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ITE '23 > Ch. 2 CV Emergencies > Flashcards

Ch. 2 CV Emergencies Flashcards

1
Q

What is the biggest risk factor for PAD?

A

atherosclerosis
which is due to factors including cigarette smoking, HLD, HTN, and DM

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2
Q

What is Leriche Syndrome?

A

Triad of
1. bilateral hip claudication,
2. erectile dysfunction,
3. absent femoral pulses
= aortoiliac occlusive disease

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3
Q

What ABI is diagnostic of PAD?

A

ABI <0.9

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3
Q

At what ABI does claudication typically occur?

A

ABI <0.6

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4
Q

At what ABI does resting angina typically occur?

A

<0.26

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5
Q

What is initial treatment for PAD?

A

Risk-factor modification: Smoking cessation, antihypertensive therapy, lipid-lowering therapy, glycemic control
Antithrombotic therapy (aspirin, clopidogrel, warfarin)

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6
Q

What is the only effective therapy for Buerger Disease?

A

Smoking cessation

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7
Q

What is the pathophysiology behind a true arterial aneurysm?

A

Constant shear stress at the vessel wall
contributes to weakening of the media and, eventually, dilation or “ballooning” of all 3 vessel wall layers

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8
Q

What is a pseudoaneurysm?

A

Disruption of the intima and media; only thin adventitia remains intact

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9
Q

What is the most common location of aortic aneurysms and what type of aneurysm are they?

A

infrarenal; usually true aneurysms

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10
Q

What diameter defines a AAA?

A

> 3 cm

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11
Q

What are primary risk factors for AAA?

A

first-degree relative with AAA,
co-morbid coronary artery disease (CAD) or occlusive PVD,
older age (mean age at diagnosis is 65-70 years), and
smoking history

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12
Q

Where is the most common location of AAA rupture?

A

retroperitoneal

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13
Q

What is the imaging modality of choice for ruptured AAA in unstable patient?

A

bedside ultrasound

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14
Q

What is blue toe syndrome?

A

atherosclerotic aneurysms can cause atheroembolism, in which microemboli travel to and obstruct distal small vessels

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15
Q

What is a acute possible complication of AAA endovascular grafting?

A

vascular injury to the renal, mesenteric, or Adamkiewicz artery (the latter causes an anterior cord syndrome)

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16
Q

How is a thoracic aortic aneurysm defined?

A

diameter >4.5 cm

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17
Q

How is expanding/ruptured thoracic aortic aneurysm diagnosed in unstable patient?

A

Transesophageal echocardiography (TEE)

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18
Q

How is expanding/ruptured thoracic aortic aneurysm diagnosed in unstable patient?

A

CT Chest

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19
Q

What is the treatment for unstable patient with Thoracic aortic aneurysm?

A

Same as dissection – resuscitation, aggressive Bp and HR control, and immediate surgical consultation

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20
Q

What is the most common risk factor for aortic dissection?

A

Uncontrolled HTN

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21
Q

What is the pathophys of aortic dissections?

A

Disruption of intima of aortic wall → blood travels (dissects) into media, creating false lumen

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22
Q

What lab test has good sensitivity for dissection and therefore can be used to rule out dissection?

A

d-dimer

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23
Q

What are the two most common ECG findings in aortic dissections?

A
  1. LVH
  2. inferior/posterior ischemia indicating RCA involvement
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24
Q

What is the diagnostic test of choice for aortic dissection?

A

CT Angiogram

25
Q

What are the HR and BP goals for aortic dissection?

A

SBP 100-120 mmHg
HR <60 BPM

26
Q

What medications are used for HR and BP control in aortic dissection?

A

Use IV Bblockers such as esmolol or labetalol

if severe asthma or COPD –> metoprolol or atenolol

Can add nitroprusside for additional control

27
Q

Acute arterial occlusion is most commonly caused by ____ (thromboembolism or thrombotic occlusion?)

A

thromboembolism

28
Q

What is the most common site of acute arterial embolism?

A

Bifurcation of common femoral A.

29
Q

What are the 6 Ps of life-threatening ischemia?

A

Pain
Pallor
Pulselessness
Paralysis
Paresthesias
Poikilothermia

30
Q

Why is it important to differentiate thromboembolic from thrombotic causes of acute limb ischemia?

A

treated differently:

Acute thromboembolism: heparin + Fogarty catheter embolectomy

Thrombosis with limb-threatening ischemia: Heparin + embolectomy + bypass grafting

Arterial thrombosis without limb-threatening ischemia: heparinization ± thrombolysis

31
Q

What is Virchows Triad?

A

Damage to the vessel wall,
venostasis, or
hypercoagulable state

32
Q

What is Wells Criteria for DVT?

A

■ Score ≤ 2 indicates a low or moderate pretest risk for DVT.
■ Score > 2 indicates a high pretest risk for DVT.

