Cardiovascular Flashcards

1
Q

What is an aortic dissection?

A

Sudden “ripping” or “tearing” CP radiating to back

  • older, history of HTN, smoking, Marfan syndrome
  • PE will show asymmetric pulses/BP, CXR = widened mediastinum
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2
Q

How do you dx an aortic dissection?

A

CT or transesophageal echocardiogram

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3
Q

What is the tx for an aortic dissection?

A

reducing BP, surgery

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4
Q

What is an aortic aneurysm?

A

flank pain, hypotension, pulsatile abdominal mass

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5
Q

What is the screening for an aortic aneurysm?

A

ultrasound, if male >65 and ever a smoker

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6
Q

What is the tx for an aortic aneurysm?

A
  • immediate surgical repair (even if asymptomic) if >5.5 cm or expands >0.6 cm per year
  • monitor annually if > 3 cm, monitor every 6 months if > 4 cm
  • beta-blocker
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7
Q

What is an arterial embolism/thrombosis?

A

caused by a sudden arterial occlusion

  • The P’s of arterial embolis: Pain, Pallor, Pulselessnes, Paresthesia, Paralysis, Poikilothermia
  • atrial fibrillation and mitral stensosi are common causes of thrombus formation
  • angiograhpy is considered the gold standard for diagnosis
  • acute arterial occlusion: treat with IV heparin if not limb threatening then call the vascular surgeon for angioplasty, graft or endarterectomy
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8
Q

What is arterial/venous ulcer disease?

A

edema, atrophic shiny skin, brawny induration, stasis dermatitis, brown hyperpigmentation, varicosities, ulcers above the medial malleolus
-ABI, trendelenburg tests, ultrasound

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9
Q

What is the tx for arterial/venous ulcer disease?

A

sclerotherapy, vein stripping, compression hose

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10
Q

What is stable angina?

A

predictable, relieved by rest and/or nitroglycerine

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11
Q

What is unstable angina?

A

previously stable and predictable symptoms of angina that are more frequent, increasing or present at rest

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12
Q

What is prinzmetal variant angina?

A

coronary artery vasospasms causing transient ST-segmetn elevations, not assocaited with clot

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13
Q

What is claudication?

A

reduction in blood flow to the leg muscles, most commonly be an atherosclerotic plaque

  • pain in the leg with walking
  • relieved within a few minutes of rest
  • reproducible a the same walking distance each time
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14
Q

What is PAD?

A

defined as an ABI <0.9

  • the ABI confirms the diagnose of PAD
  • normal ABI 1.2 -1.0
  • mild disease 0.9 - 0.7
  • moderate disease 0.7-.04
  • severe disease/rest pain <0.4
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15
Q

How is PAD/PVD dx?

A

angiography is considered the gold standard for diagnosing

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16
Q

What are the treatment options for PAD/PVD?

A
  • Platelet inhibits: cilostazol, aspirin, clopidogrel
  • treat lipids - statins
  • revascularization with PTA, bypass grafts, stenting
  • exercise - walking to the point of claudication
  • beta blockers are contraindicated in isolated PAD - it will worsen claudication
  • Treatment options for sever PVD
    1. surgical craft bypass
    2. angioplasty - balloon dilation
    3. endarterectomy - remove disease intima and media
    4. surgical patch angioplasty (place patch over stenosis)
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17
Q

What are examples of arrhythmia?

A

atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardia

18
Q

What is the hx with arrhythmias?

A

palpitations, syncope

19
Q

What is the PE of arrhythmias?

A

irregular rhythm, pauses

20
Q

How are arrhythmias dx?

A

ECG, event recorder, holter monitor, stress testing

21
Q

What are examples of myocardial?

A

cardiomyopathies, coronary ischemia

22
Q

What is the hx of myocardial?

A

depose on extertion, paroxysmal nocturnal dyspnea, orthopnea, chest pain or tightness, prior coronary artery disease or atrial fibrillation

23
Q

What is the PE of myocardial?

A

Edema, JVD, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S4

24
Q

How is myocardial dx?

A

ECG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography

25
What are examples of restrictive?
constrictive pericarditis, pericardial effusion/tamponade
26
What is the hx of restrictive?
chest pain, dyspnea
27
What is the PE of restrictive?
paradoxical pulse (exaggerated variation in blood pressure with respiration)
28
How is restrictive dx?
EKG showing low voltage QRS along with electric alternates (see media section), echocardiogram with increased pericardial fluid, radiograph: water bottle heart
29
What are examples of valvular?
aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis
30
What is the hx of valvular?
dyspnea on exertion
31
What is the PE of valvular?
Murmur, JVD
32
How is valvular dx?
echocardiography
33
What is peripheral arterial disease?
intermittent claudication, ankle-brachial-index <0.9 - lower extremity loss of hair, brittle nails, pallor, cyanosis, claudication, hypothermia - ulcers are pale to black, well circumscribed and painful, located laterally and distally - anteriography is the gold standard for diagnosis
34
What is the tx for peripheral arterial disease?
- definitive treatment: arterial bypass | - medical treatment: antiplatelets, anti lipids, manage risk factors, cilostazol aspirin, plavix
35
What is structural cardio-pulmonary?
- aortic stenosis - angina, syncope, and CHF- 3 years life expectancy if left untreated (if experiencing syncope) - cardiomyopathy - HOCM (young athletes with a positive family history has sudden death or syncopal episode) - pulmonary hypertension - acute MI
36
What is pericarditis?
chest pain that is relieved by sitting and/or leaning forward -pericardial friction rub heard best with patient upright and leaning forward
37
What is orthostatic hypotension?
drug-induced, volume depletion, cariogenic shock
38
What is cardiac arrhythmia?
Brady (sick sinus, AV block), tachycardia (SVT, VT), prolonged QT
39
What is vasovagal?
a drop in pressure with a sudden slowing of the heart | -this type of syncope is often triggered by pain or emotional shock
40
What is subclavian steal syndrome?
arm pain and syncope with use of the left arm
41
What is presentation of varicose veins?
dilated tortuous superficial veins, venous stasis ulcers, ankle edema, lower extremity pain after sitting/standing
42
What is the tx of varicose veins?
leg elevation and compression stockings