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Surgery Rotation EORE > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

what’s the 2 types of thoracic aortic aneurysms? which one is more common?

A

ascending (more common) and descending

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2
Q

what’s the MCC of ascending aortic aneurysm?

A

cystic medial necrosis

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3
Q

what’s the MCC of descending aortic aneurysm?

A

atherosclerosis

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4
Q

what are the s/s of thoracic aortic aneurysm?

A

commonly asx

Chest, back, flank, abdominal pain: compression or distortion of local anatomy

Cold foot: thromboembolism preventing blood flow to area

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5
Q

what’s the PE of thoracic aortic aneurysms?

A

commonly normal

if rupture -> hemorrhagic shock (tachy and decreased. BP)

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6
Q

what’s the best imaging study for dx of thoracic aortic aneurysm?

A

CT angiogram

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7
Q

what will you see on CXR if it’s a thoracic aortic aneurysm?

A

wide mediastinum (only if aneurysm is large enough)

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8
Q

what type of thoracic aortic aneurysm can ECHO (TTE) dx?

A

proximal ascending aorta

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9
Q

when do you use MRI for dx of thoracic aortic aneurysm?

A

if pt can’t get IV contrast for CTA

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10
Q

what’s the tx for thoracic aortic aneurysm?

A

Beta blockers(especially for pts w/ Marfan)

ACEIs/ARBs
(limit expansion and r/o rupture)

Endovascular repair→ catheter guided stent graft placed
-Closed procedure (preferred)

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11
Q

when do you do surgical repair or placement of prosthetic graft for thoracic aortic aneurysm?

A

Symptomatic

Ascending aneurysm >5.5 cm

Descending aneurysm >6.5 cm

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12
Q

where does abdominal aortic aneurysm MC occur?

A

infrarenally - at level of renal arteries

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13
Q

at what size is part of the abdominal aorta considered an aneurysm?

A

> 3.0 cm

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14
Q

what is the MC RF for development of AAA? what’s a major RF?

A

atherosclerosis = MC RF

smoking = major RF

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15
Q

what are the RFs for development of AAA?

A

***Atherosclerosis = MC RF

***Age >60 y/o

***Smoking: major RF - promotes rate of aneurysm formation, growth and rupture

Male, Caucasians

Hyperlipidemia, ***connective tissue d/o (Marfan’s syndrome), Syphilis, HTN

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16
Q

what’s the s/s of AAA?

A

Most are asx until they rupture
(often incidental finding on US, CT, MRI)

Acute leakage/rupture

Classic presentation: older male (>60 y/o) with:

  • Severe back or abdominal pain who presents with syncope or hypotension & tender, pulsatile abd mass
  • +/- Cullen’s sign (flank ecchymosis)
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17
Q

what’s the classic presentation of AAA?

A 
older male (>60 y/o) with:
-Severe back or abdominal pain who presents with syncope or hypotension & tender, pulsatile abd mass
  • +/- Cullen’s sign (flank ecchymosis)
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18
Q

at what size of AAA is there an increased rupture risk?

A

> 5cm

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19
Q

how and who do you screen for AAA?

A

Abd U/S indicated for:

  • Men 65-74 y/o with h/o smoking
  • Sibling or offspring of persons w/ AAA
  • Pts w/ thoracic aortic or peripheral arterial aneurysms
  • Pts w/ connective tissue d/o’s → Marfan’s and Ehlers-Danlos
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20
Q

how do you dx AAA?

A

Abd U/S → best imaging study

-Alternatively: CT or MRI

Angiography = gold standard

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21
Q

what’s the BEST imaging study for AAA?

A

Abd U/S

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22
Q

what’s the GOLD STANDARD imaging study for AAA?

A

angiography

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23
Q

what’s the definitive tx of AAA?

A

surgical repair

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24
Q

what’s the tx for AAA 3-4 cm?

A

monitor by U/S every year

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25
Q

what’s the tx for AAA 4-4.5 cm?

A

monitor by U/S every 6 months

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26
Q

what’s the tx for AAA >4.5 cm?

A

vascular surgeon referral

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27
Q

what’s the tx for AAA >/= 5.5 cm OR >0/5 cm expansion in 6 months?

