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Patho II > CV Disease Pt 2 > Flashcards

CV Disease Pt 2 Flashcards

1
Q

“Pulseless Disease”- inflammation/thickening of aortic arch and/or proximal great vessels, causing weak pulse

A

Takayasu arteritis

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2
Q

Symptoms of Takayasu arteritis

A

Upper extremity claudication, angina, CHF, absent pulses, arterial bruits, BP difference b/w 2 arms

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3
Q

Symptoms d/t ischemia of vessels in the carotid artery region including unilateral headache, visual disturbance (impairment of ophthalmic artery) and jaw claudication

A

Temporal arteritis

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4
Q

Tx for temporal arteritis

A

Start steroids IMMEDIATELY to prevent blindness

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5
Q

Inflammation of small & medium sized arteries. Smoker’s dz. Foot claudication, leg pain, ulceration, skin necrosis

A

Buerger’s Disease “Thromboangiitis Obliterans”

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6
Q

Triad of upper & lower airway disease and renal disease (glomerulonephritis). Sx: Sinusitis & hematuria

A

Wegener’s granulomatosis

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7
Q

Dx and Tx for Wegener’s granulomatosis

A

Dx: ANCA (antineutrophilic cytoplasmic antibodies);
Tx: Cyclophosphamide, steroid and/or methotrexate

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8
Q

Involves medium-sized arteries in kidneys, gut, & skin.
S/Sx: fever, weight loss, malaise, abd pain, Melina, HA, myalgia, HTN, & cutaneous eruption.
Microaneurysms on angiography.
Tx: cyclophosphamide, steroid

A

Polyarteritis nodosa

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9
Q

Acute, self-limiting necrotizing vasculitis in infants & children. (Asian population)
Fever, conjunctivitis, changes in lips/oral mucosa “strawberry tongue”, lymphadenitis, desqumative rash.

A

Kawasaki disease

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10
Q

Tx for Kawasaki disease

A

Aspirin, immunoglobulins

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11
Q

Bad sign that shows global ischemia

A

Third heart sound

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12
Q 
EKG is gold standard in first \_\_\_\_ 
Myoglobin \_\_\_\_\_
CK-MB test of choice in first \_\_\_\_ post MI
Troponin-I \_\_\_\_
LDH1 is elevated \_\_\_\_\_ post MI
A 
EKG= 6hrs;
Myoglobin= < 2hrs
CK-MB = 24hrs
Troponin-I = 4hrs to 7-10 days
LDH1 = 2-7 days
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13
Q

Angina pectoris = CAD narrowing > ___

A

75%

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14
Q

Most ominous sign of CAD

A

Unstable angina- pain that occurs at rest or w/out a provoking cause

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15
Q

CP occurring more and more frequently with less and less exertion

A

Crescendo angina

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16
Q

EKG with unstable angina

A

ST depression or T wave inversion (must distinguish from non-Q wave MI)

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17
Q

Angina at rest a/w ST elevation (hallmark) secondary to coronary artery spasm.

A

Prinzmetal’s angina

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18
Q

Tx for Prinzmetal’s angina

A

Nitrates and CCB to tx vasospasm

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19
Q

How do nitrates relive angina

A

Venodilation which decreases cardiac wall tension

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20
Q

How do CCB relieve angina?

Most potent to least potent?

A

By decreasing afterload, HR, and contractility;

Verapamil > Diltiazem > Nifedipine

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21
Q

Avoid ____ in bronchial spasm, CHF, or bradycardia

A

beta blockers

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22
Q

MCC of acute MI

A

Chronic coronary atherosclerosis

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23
Q

Acute MI most often occurs in which arteries greatest to least?

A

LAD > RCA > circ

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24
Q

What does persistent elevation of CK-MB indicate?

A

Post infarct ischemia- do cath, give heparin and nitro

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25
Q

Acute management of MI

A

BOOMAR

Bed rest, Oxygen, Opiate, Monitoring, Anticoagulation, Reduce clot size

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26
Q

Post infarct ischemia is most common after what type of MI?

A

Non-Q wave MI

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27
Q

Poor prognostic signs a/w pump failure post MI:

A 
Pulmonary edema (crackles) &
HR increase to maintain CO
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28
Q

Interventricular septum (L -> R) 4-10 days post MI -> SHOCK and cardiac tamponade

A

Rupture of ventricular free wall

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29
Q

Friction rub 3-5 days post MI.

PR depression, diffuse ST elevation

A

Fibrinous pericarditis

30
Q

Autoimmune phenomenon resulting fibrinous pericarditis (2-6 wks post MI). Low grade fever.
Tx: NSAID

A

Dressler’s syndrome

31
Q

Occurs w/ inferior wall MI (d/t occlusion of RCA). Hypotensive, raised JVP, clear lungs
Tx: fluids to maintain right-sided filling pressures

A

Right ventricular infarction

32
Q

Most common cause of decreased contractility a/w CHF

A

Ischemia and MI

33
Q

MCC of right-sided heart failure

A

Left-sided heart failure

34
Q

Signs of RHF

A

Tachycardia, S3 (ventricular gallop), S4 (atrial gallop), rales, cardiomegaly, ascites, hepatic congestion (increased CVP)

35
Q

Reduced EF, increased EDV, decreased contractility often secondary to ischemia/MI or dilated CM

A

Systolic dysfunction

36
Q

Preserved EF, normal EDV, decreased compliance (Increased EDP) often secondary to myocardial hypertrophy