Active cancer 1
Paralysis/immobilization 1
Bedridden 3 d/surgery in last 4 wk 1
Tender along deep vein (localized) 1
Entire leg swollen 1
Unilateral calf swelling (> 3 cm) 1
Pitting edema, 1 leg 1
Collateral superficial nonvaricose vein 1
Previous documented DVT 1
Alternative diagnosis likely −2

33
Q

What is the half life of d-dimer?

A

8 hours

34
Q

When may the d-dimer be elevated (other than DVT/PE)?

A

sepsis, pregnancy, trauma, MI, liver disease,
cancer

35
Q

What is the most common cause of PE?

A

DVT

36
Q

Which symptoms has strongest association with PE?

A

Hemoptysis

37
Q

What is the most common complaint in PE?

A

dyspnea

38
Q

What is the most common physical exam finding in PE?

A

tachypnea

39
Q

What do you call a Pleural-based, wedge-shaped density indicating infarcted lung on CXR?

A

Hampton hump

40
Q

What do you call the rare sign on CXR showing ↓ vessel markings distal to embolus (oligemia)?

A

Westermark sign

41
Q

What 7 clinical features are included in Wells PE prediction tool?

A

Clinical symptoms of DVT 3
Other diagnosis less likely than PE 3
Heart rate > 100 bpm 1.5
Immobilization or surgery within past 4 wk 1.5
Previous DVT or PE 1.5
Hemoptysis 1
Malignancy 1

42
Q

What Wells score = high risk for PE?

A

> 6 points

43
Q

What Wells score = moderate risk?

A

2-6 points

44
Q

Whats included in PERC rule?

A

Low pretest probability for PE by the treating clinician’s estimate, plus:
Age < 50 y
Pulse < 100 bpm
Oxygen saturation > 94%
No hemoptysis
No unilateral leg swelling
No recent major surgery or trauma
No prior PE or DVT
No hormone use

45
Q

What is the treatment for PE?

A

Immediate anticoagulation with unfractionated heparin infusion or
LMW heparin.

46
Q

What should be used to treat PE if heparin and LMWH are contraindicated?

A

Factor Xa inhibitor, fondaparinux

47
Q

What are indications for thrombolysis in PE?

A

hypotension (SBP < 90 mm Hg for > 15 minutes or baseline SBP reduction > 60 mm Hg), severe hypoxemia, cardiac
arrest, evidence of right heart strain on
echocardiogram

48
Q

What is the preferred agent and dosing for thrombolysis in massive PE?

A

tPA is preferred agent (100 mg over 2 hours)

49
Q

What is the most common cause of venous insufficiency?

A

DVT

50
Q

What is the law of appropriate discordance?

A

The T waves should be deflected in
the direction opposite to the terminal
deflection of the rR′ or rSR′ complexes

51
Q

What ECG findings are seen in hypercalcemia?

A

■ Shortened QT intervals (classic finding)
■ Depressed and shortened ST segments
■ Widened T waves

52
Q

What ECG findings are seen in hypocalcemia?

A

■ Hallmark = QT prolongation
■ Due to lengthening of the ST segment
■ Occurs with Ca+ < 6.0 mg/dL

53
Q

What are common ECG findings in those on Digitalis?

A

■ Depressed (scooped or sagging) ST segments
■ Shortened QT intervals
■ Flattened T waves
■ Prominent U waves

54
Q

In Digitalis toxicity, when should you give Digoxin antibody?

A

Hyperkalemia;
avoid routine use of calcium

55
Q

What ECG findings are seen in Digitalis toxicity?

A

■ Any dysrhythmia is possible (especially premature ventricular contractions
[PVCs], atrial tachyarrhythmias with AV block, bradycardia).
■ Slow, regular atrial fibrillation.
■ Bidirectional ventricular tachycardia.

56
Q

What ECG findings are seen with hypothermia?

A

Cardiac conduction abnormalities result in prolongation of all cardiac intervals.

Typical progression from sinus bradycardia to atrial fibrillation to ventricular
fibrillation.

Osborn (or J) waves at end of QRS complex.
■ Characteristic but can be seen in other heart conditions

57
Q

What is the most common cause of systolic cardiac dysfunction?

A

ischemic heart disease

58
Q

What is the most common cause of diastolic cardiac dysfunction?

A

HTN

59
Q

What is the mechanism of action of nitroglycerin?

A

↓ Preload by venodilation, ↓ afterload (at high doses) via arterial vasodilation, direct coronary vasodilator (good in ischemia)

60
Q

What two electrolyte disturbances can be caused by Furosemide?

A

Hypokalemia, hypomagnesemia

61
Q

What is the mechanism of action of nitroprusside?

A

More potent arterial vasodilator than NTG, ↓ afterload, ↓ preload via venodilator effect, may dilate normal coronaries more
than diseased → coronary steal syndrome

ITE '23 (20 decks)

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