A

IMMEDIATE SURGICAL REPAIR (even if asx), symptomatic pts or pts w/ acute rupture

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28
Q

what’s the tx after endovascular repair of AAA?

A

long-term surveillance w/ CTA or MRA

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29
Q

what’s an aortic dissection?

A

tear in the innermost layer of aorta (intima) -> creates false lumen (channel)

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30
Q

what’s the MC place to have an aortic dissection?

A

ascending aorta (high mortality)

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31
Q

what’s the MOST IMPT. predisposing factor of aortic dissection?

A

HTN

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32
Q

what’s the s/s of aortic dissection?

A

Chest Pain: MC; sudden onset of severe, tearing (ripping, knife-like)* chest/upper back pain*
-a/w N/V, diaphoresis

Decr. peripheral pulses
-Variation in pulse (>20mmHg difference b/w the right and left arm)***

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33
Q

what sx is MC in distal ascending aortic dissection?

A

HTN

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34
Q

what sx occurs in a ascending dissections?

A

acute new-onset aortic regurgitation

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35
Q

what’s the BEST imaging study for aortic dissection? what’s the GOLD STANDARD?

A

CTA = best imaging study

MRI angiography = gold standard

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36
Q

what do you see on CXR for aortic dissection?

A

WIDENING OF THE MEDIASTINUM

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37
Q

what’s the initial tx for aortic dissection?

A

HR and BP control w/ Esmolol

Pain relief w/ morphine

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38
Q

what’s the tx for acute dissection of ascending aorta?

A

surgical emergency!!!

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39
Q

what’s the tx for acute dissection of descending aorta?

A

Treat medically first

Surgery → progression w/ organ ischemia or continued hemorrhage into pleural or retroperitoneal space

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40
Q

what’s the long-term management for aortic dissection?

A

Medical therapy: minimize aortic wall stress (lifelong BB and maintaining goal BP <120/80)

Serial imaging: 3mo → 6mo → 12mo
q1-2 yrs thereafter

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41
Q

what are the indications for re-operation for aortic dissection?

A

Recurrence of dissection

Aneurysm formation

Leakage at anastomosis or stent

42
Q

what is acute limb ischemia/arterial occlusion? what’s it caused by?

A

Sudden decr. In limb perfusion that causes potential threat to limb viability

Caused by progression of PAD, arterial emboli, or thrombus

43
Q

what are the RFs for acute limb ischemia/arterial occlusion?

A
  • A-fib
  • Recent MI
  • Large vessel aneurysmal disease
  • RFs for aortic dissection
  • Arterial trauma
  • DVT
44
Q

what’s the s/s of acute limb ischemia/arterial occlusion?

A

SIX Ps OF LIMB ISCHEMIA:

  • Pulselessness
  • Pain
  • Poikilothermia
  • Pallor
  • Paresthesia
  • Paralysis
45
Q

how do you dx acute limb ischemia/arterial occlusion?

A

ABI <0.90

Vascular imaging

46
Q

what’s the tx for acute limb ischemia/arterial occlusion?

A

***Emergent or Urgent Revascularization

  • Anticoags → IV Heparin
  • Thrombectomy/Embolectomy
  • Endovascular surgery
  • Surgical intervention
  • Thrombolytic therapy
47
Q

what’s the post-revascularization tx for acute limb ischemia/arterial occlusion?

A

Medical eval for source of embolus

  • EKG and telemetry
  • Vascular U/S
  • Hypercoagulable eval
  • Cardiac eval w/ TEE to r/o cardiac thrombus
  • Chest CT
48
Q

what’s chronic venous insufficiency?

A

Vascular incompetency of either the deep and/or superficial veins

49
Q

what are the causes of chronic venous insufficiency?

A

MC occurs after superficial thrombophlebitis, after DVT, or trauma to the affected leg

50
Q

what’s the s/s of chronic venous insufficiency?