A

Diastolic dysfunction

37
Q

Tx for diminished contractility

A

Digoxin, beta agonist- dopamine, Amrinone (PDE inhibitor)

38
Q

Tx for high afterload in CHF

A

ACE inhibitors or ARBs

39
Q

Beware of ________ with hypokalemia (w/ diuretics) elderly and renal insufficiency

A

Dig toxicity

40
Q

EKG findings in dig toxicity

A

PVC’s, ST depression ”dig effect”, paroxysmal atrial tach w/ varying block

41
Q

Anesthesia concerns for CHF

A
  1. Slightly elevated head;
  2. Watch fluid status closely (SWAN);
  3. Risk of overdose d/t slow circulation;
  4. Watch UO;
  5. Sensitive to anesthetic gases;
  6. Avoid nitrous oxide in sever CHF;
  7. Watch for arrhythmia
42
Q

Tx of Heart Failure (ABCDE)

A 
ACE inhibitors
Beta blockers
CCB
Diuretics
Endothelin receptor blocker (decreased PVR)
43
Q

Pressure-volume loop for systolic heart failure

A

Increase in LVEDV;
Decreased SV;
Increased LVEDP (bc LV volume is increased)
Diastolic portion has to shift RIGHT

44
Q

Pressure-volume loop for diastolic failure

A

P-V loop has to shift UP

45
Q

Alcohol acutely diminished LV function “holiday heart syndrome”
5-10 yrs of heavy drinking

A

Alcoholic cardiomyopathy (dilated CM)

46
Q

Usually develops just before and 3 months after delivery.
Autoimmune.
Most cases are reversible

A

Peripartum cardiomyopathy (dilated CM)

47
Q

MCC of dilated CM

A

Ischemia

48
Q

Symptoms result form stiff ventricle, which restrict ventricular filling. “Hall mark” = diastolic dysfuntion.
Cardiac size & systolic functions are normal

A

Restrictive cardiomyopathy

49
Q

_______ increase diastolic relaxation and allow better filling in restrictive CM

A

CCB

50
Q

Pressure-volume loop in IHSS (hypertrophic CM)

A

Shifted to smaller volumes and larger pressure (d/t outflow tract obstruction)

51
Q

Asymmetric ventricular concentric hypertrophy with outflow obstruction (b/w hypertrophic septum & anterior MV leaflet)

Autosomal dominant.
Cause of sudden death in young athletes

A

Idiopathic hypertrophic subaortic stenosis (hypertrophic cardiomyopathy)

52
Q

_______ d/t hypertrophied and stiff ventricles in IHSS

A

Diastolic dysfunctions

53
Q

Conditions that enlarge the LV (increase in preload & afterload) separate the septum and anterior leaflet of the mitral valve and ________ (IHSS)

A

Decrease the obstruction

54
Q

Conditions that make the ventricle smaller or increase the velocity of blood flow (dehydration, + inotropes) ________ (IHSS)

A

Increase the obstruction

55
Q

Factors increasing outflow obstruction

A

Increased contractility;
Increased HR;
Decreased preload (volume) or decreased afterload

56
Q

TX for IHSS (hypertrophic CM)

A

Beta blockers and CCB

57
Q

Anesthetic concerns with IHSS:

A
  1. Increase preload “full full full”
  2. Increase afterload/SVR (Phenylephrine b/c does not increase contractility “up up up”
  3. BB to decrease contractility
  4. NO spinal or epidural (reduces SVR)
58
Q

Drugs that worsen outflow obstruction

A
  1. Vasodilators
  2. Positive inotropes
  3. B agonist
  4. Diuretics
    (Fentanyl does not depress myocardium or increase SVR so is of no use)
59
Q

Loss of circulating volume % a/w skin changes, normal BP, thirsty, cold, awake & alert

A

< 20%

60
Q

Loss of circulating volume % a/w oliguria (20ml/hr), restlessness, decreased BP, weak pulse > 120, confusion

A

20% - 40%

61
Q

Loss of circulating volume % a/w very low BP, pulse > 140, ekg changes, lethargic, coma, no UO

A

> 40%

62
Q

Septic causes

A

Gram negative rods

63
Q

S/s of septic shock

A 
Severe decreases in SVR;
Fever;
Low UO;
Hyperventilation/ resp alkalosis;
High cardiac index;
DIC
64
Q

TX for septic shock

A

Fluid resuscitate to increase MAP;
IV abx;
Surgical drainage;
Vasopressors (dopamine & NorEpi)

65
Q

S/s of Neurogenic Shock

A

Warm well perfused skin;
Low to normal UO;
Bradycardia & hypotension;
Normal CO, low SVR, low to normal PCWP

66
Q

Tx for neurogenic shock

A

IV fluid;
Vasoconstrictors;
Supine or trendelenburg;
Maintain body temp

67
Q

S/sx of cardiogenic shock

A

Elevated neck veins;

High cardiac filling pressure (increased PCWP);

68
Q

Tx for cardiogenic shock

A 
Abcs;
Treat arrhythmias;
Optimize HR;
Inotropic agents;
Vasopressors (dopamine);
Fluids HARMFUL if increased PCWP
69
Q

Best indicator of peripheral perfusion and adequate resuscitation

A

Urine output

70
Q

ALL _____ and _____ depress CVS except _____

A

Volatile agents; induction agents; Ketamine

Patho II (11 decks)

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