CV-Surgery Flashcards
treatment for Venous Thromboembolism & PE in pt with normal kidney function
Low molecular weight heparin therapy
What is the wells score for pt with severe chest pain and dyspnea
- HR>100
- Hx of surgery 4 weeks ago
- malignancy
- no diagnosis that better explains symptoms
1) 1.5
2) 1.5
3) 1
4) 3
Total is 7 (wells score)- making PE likely diagnosis
opening snap and diastolic murmur along with atrial fibrillation
Mitral stenosis
Peripheral artery disease (PAD), diagnostic? Tx?
- Ankle-brachial index (ABI)
- Graded exercise therapy
Acute Limb ischemia Diagnostic & tx?
- Duplex sonography
- Vascular bypass surgery
Abrupt standing or Valsalva maneuver causes the murmur to occur earlier during systole and with an increased intensity. What is the defect?
Mitral valve prolapse
High-frequency, mid-to-late systolic murmur heard best at the apex
Mitral valve prolapse
most common valvular abnormality in the US and is usually asymptomatic
Mitral valve prolapse
hx of atherosclerotic disease, pulmonary edema, JVD, and cold, clammy skin
Cardiogenic shock
Best choice to diagnose DVT
Compression ultrasonography
A child with easy fatigability, HTN, low-grade systolic ejection murmur, low extremity claudication and diminished pulses in LE. Dx?
coarctation of the aorta;
>5yo will have rib notching
leg pain, paleness, pulse deficit, paralysis, paresthesia, and poikilothermia. Dx? NSIM?
- Acute limb ischemia
- Digital subtraction angiography
S2 is widely split and does not vary with respiration and mid-diastolic murmur along the lower left sternal border
- Atrial septal defect
- Murmur due to increased flow across the tricuspid valve
IV user with fever, leukocyte, Roth spots, and Tricuspid valve regurgitation and vegetations
infective endocarditis
Infective endocarditis common bacteria and abx used for not confirmed & confirmed (after blood culture)?
Staphylococcus aureus
- IV vancomycin (empiric for not confirmed)
- IV nafcillin (confirmed)
MVA, hypotension, tachycardia refractive to fluid resuscitation & vasopressors, combined with A-fb, negative FAST
Cardiac contusion causing cardiogenic shock
The most common finding following cardiac and noncardiac surgery
arrhythmia- evident in PVC’s (eg. hypokalemia)
cyanotic neonate, imperforated AV septum on the right side, left-axis deviation
Tricuspid valve atresia
older female a waitress and smoker with dilated tortuous veins over both calves with multiple excoriation marks. Dx? NSIM?
Varicose veins- Chronic venous disease
Duplex ultrasonography
The predamaged heart valve is a risk of infection with
viridian streptococci (Gram + )
Hospitalized pt with the peripheral venous catheter placed with infection, risk with
Staph epidermidis (form biofilm)
Pain and swelling on R calf and positive Homan’s sign on 4 days post craniotomy pt. Dx? NSIM?
DVT, place Inferior vena cava filter
Dorsiflexion of the right foot causing server pain in the calf
positive Homan’s sign
Pain and swelling on R calf and positive Homan’s sign Dx? NSIM?
DVT. Unfractionated heparin therapy
Widened mediastinum, deviation of the esophagus, and depression of the left main-stem bronchus, as well as hemothorax, is
ruptured blood vessel (thoracic aorta)
Treatment of choice for many cases of symptomatic mitral stenosis
Percutaneous mitral balloon commissurotomy
lack of chest pain, history of rheumatic heart disease, low -pitched diastolic murmur with an opening snap and left atrial enlargement of x-ray. Dx?NSIM?
-Mitral valve stenosis
-Percutaneous mitral balloon commissurotomy
or mitral valve replacement (if not candidate for less invasive)
For preoperative risk stratification in a patient with cardiovascular risk
Radionuclide scan- myocardial perfusion imaging
-used when pt exercising or if unable to exercise, drug-like dipyridamole can be used)
Criteria used to indicate endocarditis
Duke criteria
Widened pulse pressure and early diastolic blowing murmur
Aortic regurgitation
IV drug user, fever, chills, leukocytosis, Aortic regurgitation, S3 gallop and pulmonary edema. Dx?NSIM and tx?
- Left-sided heart failure due to infective endocarditis
- TTE (echo)
- Mechanical valve replacement of the aortic valve
Postinverventional pulsatile groin mass with bruit and echolucent sac on us. Dx? NSIM?
- Femoral artery pseudoaneursym
- Ultrasound-guided thrombin injection
Tx for pseudoaneurysm that shows infection, cuase compressive symptoms (limb ischemia or neuropathy), expand rapidly, or could not be repaired
Surgical repair
will initaiate rapid formation of a fibrin clot to stop blood flow into aneursym
US-guided thrombin injection
Diagnostic used for possible acute aortic dissection/rupture with normal kidney function pt
contrast-enhanced CT angiography
Diagnostic used for possible acute aortic dissection with abnormal kidney function pt
Transesophageal echocardiography (TEE)
Syncope, orthostatic hypotension, low pitched rumbling mid-diastolic murmur over the apex, plopping sound,
obstruction of blood flow to the Left ventricle (cardiac myxomas)
Dizziness, syncope with harsh crescendo-decrescendo late systolic ejection murmur heard over the 2nd right intercostal space
Aortic valve stenosis
Pt with mechanical valve on warfarin plan for colon surgery in 5 days. Plan for anticoagulation?
- Stop warfarin now
- Start LMWH (Dalteparin) in 2 days
- Discontinue Dalteparin 24hr before surgery
Pt with threatened lower extremity acute arterial occlusion due to A-fib is given heparin therapy and NSIM?
Ballon catheter embolectomy
Acute arterial occlusion what NSIM
Percutaneous transluminal angioplasty
5 weeks old, SOB, noisy breathing, regurgitation of his feeds, x-ray show anterior tracheal bowing and narrowing. Dx? NSIM?
- Vascular ring
- Surgical division of a vascular ring
Health child, with Split S2 during inspiration. DX?NSIM?
Patent foramen ovale no intervention (unless >2.5 cm that needs surgical closure)
Number 1 risk factor for rupture of an active abdominal aortic aneurysm
smoking
severe abd pain, leukocytosis, elevated lactate & lactate dehydrogenase, A-fib suggest dx?NSIM?
Acute mesenteric ischemia
Balloon angioplasty and stenting
Post femoral artery catheterization with limb ischemia, venous dilation, limb edema. Dx?
Femoral AV fistula -due to accedental puncture of femoral vein
Post femoral artery catheterization with pain in the groin, a pulsatile mass, a systolic bruit over the swelling. Dx?
Femoral artery pseudoaneurysm
Multiple cv diseases, erectile dysfunction and symptoms of intermittent claudication. Dx?
Leriche’s syndrome (aortoiliac disease) is PAD- occlusion of either the bilateral iliac arteries or the aortic bifurcation
