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EOR - Surgery > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

types of angina

A

stable
unstable
prinzmetal

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2
Q

chest pain/discomfort/pressure/squeezing increased w. exertion or emotion

A

stable angina

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3
Q

stable angina is relieved by (2)

A

rest
nitro

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4
Q

what is levine sign

A

clenched fist over the sternum and clenched teeth when describing cp -> stable angina

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5
Q

what do q waves on ekg indicate

A

prior MI

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6
Q

stress test findings of stable angina

A

reversible wall motion abnl
ST dpn > 1 mm

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7
Q

gs dx for angina

A

CTA

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8
Q

5 indications for CTA w. cp

A

severely symptomatic despite tx
being considered for PCI
troublesome sx difficult to dx
previous cardiac event
ischemia visualized on noninvasive tests

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9
Q

tx for stable angina (4)

A

nitro
bb
angioplasty
bypass

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10
Q

previously stable and predictable sx of angina that are now more frequent or present at rest

A

unstable angina

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11
Q

what will cardiac enzymes show for unstable angina

A

normal

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12
Q

tx for unstable angina

A

continuous cardiac monitoring
IV, O2
NTG
morphine
ASA and/or clopidogrel
LMWH
bb
stress test when stable
revascularization
ACEI/statin

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13
Q

angina not associated w. ischemia

A

prinzmetal

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14
Q

4 triggers for prinzmetal angina

A

hyperventilation
cocaine
tobacco
nitric oxide deficiency

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15
Q

4 substances that may trigger prinzmetal angina

A

Ach
ergonovine
histamine
serotonin

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16
Q

3 HPI clues that it’s prinzmetal angina over unstable angina

A

preservation of exercise capacity
smoking or cocaine hx
cyclical AM pain w. no relation to cardiac load

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17
Q

EKG findings of prinzmetal angina

A

inverted u waves
ST segment/T wave abnl’s

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18
Q

tx for prinzmetal angina

A

stress test
NTG

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19
Q

what 2 meds are used for long term management of prinzmetal angina

A

ccb
long acting nitrates

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20
Q

revascularization is indicated when stenosis of the left main coronary artery is > _

A

50%

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21
Q

tearing cp radiating to the back

A

aortic dissection

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22
Q

back pain, pulsatile mass, hypotn

A

AAA

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23
Q

screening recs for AAA

A

1 time US for males 65-75 yo w. any prev hx smoking

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24
Q

management of AAA based on size

A

< 3 cm: no further testing
3.0-4.4 cm: monitor annually
4.5-5.0 cm: monitor q 6 mo, refer to vascular
5.5-5.4 cm: monitor q 3 mo
>5.5 cm OR expands > 0.5 cm/year: surgery

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25
Q

pharm for AAA

A

bb

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26
Q

CXR finding of AAA

A

widened mediastinum

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27
Q

two types of AAA

A

typa a (ascending): emergency
type b (descending): bb

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28
Q

PE finding of aortic dissection

A

variation in pulse btw left and right arm

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29
Q

gold standard imaging for dissection

A

MRA

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30
Q

4 arrhythmias that cause DOE

A

afib
inappropriate sinus tachy
sick sinus syndrome
bradycardia

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31
Q

2 myocardial causes of DOE

A

cardiomyopathy
ischemia

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32
Q

PE findings of cardiomyopathy

A

edema
jvd
s3
displaced aplical impulse
murmur
crackles
wheezing
tachy

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33
Q

2 restrictive causes of DOE

A

pericarditis
pericardial effusion/tamponade

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34
Q

PE finding of pericarditis/pericardial effusion

A

paradoxical pulse: exaggerated variation in bp w. respiration

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35
Q

EKG finding of pericarditis/effusion

A

electrical alternans

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36
Q

CXR finding of pericarditis/effusion

A

bottle shaped heart

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37
Q

valvular causes of DOE

A

aortic stenosis
mitral stenosis
congenital defects

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38
Q

what causes claudication

A

atherosclerotic plaque -> reduced blood flow to the leg muscles -> demand exceeds supply

not a clot

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39
Q

presentation of claudication (3)

A

pain in legs w. walking
relieved w. a few minutes of rest
reproducible w. same distance each time

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40
Q

claudication is a sx of what condition

A

PAD

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41
Q

PAD mc affects the _ extremeties and the _ arteries

A

lower extremeties
intestinal/renal arteries

42
Q

consequence of PAD

A

chronic limb ischemia

43
Q

rf for PAD (lots!)

A

smoking
DM
htn
hypercholesterolemia
advanced age
male
obesity
sedentary
fam hx vascular dz
heart attack/stroke

44
Q

5 PE findings of PAD

A

calf muscle atrophy
lower limb hair loss
dry scaly, shiny skin
ulcers
prolonged cap refill

45
Q

always ask about _ when you suspect PAD

A

pain at rest

this suggests life-threatening limb ischemia

46
Q

diagnosis for PAD

A

ABI < 0.9 confirms dx
gs: CTA

47
Q

severity of PAD based on ABI

A

normal: 1.2-1.0
mild: 0.9-0.7
mod: 0.7-0.4
severe/pain at rest: < 0.4

48
Q

3 antiplatelet drugs to know

A

cliostazol
asa
clopidogrel

49
Q

what med is contraindicated in isolated PAD

A

bb

worsens claudication

50
Q

pharm management for PAD

A

antiplatelets
statins

51
Q

surgical management of PAD (4)

A

bypass
angioplasty
endarterectomy
patch angioplasty

52
Q

what graft material has the longest patency rate

A

autologous vein graft

53
Q

saphenous vein is left in place, all branches are ligated, and the vein valves are broken w. a small hook or cut out

A

in situ vein graft

54
Q

pain, cramping, or both of the lower extremity - usually calf muscle - after walking a specific distance; pain resolves after stopping for a specific amt of time while standing - pain is reproducible

A

intermittent claudication

55
Q

claudication of buttocks and thighs, impotence, atrophy of legs

A

leriche syndrome

56
Q

leriche syndrome is associated w. what disease

A

iliac occlusive dz

57
Q

how can vascular causes of claudication be differentiated from nonvascular causes (ex neurogenic claudication or arthritis)

A

vascular claudication: appears after a specific distance and resolves after a specific time of rest while standing

58
Q

acronym to remember tx for intermittent claudication

A

pace:
pentoxifylline
asa
cessation of smoking
exercise

59
Q

moa for pentoxifylline (trental)

A

increases rbc flexibility

whatever this means?

