer margins
- Stasis dermatitis - eczematous rash, thickening of skin
- brownish pigmentation
- Pulses and temp usu normal
- Prominent edema common
Tx
- below-knee compression
- brisk walk
- Prognosis for this condition as poor