A
  1. Leg pain: burning, aching, throbbing, cramping, muscle fatigue, **“heavy leg”
    - Pain/color worse with: prolonged standing/sitting, foot dependency
    - Pain/color improves with: leg elevation     & walking
  2. Leg edema: incr. Leg circumference, pitting edema, varicosities, erythema.
  3. Stasis dermatitis: eczematous rash, itching, scaling, weeping, erosions w/ crusting
  4. **BROWNISH HYPERPIGMENTATION: hemosiderin deposition in the skin from damaged vessels
  5. Venous stasis ulcers w/ uneven margins may occurs, esp. at the ***MEDIAL malleolus
51
Q

where do venous stasis ulcers occur? what are they a/w?

A

medial malleolus - a/w chronic venous insufficiency?

52
Q

what d/o has sx’s of a “heavy” leg?

A

chronic venous insufficiency

53
Q

what d/o has sx’s of brownish hyper pigmentation?

A

chronic venous insufficiency

54
Q

how do you dx chronic venous insufficiency?

A

Trendelenburg test: shows slow filling at the ankle

U/S: done for confirmation and if procedures planned

55
Q

what’s the MAINSTAY of tx for chronic venous insufficiency?

A

Compression

-periods of leg elevation, compression stockings, avoid long periods of standing or sitting

56
Q

how do you manage venous ulcers?

A

Wet to dry dressings, Unna boot, edema control

Severe → skin grafting, hyperbaric oxygen

57
Q

what is peripheral arterial disease (PAD)?

A

Atherosclerotic disease of the LEs

Symptomatic ischemic d/t supply/demand imbalance

-Ischemic type pain with exercise → Claudication

58
Q

what are the RFs for PAD?

A

Age, smoking, M > F

Family hx

Homocysteinemia

Metabolic syndrome

59
Q

what’s the s/s of PAD?

A

INTERMITTENT CLAUDICATION***

  • MC sx
  • Reproducible pain/discomfort in the LEs brought on by exercise/walking & relieved w/rest

Ischemic rest pain = advanced disease
-Occurs while lying in bed at night

Non-healing wound or ulcer (no blood flow to site, decr. ability to heal)

60
Q

what’s the MC sx of PAD?

A

intermittent claudication

61
Q

what’s the PE like for PAD?

A

Pulses: decr./absent pulses; decr. cap refill

Skin: atrophic skin changes:
-Thin/shiny skin, no hair

Color: pale on elevation, dusky red w/ dependency (dependent rubor)

62
Q

how do you dx PAD?

A

ABI (compare SBP in ankle w/ that of the arm) - <0.90 = PAD

Arteriography (GOLD STANDARD)

Doppler U/S (used in ER)

63
Q

what’s the GOLD STANDARD to dx PAD?

A

Arteriography

64
Q

what’s the tx of PAD?

A

Platelet inhibitors:

  • Cilostazol = mainstay of tx
  • Aspirin, Clopidogrel (Plavix)

Revascularization:
-If rest pain

Surgery (when meds fail):

  • Angioplasty (TOC for mild-mod disease)
  • Endarterectomy (mod-severe disease)
  • Surgical open bypass procedure (sim to CABG) (-for severe disease when other tx’s fail)
  • Amputation (last resort)
65
Q

what’s the MAINSTAY of tx for PAD?

A

Cilostazol (platelet inhibitor)

66
Q

what’s the TOC for mild-moderate disease PAD?

A

Angioplasty (surgery)

67
Q

when is surgery the tx for PAD?

A

when meds fail

68
Q

what are the main meds used for PAD?

A

Platelet inhibitors:

  • Cilostazol (mainstay)
  • ASA, Clopidogrel
69
Q

when is CABG done for PAD?

A

in severe disease once other tx’s fail

70
Q

what are varicose veins?

A

Dilated, tortuous superficial veins 2/2 defective valve structure & fxn of the superficial veins (esp. the superficial saphenous veins)

71
Q

varicose veins are seen with what?

A

Incr. estrogen: OCPs, pregnancy; incr. stress on legs: prolonged standing, obesity

72
Q

what’s the s/s of varicose veins?

A

Dilated, tortuous veins

Dull ache or pressure sensation worsened w/ prolonged standing & relieved with elevation

Venous stasis ulcers

73
Q

what’s the tx for varicose veins?

A

Conservative:
-Leg elevation, elastic compression stockings, avoid prolonged standing & girdles

Sclerotherapy, radiofrequency or laser ablation & ambulatory phlebectomy commonly used

74
Q

what is acute mesenteric ischemia?

