Cardiology - syncope, arterial, venous Flashcards
syncope when arising?
orthostatic hypotension
syncope when shaving?
carotid sinus hypersensitivity (bradycardia)
syncope during an argument?
older pt = myocardial ischemia
child = long QT
syncope with prolonged, motionless standing?
neurocardiogenic (vasovagal)
What does BP have to change for orthostatic hypotension?
> 20mmHg systolic
> 10mmHg diastolic
What test do you do to test for carotid hypersensitivity?
carotid sinus massage
when should you NOT perform carotid sinus massage?
if you ascultate a carotid bruit
How do you test for neurogenic syncope?
tilt table test
Peripheral artery ischemia s/s?
6 P’s
-pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
what are causes of arterial embolism/thrombus?
- afib, mitral stenosis
- local arterial trauma, septic emboli, endocarditis, hypercoagulable states
Treatment for arterial embolism/thrombus?
- IV heparin
- thrombolytics
- angiography with thrombectomy
- open thrombectomy
Treatment for arterial embolism/thrombus?
- IV heparin
- thrombolytics
- angiography with thrombectomy
- open thrombectomy
chronic inflammation of medium to large cranial blood vessels
giant cell arteritis (temporal arteritis)
what is associated with polymyaliga rheumatic?
giant cell arteritis
patient presents with severe temporal or occipital HA, amaurosis fugal (decreased unilateral vision), jaw claudication, pain on palpation of temporal artery, scalp tenderness
giant cell arteritis
What is the diagnostic study for giant cell arteritis?
temporal artery biopsy
Treatment for giant cell arteritis?
high dose prednisone ASAP (try to avoid blindness)
patient presents with claudication, paresthesia, erectile dysfunction, atrophic skin, hair loss, history of HTN
peripheral artery disease
-obstruction or narrowing of vessels causing disruption of flow
What is the gold standard for peripheral artery disease?
angiography
Treatment for peripheral artery disease?
- control lipids
- antiplatelet
- stent or bypass prn
NO BB = worsen claudication
What is inflammation of the wall of a vein?
phlebitis
focal venous pain, tenderness, induration, palpable cord, erythema, recent trauma, IV catheter, IV drug use
phlebitis
Treatment for phlebitis?
- elevation
- warm/cool compress
- NSAID
phlebitis + associated thrombosis?
thrombophlebitis
Treatment for thrombophlebitis?
LMWH x1 month
Treatment for varicose veins?
- elevation
- compression
- exercise
-surgery (if severe)
leg is heavy, edema, pain, stasis dermatitis, non healing ulcer (medial malleolus)
venous insufficiency
What is a test to determine valve competency?
Brodie-Trendelenburg
would get a LE US to r/o DVT = when venous insufficiency
Treatment for venous insufficiency?
compression = decrease hydrostatic pressure and increase capillary flow
What is Virchow’s Triad?
DVT
- stasis (postop, immobile, venous insufficiency
- hyper coagulable state (factor V, OCP, pregnancy)
- trauma - surgery, cellulitis, endothelial injury
DVT prophylaxis?
heparin SC q8h
lovenox 30-40mg SC q24 h
DVT prophylaxis?
heparin SC q8h
lovenox 30-40mg SC q24 h
DVT physical exam?
- increased calf diameter
- calf tenderness
- edema
- asympomatic
- homan sign
DVT Treatment?
IV heparin — then warfarin
if recurrent = lifetime antigoaculation
- may consider IVC filter
