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Surgery EOR > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

MC underlying pathology of aortic dissection

A

chronic HTN –> separation of the intima and media and creation of a false lume

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2
Q

classic presentation of aortic dissection

A

> 60 years of age and presents with sudden onset of severe, sharp, and tearing chest or back pain
pulse or blood pressure asymmetry between limbs

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3
Q

Stanford systemic classification of aortic dissection

A

Stanford type A dissections involve the ascending aorta, and Stanford type B dissections do not

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4
Q

differences btwn type A and B dissections

A

Stanford type A dissections - occur proximal to the subclavian artery; more likely to present with chest pain radiating to the back or syncope; hypotension

Stanford type B dissections - occur distal to the subclavian artery; more likely to present with abdominal or back pain; HTN

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5
Q

Common chest XR findings for aortic dissection

A

widened mediastinum (> 8 cm at the aortic knob)
abnormal aortic or cardiac contour
displaced intimal calcification
widened right paratracheal stripe (≥ 5 mm)
tracheal deviation (usually rightward)
opacified aortopulmonary window
pleural effusion (usually left-sided)

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6
Q

what is the best diagnostic study for aortic dissection (esp if hemodynamically stable)

A

CT angiography

  • keep in mind that MRI is gold standard but not normally done-
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7
Q

initial management of aortic dissection

A

aggressive reduction of blood pressure with beta-blockers (e.g., labetalol, esmolol) to a systolic blood pressure goal of 100–120 mm Hg
- patients with a history of asthma or bradycardia should be given esmolol to assess for tolerance because esmolol has a shorter half-life than labetalol
-Sodium nitroprusside can also be used to lower BP

morphine for pain

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8
Q

which type of aortic dissection requires immediate surgery

A

type A – requires open vascular repair

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9
Q

which type of aortic dissection does not require surgery and can be treated with medical management

A

type B

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10
Q

What are the three layers of the aorta?

A

Tunica intima
Tunica media
Tunic adventitia

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11
Q

debakey classification for aortic dissection

A

type 1 (ascending aorta, descending aorta, arch)
type 2 (ascending aorta)
type 3 (descending aorta)

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12
Q

Risk factors associated with aortic dissection

A

tobacco use
HTN
hyperlipidemia
atherosclerotic vascular disease
stimulant drug use

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13
Q

what is a good test to dx aortic dissection in pts who are hemodynamically unstable

A

transport to operating room

bedside transesophageal echocardiogram

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14
Q

Abdominal aortic aneurysm (AAA)

A

abnormal dilation of the aorta most commonly occurring between the renal arteries and the iliac bifurcation

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15
Q

sx AAA

A

most are asx
when sx - sense of abdominal fullness that may or may not be accompanied by pain. Abdominal pain - located at the hypogastrium and may radiate to the lower back - described as throbbing

triad of abdominal pain, hypotension, and a palpable pulsatile abdominal mass

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16
Q

PE for AAA

A

Pulsatile mass!!!!

may see grey turner sign or Cullen sign

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17
Q

test of choice to evaluate AAA

A

Abdominal US

gold standard is angiography but is often only used before surgery

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18
Q

screening for AAA

A

one time US for men 65-75 years who have ever smoked

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19
Q

surveillance for AAA Per the Society for Vascular Surgery

A

aneurysm is greater than 5.5 cm or the aneurysm has grown more than 0.5 cm in 5 months –> surgical repair (endovascular stent-graft placement)

aneurysm is 5.0-5.4 –> repeat US or CT q 6 months

aneurysm is 4.0-4.9 –> repeat US or CT q 12 months

aneurysm is 3.0-3.9 –> repeat US or CT q 3 years

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20
Q

Preferred anticoagulant for CA

A

LMWH
Edoxaban, Apixaban, Rivaroxaban

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21
Q

preferred anticoagulant for liver disease and coagulopathy

A

LMWH

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22
Q

preferred anticoagulant for kidney disease and renal impairment < 30 mg/mL

A

UFH followed by warfarin

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23
Q

preferred anticoagulant for coronary artery disease

A

Warfarin
Apixaban
Edoxaban
Rivaroxaban

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24
Q

Preferred anticoagulant for dyspepsia or GI bleed

A

Warfarin
Apixaban

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25
Q

preferred anticoagulant for pregnancy

A

LMWH

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26
Q

what is another name for primary upper extremity DVT

A

Paget-Schroetter syndrome

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27
Q

Signs and symptoms of upper extremity DVT

A

arm pain
swelling
cyanosis
heaviness
palpable venous cord

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28
Q

tx for upper extremity DVT

A

NSAIDs (pain)
Thrombolytics (alteplase)
Anticoagulants (heparin)
Venoplasty
Compression stocking
Limb elevation

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29
Q

early clinical signs of arterial occlusion

A

cold and pale extremity
pain out of proportion to exam
loss of sensation
loss of distal pulse

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30
Q

late clinical signs of arterial occlusion

A

poikilothermia (differences in temperature)
loss of motor function

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31
Q

what is the MC cause of morbidity from arterial occlusion

A

limb ischemia

32
Q

what is commonly used to identify emboli in lower extremities

A

doppler US

33
Q

embolic versus thrombotic occlusions

A

Embolic occlusions are more likely to present with atrial fibrillation and are associated with more severe complications of limb ischemia (e.g., limb loss, gangrene); abrupt onset

Thrombotic occlusions are more likely to present with diabetes mellitus, hypertension, and hyperlipidemia and are associated with a history of claudication; may take hours-days before sx are apparent