A

Ischemic bowel disease

sudden decrease of mesenteric blood supply to the bowel -> inadequate perfusion esp. @ splenic flexure (b/c of less collateral blood perfusion)

75
Q

what is acute mesenteric ischemia due to?

A

MC due to occlusion -> embolus (a-fib), thrombus (atherosclerosis)

Non-occlusive causes are shock and cocaine

76
Q

what’s the MC cause of acute mesenteric ischemia? MC what artery is involved?

A

due to occlusion -> embolus (a-fib), thrombus (atherosclerosis) MC at SMA

77
Q

what’s the s/s of acute mesenteric ischemia?

A

SEVERE abd pain out of proportion to PE findings***

-also: N/V, diarrhea

78
Q

what’s the definitive dx of acute mesenteric ischemia?

A

angiogram

79
Q

what’s the tx for acute mesenteric ischemia?

A

surgical revascularization (angioplasty with stunting or bypass)

surgical resection if the bowel is not salvageable

80
Q

what is chronic mesenteric ischemia?

A

Ischemic bowel disease

mesenteric atherosclerosis of the GIT -> inadequate perfusion especially @ splenic flexure during post-prandial states during POST-PRANDIAL STATES (W/IN 1 HR)

81
Q

what’s the s/s of chronic mesenteric ischemia?

A

chronic dull abdominal pain WORSE AFTER MEALS (W/IN 1 HR) - “intestinal angina”***

weight loss (anorexia)*** b/c afraid of pain and so limit PO intake

82
Q

how do you dx chronic mesenteric ischemia?

A

CT angiogram or MR angiogram -> confirms dx (best dx studies)

can do Duplex U/S

83
Q

what’s the tx for chronic mesenteric ischemia?

A

bowel rest & surgical revascularization (angioplasty w/ stunting or bypass)

84
Q

what is coronary artery disease?

A

inadequate tissue perfusion/ischemia d/t imbalance b/w decr. coronary blood supply & increased demand

85
Q

what is the MC cause of coronary artery disease?

A

atheroscleross

86
Q

what are risk factors of CAD?

A

DM (worst RF)

cigarette smoking (most impt. modifiable RF)

hyperlipidemia, HTN, males, age (>45 y in men, >55 y in women), family hx of CAD

87
Q

what’s the worst RF for CAD?

A

DM

88
Q

what’s the most important modifiable RF for CAD?

A

cigarette smoking

89
Q

what is angina?

A

substernal chest pain usu. brought on by exertion (d/t decr. supply and incr. demand of heart)

90
Q

what is class 1 of angina pectoris?

A

angina only with unusually strenuous activity.

No limitations of activity

91
Q

what is class 2 of angina pectoris?

A

angina with more prolonged or rigorous activity

slight limitation of physical activity

92
Q

what is class 3 of angina pectoris?

A

angina with usual daily activity

marked limitation of physical activity

93
Q

what is class 4 angina pectoris?

A

angina at rest

often unable to carry out any physical activity

94
Q

how long does stable angina last?

A

<15 mins

95
Q

what’s the difference b/w stable and unstable angina

A

stable angina - occurs with physical exertion only and not at rest

unstable angina - occurs even at rest and more often

96
Q

what are EKG findings of unstable angina/NSTEMI? what about troponin levels?

A

ST depression and/or T wave inversion

EKG can be normal

Troponin levels are normal

97
Q

what is the s/s of ACS?

A

retrosternal pain >30mins NOT RELIEED WITH REST/NITROGLYCERIN

98
Q

what is zener’s diverticulum?

A

pharyngoesophageal pouch (false diverticulum - only involves the mucosa)

weakness at the junction b/w cricopharynxgeus muscles and lower inferior constrictor -> herniation/outpouching

99
Q

what are the s/s of zener’s diverticulum?

A

***dysphagia

regurgitate of undigested food, feeling at if there is a lump in neck, choking sensation

100
Q

how do you dx zener’s diverticulum?

A

barium esophagram

101
Q

what’s the tx of zener’s diverticulum?

A

diverticuloectomy, cricopharyngeal myotomy

observation if small & asx

Surgery Rotation EORE (10 decks)

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