Cardiovascular Flashcards by Alice Richards

types of angina

stable
unstable
prinzmetal

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

stable angina

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stable angina is relieved by (2)

rest
nitro

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what is levine sign

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

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what do q waves on ekg indicate

prior MI

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stress test findings of stable angina

reversible wall motion abnl
ST dpn > 1 mm

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gs dx for angina

CTA

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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

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tx for stable angina (4)

nitro
bb
angioplasty
bypass

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

unstable angina

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what will cardiac enzymes show for unstable angina

normal

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tx for unstable angina

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

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angina not associated w. ischemia

prinzmetal

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4 triggers for prinzmetal angina

hyperventilation
cocaine
tobacco
nitric oxide deficiency

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4 substances that may trigger prinzmetal angina

Ach
ergonovine
histamine
serotonin

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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

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EKG findings of prinzmetal angina

inverted u waves
ST segment/T wave abnl’s

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tx for prinzmetal angina

stress test
NTG

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

ccb
long acting nitrates

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

50%

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tearing cp radiating to the back

aortic dissection

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back pain, pulsatile mass, hypotn

AAA

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screening recs for AAA

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

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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

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pharm for AAA

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

1. afib 2. 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

1. CTA 2. ECG: MI/Afib 3. 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