60
Q

55 yo f w. calf claudication, hourglass stenosis on angiogram of popliteal a, and cyst on US of posterior knee

A

cystic degeneration of popliteal a

61
Q

8 yo boy w. hx of claudication when running, epistaxis, decreased left extremity pulses, and HA

A

coarctation of aorta

62
Q

triad for leriche syndrome

A

claudication
impotence
thigh atrophy

Smarty PANCE really likes leriche syndrome

63
Q

classic s/sx of acute arterial occlusion

A

6 p’s

pain
paralysis
pallor
paresthesia
polar/poikilothermia
pulselessness

64
Q

2 mcc of embolus from the heart

A
  1. afib
  2. mitral stenosis
65
Q

gs dx for embolus/thrombus

A

CTA

66
Q

tx for embolism/thrombus

A

bolus LMWH followed by infusion
embolectomy via cutdown and fogarty balloon
bypass if embolectomy failure

67
Q

4 post op complications of embolectomy

A

compartment syndrome
hyperK
renal failure from myoglobinuria
MI

68
Q

classic timing of pain w. acute arterial occlusion from an embolus

A

pt can tell you exactly when and where it happened

69
Q

mc site of arterial occlusion by an embolus

A

common femoral artery

70
Q

mc site of arterial occlusion from atherosclerosis

A

superficial femoral artery

71
Q

order of diagnostic studies for embolism/thrombus

A
  1. CTA
  2. ECG: MI/Afib
  3. echo: clot/MI/valve vegetation
72
Q

what is a fogarty

A

catheter w. a balloon tip that can be inflated w. saline - used for embolectomy

73
Q

what is the timeline for an embolectomy

A

goal: w.in 4-6 hr of sx onset

74
Q

PAD is mc a consequence of _

A

atherosclerosis

75
Q

are ulcers from arterial insufficiency (atherosclerosis) painful or painless

A

painful

76
Q

8 causes of thrombotic dz

A

atherosclerosis/PAD
trauma
hypovolemia
inflammatory arteritis
polycythemia
dehydration
repeated arterial punctures
hypercoagulable states

77
Q

2 causes of inflammatory arteritis

A

takayyasu arteritis
cuerger dz

78
Q

3 indications to screen for PAD

A

abnl/absent pedal pulse
> 70 yo
> 50-69 yo w hx of smoking or DM

79
Q

screening test for PAD

A

ABI

80
Q

most syncope results from

A

decreased CO -> insufficient cerebral blood flow

81
Q

2 mcc of syncope

A

vasovagal
idiopathic

82
Q

6 red flags w. syncope

A

during exertion
multiple recurrences in a short time
e/o heart murmur/structural dz
older age
significant injury during episode
fam hx sudden/unexpected death

83
Q

3 characteristics of vasovagal syncope

A

-apparent trigger
-warning sx
-minutes of post-recovery sx

84
Q

definition of venous ulcer dz

A

chronic defects of the skin
fail to heal spontaneously
persist > 4 weeks

85
Q

mc location for venous ulcers

A

gaiter region -> just proximal to anterior aspect of the ankle

86
Q

describe venous ulcers (4)

A

-painless
-partial thickness
-irregularly shaped
-well defined borders
-granulation tissue/fibrin present at base
-surrounded by brown stained skin/dry itchy red skin

87
Q

4 rf for venous ulcers

A

obesity
increasing age
fam hx venous insufficiency
hx of DVT

88
Q

any time you see an ulcer in the gaiter region, think

A

stasis/venous ulcer

89
Q

what class of conditions is found in a significant amt of people with venous insufficiency

A

coagulation defects

90
Q

if vasculitis is suspected with ulcers, what can confirm the dx

A

bx of the edge of the ulcer

91
Q

indication to bx an ulcer

A

failure to improve after 4 weeks of tx

92
Q

tx for venous ulcers (3)

A

below the knee compression stockings -> first line
surgical debridement
regular, risk walking
wound care clinic

93
Q

what tx has no proven benefit in venous ulcer tx

A

endovenous catherter ablation

94
Q

6 rf for varicose veins

A

female
pregnant
obesity
fam hx
prolonged sitting/standing
plebitis

95
Q

dilated superficial veins the the lower extremities

A

varicose veins

96
Q

5 describe varicose veins

A

dilated, tortuous veins
lower extremity
smaller blue/green
flat
reticular

97
Q

varicose veins are mc in the distribution of what vein

A

great saphenous

98
Q

varicose veins are probs asymptomatic, but may be associated w. what symptoms (5)

A

aching
fatigue
edema
abnl pigmentation
fibrosis

99
Q

mc complaint in pt’s presenting initially w. varicosities (2)

A

dull aching/heaviness
feeling of fatigue

100
Q

gs dx for varicose veins

A

duplex US

101
Q

tx for varicose veins (5)

A

graduated compression stockings
leg elevation
regular exercise
unna boot
radiofrequency/laser ablation/sclerotherapy

EOR - Surgery (13 decks)

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