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Step 2 CK: Surgery > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

What is the consequence of limb reperfusion after 4-6 hours of arterio-occlusive ischemia.

A

Intracellular and interstitial edema

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2
Q

At what pressure within the muscular fascial compartment does edema result in compartment syndrome?

A

Pressures > 30mmHg

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3
Q

What are two important early complications of operation on the abdominal aorta (i.e. AAA repair)?

A
  1. Bowel ischemia

2. Bowel infarction

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4
Q

What must be ruled out in ANY patient who suffers a blunt deceleration trauma?

A

blunt aortic trauma/injury

Note, deceleration traumas include MVA and free fall from > 10 feet.

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5
Q

What is the initial screening/work done for a patient with deceleration trauma?

A

CXR

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6
Q

Diagnosis:

Blunt aortic trauma on CXR

A
  1. Widening of the mediastinum (most sensitive)

2. Deviation of the trachea (possible)

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7
Q

Work-up:

Peripheral arterial disease in a symptomatic patient

A

Ankle-brachial index

ABI is noninvasive and both highly sensitive and highly specific. It is the preferred first step to confirm the diagnosis of PAD in most cases.

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8
Q

Clinical Manifestation:

Patient s/p cardiac surgery with:

  1. fever
  2. chest pain
  3. leukocytosis
  4. mediastinal widening on CXR
A

Acute mediastinitis

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9
Q

Treatment:

Acute Mediastinitus

A
  1. Drainage
  2. Surgical debridement
  3. Prolonged antibiotic therapy
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10
Q

Diagnosis:

CXR with:

  1. Widened mediastinum
  2. Left-sided hemothorax
A

Most likely aortic injury due to high-energy, blunt, rapid deceleration trauma.

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11
Q

Clinical Manifestation:

Acute, sharp tearing chest or back pain

A

Aortic dissection needs to be at the TOP of the list.

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12
Q

What would happen if an aortic dissection extended to the following vessels:

  1. carotid arteries
  2. renal arteries
  3. spinal arteries
A
  1. Stroke
  2. Acute renal failure
  3. Lower-extremity weakness or paraplegia
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13
Q

What is another name for acute arterial occlusion?

A

Limb ischemia

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14
Q

Clinical manifestation:

Acute arterial occlusion (Limb ischemia)

A

Remember the 5 P’s!

  1. Pain
  2. Pallor
  3. Pulselessness
  4. Parasthesias
  5. Paralysis
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15
Q

Treatment:

Acute arterial occlusion (Limb ischemia)

A
  1. Immediate anticoagulation

2. Emergency vascular surgery referral

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16
Q

What is another name for aortoiliac occlusion?

A

Leriche syndrome

17
Q

Clinical Manifestation:

Leriche syndrome

A
  1. Bilateral hip, thigh and buttock claudication
  2. Impotence
  3. Symmetric atrophy of the bilateral lower extremities
18
Q

Diagnosis:

Patient with:

  1. acute onset back pain
  2. profound hypotension
A

This is ruptured abdominal aortic aneurysm until proven otherwise! This patient needs to go to the operating room immediately.

19
Q

Clinical manifestation:

Embolic arterial occlusion

A
  1. sudden onset severe pain
  2. asymmetric pulselessness

Also, the 5 P’s! (pain, pallor, pulselessness, parasthesia & paralysis).

20
Q

What complication of cardiac catheterization often presents with:

  1. sudden hemodynamic instability
  2. flank or back pain
A

Retroperitoneal hematoma

Flank or back pain is typically ipsilateral.

21
Q

Diagnosis:

Retroperitoneal hematoma

A

1a. non-contrast CT of the abdomen and pelvis -OR-

1b. abdominal ultrasound

22
Q

Treatment:

Retroperitoneal hematoma

A
  1. bed rest
  2. intravenous fluids
  3. blood transfusion (if IV fluids fail)
23
Q

Diagnosis:

  1. increased jugular venous distention
  2. tachycardia
  3. hypotension despite aggressive fluid resuscitation

in a patient with a history of blunt chest trauma

A

acute cardiac tamponade

24
Q

Diagnosis:

CXR in acute cardiac tamponade

A
  1. Normal cardiac silhouette

2. LACK of tension pneumothorax

25
Q

What is the most common cause of lower extremity edema?

A

venous insufficiency (valvular incompetence)

26
Q

How does venous insufficiency manifest:

  1. during the day
  2. during the night
A
  1. Worsens during the day

2. Resolves overnight while patient is recumbent

27
Q

What is the most predisposing factor for aortic dissection?

A

Hypertension

28
Q

Diagnosis:

MVA patient with:

  1. Elevated pulmonary capillary wedge pressure (PCWP)
  2. Hypotension/shock
A

Cardiac contusion

Normal PCWP~ 9 mmHg

29
Q

Diagnosis:

Right atrial pressure (RAP)= decreased
Pulmonary capillary wedge pressure (PCWP)= decreased
Cardiac index (CI)= decreased
Systemic vascular resistance= increased
Mixed venous oxygen saturation= decreased

A

Hypovolemic shock!

*If all values EXCEPT systemic vascular resistance are decreased think shock!

30
Q

Diagnosis:

Right atrial pressure (RAP)= increased
Pulmonary capillary wedge pressure (PCWP)= increased
Cardiac index (CI)= decreased x 2
Systemic vascular resistance= increased
Mixed venous oxygen saturation= decreased

A

Cardiogenic shock

*If the CI or cardiac output is low, and both atrial pressures are high, the heart is having pump dysfunction! SVR increases in an attempt to maintain adequate blood pressure.

31
Q

Diagnosis:

Right atrial pressure (RAP)=Normal to slight decrease
Pulmonary capillary wedge pressure (PCWP)= Normal to slight decrease
Cardiac index (CI)= increased
Systemic vascular resistance= decreased
Mixed venous oxygen saturation= increased

A

Septic shock

*If the heart is pumping harder (increased CI), but the tissues are not extracting oxygen (increased mixed venous O2 sat) think of sepsis! Also SVR decreased due to vasodilatory inflammatory mediators.

32
Q

What are the most common peripheral artery aneurysms?

A
  1. Popliteal artery aneurysms
  2. Femoral artery aneurysms

These aneurysms are frequently associated with abdominal aortic aneurysms.

33
Q

Clinical Manifestation:

  1. Edema
  2. Stasis dermatitis
  3. Venous ulcerations

on the medial aspect of the lower extremity, superior to the medial malleolus

A

venous insufficiency

Step 2 CK: Surgery (4 decks)

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