Cardiovascular Flashcards
acute onset back pain and profound hypotension. may have gross hematuria
Dx and Tx
ruptured AAA
emergent surgery
why hematuria in a AAA?
gross hematuria from aortocaval fistula with IVC, leading to venous congestion in retroperitoneal structures like that bladder.
hypotension and distended beck veins
massive PE
MCC of LE edema
venous insufficiency/valvular incompetence
After cardiac catheterization, a patient presents with sudden hemodynamic instability and ipsilateral flank/back pain.
Test used to diagnose this condition.
non-contast CT of abd/pelvis or abd US to diagnose a retroperitoneal hematoma
treatment of retroperitoneal hematoma
supportive
right anterior thigh pain worse with walking. small pulsatile mass in right groin.
femoral artery aneurysm
ankle-brachial index definition
(higher dorsalis or posterior tibial systolic in each LE) / (higher brachial artery systolic)
0.90 or less ankle-brachial index interpretation
diagnostic of occlusive PAD**
0.91 to 1.30 ankle-brachial index interpretation
normal
1.31 or higher ankle-brachial index interpretation
suggestive of calcified and uncompressible vessels; additional vascular studies should be considered.
Following cardiac surgery, patient presents with fever, chest pain, leukocytosis, mediastinal widening on CXR.
Dx and management
acute mediastinitis. requires surgical drainage, debridement, and antibiotics.
describe the triad that follows arterial occlusion at bifurcation of aorta into iliac arteries.
leriche syndrome
triad:
- bilateral hip, thigh, and buttock claudication (aching pain with walking)
- impotence
- symmetric atrophy of bilateral lower extremity due to chronic ischemia
high energy, blunt, rapid deceleration MVA trauma. large bruises over entire chest wall. collapsed neck veins bilaterally. decreased breath sounds on the left. Large left hemothorax and widened, right-deviated mediastinum.
aortic injury
blunt chest trauma. decreased breath sounds, dullness to percussion and contralateral tracheal deviation.
BP 85/55, HR 120, R 30
large hemothorax with hemorrhagic shock
Right atrial pressure (preload) - DECREASED
PCWP (preload) - DECREASED
Cardiac index (pump function) - DECREASED
Systemic vascular resistance (afterload) - INCREASED
Mixed venous oxygen saturation - DECREASED
HYPOVOLEMIC SHOCK
Right atrial pressure (preload) - INCREASED
PCWP (preload) - INCREASED
Cardiac index (pump function) - VERY DECREASED
Systemic vascular resistance (afterload) - INCREASED
Mixed venous oxygen saturation - DECREASED
CARDIOGENIC SHOCK
Right atrial pressure (preload) - NML TO SLIGHT DECR
PCWP (preload) - NML TO SLIGHT DECR
Cardiac index (pump function) - INCREASED
Systemic vascular resistance (afterload) - DECREASED
Mixed venous oxygen saturation - INCREASED
SEPTIC SHOCK - severely decreased systemic vascular resistance
PCWP is elevated and increases significantly after infusion of saline without appreciable change in systemic BP. what is this suggestive of?
elevated intracardiac filling pressures due to left ventricular dysfunction, ML caused by myocardial contusion
surgical repair of aneurysm of infrarenal aorta. presents with T 101, BP 110/65, P 110/min, R 22/min. Tenderness in LLQ w/o rebound. WBC 12,000. ML dx?
ischemia of the bowel - complication in 1-7% of AAA repairs
severe retrosternal chest pain and mediastinal free air on CXR.
esophageal rupture
