Cardiology: Valvular Heart Disease Flashcards
name leading cause of valvular heart disease? what used to be the leading cause?
mechanical degeneration
used to be rheumatic fever (affecting mitral valve more than aortic valve)
how is aortic aneurysm defined?
associated with?
most are located where?
what percentage below renal arteries?
defined as >50% dilation of all 3 layers of aortic wall
associated with atherosclerosis
abdominal
>90% below renal arteries
name signs and symptoms of aortic aneurysm
usually asymptomatic
pulsatile abdominal mass of abdominal bruits
name risk factors of aortic aneurysm
HTN, high cholesterol, other vascular disease, + family history, smoking, gender (male>female) and age
how does ruptured aneurysm present
hypotension, severe tearing abdominal pain that radiates to back
when should men be screened for aortic aneurysm
all men 65-75yrs with history of smoking should be screened once by ultrasound for AAA
70 year old male with HTN presents for routine appointment. He quit smoking 20 yrs ago but has a 20 pack yr history. What screening if any is indicated?
the US Preventative Services Task Force (USPSTIF) guidelines recommend one-time screening for AA by ultrasound in males ages 65-75 who have ever smoked
how should pts with aortic aneurysm be treated?
asymptomatic pts monitor for lesions 5cm
when should aortic aneurysm be surgically repaired?
- surgical repair if >5.5 (abdominal), >6 cm (thoracic), or smaller but rapidly enlarging
- emergent surgery for symptomatic or ruptured aneurysm
how is aortic dissection defined
transverse tear in the intima of a vessel that results in blood entering the media creating a false lumen and leading to a hematoma that propagates longitudinally
what is most common cause of aortic dissection?
the most common sites (2)?
most common age?
gender?
- HTN
- mc sites above the aortic valve and distal to left subclavian artery
- 40-60yrs
- females more than males
how does aortic dissection present?
sudden tearing/ripping pain in anterior chest (ascending) or back (descending)
what is BP of pts with aortic dissection?
usually HTN
if hypotensive consider tamponade, blood loss, or other cardiopulmonary etiologies
what may be found on PE in pt with aortic dissection?
asymmetric pulses
murmur of aortic regurgitation if aortic valve is invovled
neurologic deficits may be seen if aortic arch or spinal arteries are involved
name gold standard of imaging for aortic dissection? if contraindicated what is indicated
CT angiography
use MRA if CT is contraindicated
how can TEE be helpful in aortic dissection
can provide details of thoracic aorta, the proximal coronary arteries, the origins of arch vessels, presence of pericardial effusion, and aortic valve ingetrity
what system is used to classify aortic dissection? which should be treated surgically?
Stanford system is used to classify dissection
type A:proximal to left subclavian artery (proximal or ascending)
type B: all others (descending)
treat all ascending aortic dissections with surgery
how should aortic dissection be treated? what should be avoided? what should be given to avoid reflex tachy?
- monitor and medically manage BP and HR
- avoid thrombolytics
- begin beta-blockers before starting vasodilators to prevent reflex tachy
how is deep venous thrombosis (DVT) defined?
clot formation in large veins of the extremities or pelvis
what is triad of DVT?
venous stasis (plane flights, bed rest, incompetent venous valves in lower extremities), endothelial trauma (surgery, injury to lower extremities) and hypercoagulable states (malignancy, pregnancy, OCP use)
how does DVT present
-unilateral extremity pain and swelling
what is Homans’ sign
calf tenderness with passive foort dorsiflexion (poor sensitivity and specificity for DVT)
how is DVT diagnosed? PE?
DVT: doppler US,
PE: a spiral CT or V/Q scan
how is DVT treated?
- anticoagulation (IV unfractionated heparin, or SQ low molecular weight heparin (LMWH)
- follow this by PO for a total of 3-6 months
how is DVT treated in pts which anticoagulation is contraindicated?
IVC filters
what is DVT prophylaxis for pts that are hospitalized?
exercise as tolerated
anti-thromboembolic stockings
SQ unfractionated heparin or LMWH
what can be used to rule out possibility of PE in low risk pts
d dimer
how is peripheral arterial disease defined? which area is most common affected?
- restriction of blood supply to extremities by artherosclerotic plaque
- lower extremities
how does peripheral arterial disease present? how does limb ischemia present?
- intermittent claudication (reproducible leg pain that occurs with walking and is relieved with rest)
- dorsal foot ulcerations
- painful cold, numb foot=limb ischemia
name signs and symptoms of aortoiliac disease
buttock claudication, decreased femoral pulses, male impotence (Leriche’s syndrome)
name signs and symptoms of femoropopliteal disease
calf claudication; decrease pulses below the femoral artery
what is mc cause of acute ischemia? what is mc location name another cause?
-embolization from heart,
occurs a bifurcations distal to last palpable pulse
-cholesterol atheroembolism (“blue toe syndrome”)
name 6 P’s of acute ischemia?
Pain Pallor Paralysis Pulse deficit Paresthesias Poikilothermia (limb’s temperature equalizes with the surrounding environment)
name signs and symptoms of chronic ischemia
lack of blood perfusion causes muscle atrophy, pallor, cyanosis, hair loss, and gangrene/necrosis
name how BP measurement can be used to provide evidence of atherosclerosis
- measure ankle and brachial systolic BP (ABI)
- ABI=Pleg/Parm
- rest pain occur with and ABI<0.4
- a high ABI indicated calcification of arteries
what does doppler US help to identify in peripheral arterial disease?
- helps identify stenosis and occlusion
- normal ankle doppler readings are >90% of brachial readings
what is necessary for surgical evaluation
arteriography and digital subtraction angiography
what is treatment for peripheral arterial disease?
control underlying condition exercise helps develop collateral circulation
what medications can help with symptoms of peripheral arterial disease?
ASA, cilostazol, and thromboxane inhibitors
what should be done for pts with peripheral arterial disease when conservative treatment fails?
angioplasty and stenting
surgical arterial bypass or amputation
how is lymphedema defined
disruption of lymphatic circulation that results in peripheral edema and chronic infection of the extremities
what is lymphedema caused by?
complication of surgery invovling lymph node dissection
when does lymphedema present in childhood?
Milroy’s disease (congenital malformation of lymphatic system)
what is condition of immigrants with progressive swelling of lower extremitiess with no cardiac abnormalities
filarisis
how is lymphedema treated? what medications should be contraindicated. what complication would be monitored for?
symptom management- exercise, massage therapy, pressure garments
diuretics are ineffective and
maintain villagence for cellulitis with prompt gram + antibiotics coverage for infection
