Cardiovascular Problems Flashcards
thoracic aortic aneurysm story
person has hemoptosi, wheezing, coughing, and sudden onset severe chest/back/abdo pain. You think its thoracic AA ( because lungs involved), or perhaps dissection, so you so CT or CXR. Med therapy: bblcockers, Surg: if the descending aorta is larger than 5cm
what do you see on CXR in Thoracic Aortic Aneurysm?
widened mediastinum, enlargement of aortic knob, displacment of trachea from midline, aortic calficiation and kinking
story with Abdomnal Aortic aneurysm
you get sudden onsent abdo/back pain that radiates to the groin/ thighs. Make sure its not a perforation, a bowel ischemia, a pyelo etc. to confirm dx, use bedside US, or CT andyou will see aorta is 1.5x normal diameter. Now you treat depending on symptomatic pt or asymp. Do surg if aorta over 5.5 cm, risk factors : male, smoker, obesity, HTN, hyperlipidemia etc
Aortic Dissection
male smoker comes in with RIPPING/tearing pain in chest/back. Youre scared for dissection so do CXR( shows widenened mediastinum), and pulse pressures in both arms ( there is greater than 20mmHg difference between right and left arm). so its wide, but with what? We need to use Ddimer, ecg and Thoracic CT to see what is going on (see the blood that is filling the intima, and ripping between layers of the aorta), and tx by
a) surgery ( if tis ascending aorta) b) meds if its descending aorta, like, ACEs, analgesia
what are the three mgmt issues of ppl with dissection?
1) medical therapy needs to be initiated to minimize aortic wall shear stress
2) You need to image their aorta to detect signs of re-dissection
3) be prepared to reoperate as needed
- but hopefully everything is fine: 10 yr survival is between 30-88 perfecnt, for both types A and B
Acute Pulmonary Embolus, story and explain it to patient
patient with cough, leg pain, pleuritic pain ( pain with inhalation or exhalation), decreased breath sounds and tachycardic needs to be assessed with wells criteria for PE. Gold standard to find the clot is to look in the pulm branches ( pulmonary angiography), but before that you can get a CT angiogram, D-dimer. Now tell pt: you have blood clot in lungs = increased PVR, = impaired pulm blood flow. We are going to put you on anticoagulation, cut up your clot (embolectomy), hemodynamic support. you may need IVC filter too.
carotid occlusive disease
person comes in with hx shade over eye/ vision changes + weak arm that resolves quickly and spontaneously. ( think TIAs, but r/o stroke, seizure, tumour, migraine). ix: Duplex flow of carotid artery. mgmt : diet, decrease risk factors ( smoking, DM). Meds= stop clotting ( ASA, plavix), decrease cholesterol in vessels ( statins), Bp control. Surgery- cartoid enarterectomy or stent
