Cardiovascular Flashcards
types of angina
stable
unstable
prinzmetal
chest pain/discomfort/pressure/squeezing increased w. exertion or emotion
stable angina
stable angina is relieved by (2)
rest
nitro
what is levine sign
clenched fist over the sternum and clenched teeth when describing cp -> stable angina
what do q waves on ekg indicate
prior MI
stress test findings of stable angina
reversible wall motion abnl
ST dpn > 1 mm
gs dx for angina
CTA
5 indications for CTA w. cp
severely symptomatic despite tx
being considered for PCI
troublesome sx difficult to dx
previous cardiac event
ischemia visualized on noninvasive tests
tx for stable angina (4)
nitro
bb
angioplasty
bypass
previously stable and predictable sx of angina that are now more frequent or present at rest
unstable angina
what will cardiac enzymes show for unstable angina
normal
tx for unstable angina
continuous cardiac monitoring
IV, O2
NTG
morphine
ASA and/or clopidogrel
LMWH
bb
stress test when stable
revascularization
ACEI/statin
angina not associated w. ischemia
prinzmetal
4 triggers for prinzmetal angina
hyperventilation
cocaine
tobacco
nitric oxide deficiency
4 substances that may trigger prinzmetal angina
Ach
ergonovine
histamine
serotonin
3 HPI clues that it’s prinzmetal angina over unstable angina
preservation of exercise capacity
smoking or cocaine hx
cyclical AM pain w. no relation to cardiac load
EKG findings of prinzmetal angina
inverted u waves
ST segment/T wave abnl’s
tx for prinzmetal angina
stress test
NTG
what 2 meds are used for long term management of prinzmetal angina
ccb
long acting nitrates
revascularization is indicated when stenosis of the left main coronary artery is > _
50%
tearing cp radiating to the back
aortic dissection
back pain, pulsatile mass, hypotn
AAA
screening recs for AAA
1 time US for males 65-75 yo w. any prev hx smoking
management of AAA based on size
< 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
pharm for AAA
bb
CXR finding of AAA
widened mediastinum
two types of AAA
typa a (ascending): emergency
type b (descending): bb
PE finding of aortic dissection
variation in pulse btw left and right arm
gold standard imaging for dissection
MRA
4 arrhythmias that cause DOE
afib
inappropriate sinus tachy
sick sinus syndrome
bradycardia
2 myocardial causes of DOE
cardiomyopathy
ischemia
PE findings of cardiomyopathy
edema
jvd
s3
displaced aplical impulse
murmur
crackles
wheezing
tachy
2 restrictive causes of DOE
pericarditis
pericardial effusion/tamponade
PE finding of pericarditis/pericardial effusion
paradoxical pulse: exaggerated variation in bp w. respiration
EKG finding of pericarditis/effusion
electrical alternans
CXR finding of pericarditis/effusion
bottle shaped heart
valvular causes of DOE
aortic stenosis
mitral stenosis
congenital defects
what causes claudication
atherosclerotic plaque -> reduced blood flow to the leg muscles -> demand exceeds supply
not a clot
presentation of claudication (3)
pain in legs w. walking
relieved w. a few minutes of rest
reproducible w. same distance each time
claudication is a sx of what condition
PAD
PAD mc affects the _ extremeties and the _ arteries
lower extremeties
intestinal/renal arteries
consequence of PAD
chronic limb ischemia
rf for PAD (lots!)
smoking
DM
htn
hypercholesterolemia
advanced age
male
obesity
sedentary
fam hx vascular dz
heart attack/stroke
5 PE findings of PAD
calf muscle atrophy
lower limb hair loss
dry scaly, shiny skin
ulcers
prolonged cap refill
always ask about _ when you suspect PAD
pain at rest
this suggests life-threatening limb ischemia
diagnosis for PAD
ABI < 0.9 confirms dx
gs: CTA
severity of PAD based on ABI
normal: 1.2-1.0
mild: 0.9-0.7
mod: 0.7-0.4
severe/pain at rest: < 0.4
3 antiplatelet drugs to know
cliostazol
asa
clopidogrel
what med is contraindicated in isolated PAD
bb
worsens claudication
pharm management for PAD
antiplatelets
statins
surgical management of PAD (4)
bypass
angioplasty
endarterectomy
patch angioplasty
what graft material has the longest patency rate
autologous vein graft
saphenous vein is left in place, all branches are ligated, and the vein valves are broken w. a small hook or cut out
in situ vein graft
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
intermittent claudication
claudication of buttocks and thighs, impotence, atrophy of legs
leriche syndrome
leriche syndrome is associated w. what disease
iliac occlusive dz
how can vascular causes of claudication be differentiated from nonvascular causes (ex neurogenic claudication or arthritis)
vascular claudication: appears after a specific distance and resolves after a specific time of rest while standing
acronym to remember tx for intermittent claudication
pace:
pentoxifylline
asa
cessation of smoking
exercise
moa for pentoxifylline (trental)
increases rbc flexibility
whatever this means?