34
Q

what is the gold standard test to different btwn thrombotic and embolic occlusions

A

CT angiogram

35
Q

Arterial occlusion most commonly occurs from

A

in situ thrombosis from the superficial femoral artery or popliteal artery in the setting of preexisting PAD

36
Q

classic presentation of limb ischemia

A

the six Ps: pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia

37
Q

How do you know when tissue is viable for thrombotic/embolic occlusion

A

mild pain
capillary refill < 3 seconds
normal motor function and sensation
audible arterial and venous doppler flow

38
Q

how do you know when tissue is nonviable for thrombotic/embolic occlusion

A

absent capillary refill
profound paralysis or sensory deficits
inaudible arterial or venous Doppler pulses

39
Q

tx embolic occlusion

A

surgical consultation and hourly neurovascular checks are indicated
IV fluids
analgesics
UFH
revascularization via thrombectomy or catheter-directed thrombolysis

40
Q

tx nonviable tissue embolic occlusion

A

amputation

41
Q

Syncope

A

transient period of loss of consciousness (LOC) caused by inadequate cerebral blood flow that typically lasts 8 to 10 seconds and is self-limited, resolving spontaneously

42
Q

what is the MC cause of syncope

A

reflex syncope

43
Q

what is reflex syncope

A

cerebral hypoperfusion secondary to vasodilation or bradycardia

44
Q

what is the MC cause of reflex syncope

A

vasovagal reactions

45
Q

classic sx of reflex syncope

A

there is a classical prodrome of symptoms, including nausea, sweating, or feeling hot or cold

46
Q

sx of syncope related to cardiopulmonary dz

A

sudden onset without prodromal symptoms

47
Q

Orthostatic hypotension

A

a drop in systolic blood pressure > 20 mm Hg or diastolic blood pressure > 10 mm Hg measured with the patient supine, then after standing for 1 to 2 minutes, and again at 4 to 5 minutes

48
Q

what extremities are MC affected in peripheral arterial disease

A

lower extremities

49
Q

common sx peripheral arterial dz

A

intermittent claudication, arterial ulcers, tissue ischemia, decreased or absent peripheral pulses, dry, shiny, hairless, atrophic skin, and cool distal extremities

pain that worsens with limb elevation

if advanced –> pain at rest

50
Q

diagnose peripheral arterial dz

A

ankle brachial index – levels < 0.9 are abnormal

51
Q

at what levels on ABI does claudication normally start to occur

A

Claudication typically occurs with an ankle-brachial index between 0.4 and 0.9

52
Q

at what levels on ABI does rest pain normally start to occur

A

between 0.2 and 0.4

53
Q

at what levels on ABI does tissue loss start to occur

A

0 - 0.4

54
Q

wet vs dry gangrene

A

dry - clear demarcation; usually starts on fingers and toes; hard, dry texture

wet - moist, gross swelling, blistering (usually there is bacterial invasion)

55
Q

tx gangrene

A

dry - surgical revascularization

wet - surgical debridement followed by revascularization

if no response to revascularization –> amputation

56
Q

describe arterial ulcers

A

extremely painful
deep, “punched out” appearance
Granulation tissue is pale in color or necrotic
Weak or absent pulses
Little to no drainage

57
Q

describe venous ulcers

A

Larger and less painful
worse with extended periods of standing/sitting, better with LE elevation or walking
presence of drainage
pink/red granulation tissue
normal pulses

58
Q

MC cause PAD

A

atherosclerosis

59
Q

Chronic venous insufficiency

A

condition in which incompetent valves, particularly in the LE cause venous HTN, edema, fibrosis, and hyperpigmentation

60
Q

The most common presenting symptom of chronic venous insufficiency

A

progressive pitting edema of the LE

61
Q

mainstay of tx for chronic venous insufficiency

A

graduation compression stockings

62
Q

if there is occlusion to the distal superficial femoral artery, where would you feel pain

A

calf

63
Q

varicose veins is caused by

A

venous insufficiency

64
Q

which vein is most commonly affected in varicose veins

A

saphenous vein

65
Q

who is more commonly affected by varicose veins: men or women

A

women

66
Q

remember that sx for varicose veins are the same for chronic venous insufficiency

A
67
Q

how large are varicose veins

A

at least 3 mm in diameter

68
Q

why do we get hyperpigmentation in varicose veins and venous insufficiency

A

deposits of hemosiderin

69
Q

gold standard diagnosis of venous disease

A

duplex US of saphenous vein

70
Q

duplex US of saphenous vein for dx of venous disease

A

Normal retrograde flow occurs in 0.5 seconds or less

Flow that is greater than 0.5 seconds is indicative of valvular incompetence and venous insufficiency

71
Q

what is the MC valvular disorder in the US

A

mitral valve regurgitation

72
Q

what is the MC cause of mitral valve regurgitation

A

mitral valve prolapse

73
Q

murmur associated with mitral regurgitation (what does it sound like)

A

holosystolic murmur best heard at the apex and radiating to the axilla

blowing and high pitched

74
Q

what test is used to confirm mitral valve regurgitation

A

transthoracic echocardiogram (TTE)

if insufficient –> ransesophageal echocardiogram (TEE), stress test, or cardiac cath

75
Q

what is the most commonly used preoperative prophylactic measure for atrial fibrillation

A

beta blockers

76
Q
A

Surgery EOR (7 decks)

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