Cardiovascular Flashcards
What is the indication for surgical repair of abdominal aortic aneurysms in asymptomatic patients?
An aneurysm greater than 5.5 cm in diameter or that is growing at a rate greater than 0.5 cm in 6 months or greater than 1 cm/year
Which valvular disease is associated with a widened pulse pressure?
Aortic Regurgitation
What is the most common precipitating event leading to compartment syndrome?
What is the most common first sign of compartment syndrome?
Tibial Fracture
Pain
You are assessing a patient’s perioperative cardiac risk for a noncardiac surgery. Which of the following surgical procedures is considered to have high intrinsic cardiac risk?
A) Breast lumpectomy
B) Laparoscopic appendectomy
C) Open appendectomy
D) Open cholecystectomy
Open cholecystectomy
Surgeries with high cardiac risk include laparoscopic total abdominal colectomy with ileostomy, breast reconstruction with free flap, open cholecystectomy, open ventral hernia repair of incarcerated or strangulated hernia, and Whipple procedure.
What are the characteristic features of an aortic stenosis murmur?
Harsh crescendo-decrescendo systolic ejection murmur best heard in the second right intercostal space.
Are atrial fibrillation and atrial flutter common dysrhythmias in the postoperative period?
Yes, they are common after a cardiac procedure such as coronary bypass surgery
What are the three layers of the aorta?
- Tunica intima
- Tunica media
- Tunica adventitia
What is the most common predisposing factor for aortic dissection?
Hypertension
Which imaging modality is the gold standard for diagnosing aortic dissection?
A) Chest X-ray
B) CT angiography
C) MRI
D) Transesophageal echocardiogram (TEE)
CT angiography
CT angiography is the gold standard for diagnosing aortic dissection because it provides detailed images of the aorta and the dissection flap.
What is the typical presentation of aortic dissection?
A) Sudden onset of tearing chest pain radiating to the back
B) Sharp epigastric pain with nausea
C) Gradual onset of chest tightness
D) Cramping leg pain with walking
Sudden onset of tearing chest pain radiating to the back
A 55-year-old man with a history of uncontrolled hypertension presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as “tearing.” On exam, his blood pressure is 160/95 mmHg in the right arm and 130/80 mmHg in the left arm. A chest X-ray shows a widened mediastinum. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Tension pneumothorax
Aortic dissection
The patient’s presentation of sudden, tearing chest pain with a widened mediastinum and blood pressure discrepancy between arms strongly suggests aortic dissection.
A 70-year-old male presents with acute onset of chest pain radiating to his back. His blood pressure is 200/120 mmHg, and he has diminished pulses in his left arm. A CT angiogram confirms an ascending aortic dissection. What is the most appropriate initial treatment?
A) IV fluids and pain control
B) Immediate surgical intervention
C) Beta-blockers and blood pressure control
D) Observation with serial imaging
Beta-blockers and blood pressure control
Initial management of aortic dissection involves controlling blood pressure with beta-blockers to reduce the stress on the aorta. Immediate surgical intervention is required for ascending dissections after blood pressure is stabilized.
A 60-year-old woman with a history of hypertension presents with sudden, severe chest pain radiating to her back. Her blood pressure is 180/110 mmHg, and she has diminished pulses in her right leg. What is the most appropriate next step in diagnosis?
A) Chest X-ray
B) Abdominal ultrasound
C) CT angiography of the chest and abdomen
D) Cardiac catheterization
CT angiography of the chest and abdomen
CT angiography is the diagnostic imaging of choice for aortic dissection because it provides detailed views of the entire aorta, identifying the location and extent of the dissection.
A 65-year-old male with a history of smoking and hypertension is found to have a Stanford type A aortic dissection on imaging. What is the definitive treatment for this condition?
A) Beta-blockers and observation
B) Immediate surgical intervention
C) Endovascular stent placement
D) Thrombolytics
Immediate surgical intervention
Stanford type A dissections (involving the ascending aorta) require urgent surgical repair to prevent fatal complications such as aortic rupture, cardiac tamponade, or organ ischemia.
What ankle-brachial index value indicates chronic limb-threatening ischemia?
< 0.4
What is the most common presenting symptom of peripheral artery disease?
Claudication
Claudication, or pain in the legs with exertion that is relieved with rest, is the most common initial symptom of PAD
Which of the following is the most appropriate first-line diagnostic test for suspected peripheral artery disease?
A) Doppler ultrasound
B) Ankle-brachial index (ABI)
C) CT angiography
D) Magnetic resonance angiography (MRA)
Ankle-brachial index (ABI)
What is the most important modifiable risk factor for peripheral artery disease?
A) Diabetes
B) Hypertension
C) Smoking
D) Hyperlipidemia
Smoking
A 55-year-old male presents with complaints of pain in his right calf when walking more than 100 yards, which resolves with rest. His medical history is significant for smoking and hyperlipidemia. An ankle-brachial index (ABI) is calculated at 0.65. What is the best initial treatment?
A) Angioplasty with stent placement
B) Smoking cessation and statin therapy
C) Surgical revascularization
D) Anticoagulation with heparin
Smoking cessation and statin therapy
Initial management of PAD includes lifestyle modifications, particularly smoking cessation, and medical management with statins to reduce cardiovascular risk.
A 70-year-old woman with a history of hypertension and diabetes presents with persistent pain in her left foot, even at rest. On physical exam, the foot is cold to the touch, and her left dorsalis pedis pulse is absent. An ankle-brachial index (ABI) is 0.4 on the left. What is the next best step in management?
A) Referral for surgical revascularization
B) Continue medical management
C) Prescribe compression stockings
D) Initiate anticoagulation therapy
Referral for surgical revascularization
Rest pain with a significantly low ABI indicates critical limb ischemia. Surgical revascularization is often required to restore blood flow and prevent limb loss.
A 68-year-old woman is two days post-colon resection due to colorectal cancer. She reports her left leg is painful and feels heavy. Physical exam reveals vitals within normal limits, and her left calf is erythematous, swollen, and tender to palpation. What is the initial imaging modality used to evaluate for the suspected diagnosis?
A) Compression ultrasound with Doppler
B) Computed tomography angiogram
C) Ventilation-perfusion scan
D) X-ray of the left leg
Compression ultrasound with doppler
A DVT is confirmed with compression ultrasound with Doppler
A 58-year-old man presents to the emergency department with two hours of right leg weakness and pain of sudden onset. On exam, his right leg is pale and cool to the touch. Sensation and muscle strength are diminished on the right from thigh to toes, and no pedal, popliteal, or femoral pulses are palpable on the right. Sensation and pulses are normal on the left. Which of the following is an appropriate clinical intervention for this patient?
A) Intra-arterial thrombolysis
B) Open embolectomy
C) Pharmacomechanical thrombolysis
D) Transcatheter embolectomy
Open embolectomy
Revascularization of acutely threatened limbs is best accomplished with open thrombectomy or embolectomy because this method is fastest.