55 yo f w. calf claudication, hourglass stenosis on angiogram of popliteal a, and cyst on US of posterior knee
cystic degeneration of popliteal a
8 yo boy w. hx of claudication when running, epistaxis, decreased left extremity pulses, and HA
coarctation of aorta
triad for leriche syndrome
claudication
impotence
thigh atrophy
Smarty PANCE really likes leriche syndrome
classic s/sx of acute arterial occlusion
6 p’s
pain
paralysis
pallor
paresthesia
polar/poikilothermia
pulselessness
2 mcc of embolus from the heart
- afib
- mitral stenosis
gs dx for embolus/thrombus
CTA
tx for embolism/thrombus
bolus LMWH followed by infusion
embolectomy via cutdown and fogarty balloon
bypass if embolectomy failure
4 post op complications of embolectomy
compartment syndrome
hyperK
renal failure from myoglobinuria
MI
classic timing of pain w. acute arterial occlusion from an embolus
pt can tell you exactly when and where it happened
mc site of arterial occlusion by an embolus
common femoral artery
mc site of arterial occlusion from atherosclerosis
superficial femoral artery
order of diagnostic studies for embolism/thrombus
- CTA
- ECG: MI/Afib
- echo: clot/MI/valve vegetation
what is a fogarty
catheter w. a balloon tip that can be inflated w. saline - used for embolectomy
what is the timeline for an embolectomy
goal: w.in 4-6 hr of sx onset
PAD is mc a consequence of _
atherosclerosis
are ulcers from arterial insufficiency (atherosclerosis) painful or painless
painful
8 causes of thrombotic dz
atherosclerosis/PAD
trauma
hypovolemia
inflammatory arteritis
polycythemia
dehydration
repeated arterial punctures
hypercoagulable states
2 causes of inflammatory arteritis
takayyasu arteritis
cuerger dz
3 indications to screen for PAD
abnl/absent pedal pulse
> 70 yo
> 50-69 yo w hx of smoking or DM
screening test for PAD
ABI
most syncope results from
decreased CO -> insufficient cerebral blood flow
2 mcc of syncope
vasovagal
idiopathic
6 red flags w. syncope
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
3 characteristics of vasovagal syncope
-apparent trigger
-warning sx
-minutes of post-recovery sx
definition of venous ulcer dz
chronic defects of the skin
fail to heal spontaneously
persist > 4 weeks
mc location for venous ulcers
gaiter region -> just proximal to anterior aspect of the ankle
describe venous ulcers (4)
-painless
-partial thickness
-irregularly shaped
-well defined borders
-granulation tissue/fibrin present at base
-surrounded by brown stained skin/dry itchy red skin
4 rf for venous ulcers
obesity
increasing age
fam hx venous insufficiency
hx of DVT
any time you see an ulcer in the gaiter region, think
stasis/venous ulcer
what class of conditions is found in a significant amt of people with venous insufficiency
coagulation defects
if vasculitis is suspected with ulcers, what can confirm the dx
bx of the edge of the ulcer
indication to bx an ulcer
failure to improve after 4 weeks of tx
tx for venous ulcers (3)
below the knee compression stockings -> first line
surgical debridement
regular, risk walking
wound care clinic
what tx has no proven benefit in venous ulcer tx
endovenous catherter ablation
6 rf for varicose veins
female
pregnant
obesity
fam hx
prolonged sitting/standing
plebitis
dilated superficial veins the the lower extremities
varicose veins
5 describe varicose veins
dilated, tortuous veins
lower extremity
smaller blue/green
flat
reticular
varicose veins are mc in the distribution of what vein
great saphenous
varicose veins are probs asymptomatic, but may be associated w. what symptoms (5)
aching
fatigue
edema
abnl pigmentation
fibrosis
mc complaint in pt’s presenting initially w. varicosities (2)
dull aching/heaviness
feeling of fatigue
gs dx for varicose veins
duplex US
tx for varicose veins (5)
graduated compression stockings
leg elevation
regular exercise
unna boot
radiofrequency/laser ablation/sclerotherapy
