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Cardiology > Diseases of vasculature: Arteries > Flashcards

Diseases of vasculature: Arteries Flashcards

1
Q

What is the definition of hypertensive emergency and hypertensive urgency

A

Hypertensive emergency: BP > 220/120 + end organ damage - immediate treatment required

Hypertensive urgency: BP > 220/120 - lower BP over 24 hours

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2
Q

What are five places that end organ damage can occur from hypertension and what occurs in each

A

Eyes - papilledema
CNS - altered mental status or intracranial hemorrhage, or hypertensive encephalopathy (BP > 240/140)
Kidneys - Renal failure/hematuria
Heart - Unstable angina, MI, CHF with pulmonary edema, aortic dissection
Lungs - pulmonary edema

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3
Q

What is one major complication that can result in the brain due to hypertensive emergency

A

Posterior reversible encephalopathy syndrome: Radiographic condition, caused by autoregulatory failure of cerebral vessels leading to arteriolar dilation and fluid going into brain, causing CEREBRAL EDEMA

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4
Q

What are the symptoms of posterior reversible encephalopathy syndrome:

A

Insidious headache, altered consciousness, visual changes, seizures (same as hypertensive emergency)

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5
Q

What is the treatment for hypertensive emergency and difference between more immediate and less immediate danger

A

Reduce arterial pressure 25% in first 2 hours
More immediate danger (diastolic > 130 or hypertensive encephalopathy) - IV hydralzine, esmolol, nitroprusside, labetalol

Less danger - regular oral hypertensives

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6
Q

What is the treatment of hypertensive urgency

A

BP lowered within 24 hours using oral agents

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7
Q

What is the pathophysiology of aortic dissection

A

Tearing through intima (layer closest to blood) allowing blood through media or aortic wall with already preexisting weakness of media

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8
Q

What are some predisposing conditions to aortic dissection (five things)

A
  1. ) Long standing systemic HTN - most common, hyaline arteriosclerosis of vasa vasorum leading to media atrophy
  2. ) Connective tissue diseases - marfans and ehlers danlos - younger ppl
  3. ) Trauma
  4. ) Bicuspid aortic valve and coarctation of aorta
  5. ) Third trimester of pregnancy
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9
Q

What are two types of aortic dissection

A
  1. ) Type A (proximal) - Ascending aorta

2. ) Type B (distal) - Descending aorta (after subclavian artery)

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10
Q

What are the clinical features of aortic dissection

A

Tearing/ripping, stabbing pain abruptly

  • anterior = proximal dissection
  • posterior = distal dissection

Pulse/BP assymetry between limbs and hypertensive at same time - important

Neurological manifestations (hemiplegia, hemisensory) due to obstruction of carotid artery

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11
Q

What are four diagnostic modalities possible for aortic dissection

A
  1. ) CXR - shows WIDENED MEDIASTINUM
  2. ) TEE - noninvasive and highly accurate, preferred if unstable patient because it’s super fast
  3. ) CT/MRI - test of choice because not invasive
  4. ) Aortic angiography - invasive but best for determining extent of dissection for surgery
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12
Q

What is the first initial management step for aortic dissection

A

Medical therapy immediately: IV beta blockers to lower heart rate, and IV nitroprusside to lower systolic BP below 120

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13
Q

What is the management for type A dissections vs. type B dissections

A

Type A: Open heart surgery for sure

Type B: Control BP fast, IV beta blockers, possible surgery

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14
Q

What is the most common location of abdominal aortic aneurysm

A

Between renal arteries and iliac bifurcation, usually between age 65 and 70

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15
Q

What is the pathophysiology of abdominal aortic aneurysm and who does it primarily affect

A

Weakening of aortic wall from athersclerosis preventing O2 diffusion, causing it to bulge

Happens to male smokers over 60 with hypertension. Trauma, family history, and vasculitis also play a role

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16
Q

What are two clinical features seen with AAA

A

Pulsatile mass in abdomen, throbbing pain if present at hypogastrum and lower back

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17
Q

What are two signs to show that AAA may rupture soon

A
  1. ) Sudden onset of severe pain

2. ) Grey Turner’s signs (ecchymoses on back/flanks) and cullens sign (ecchymoses around umbilicus)

18
Q

What is teh classic triad for rupture of AAA, requiring no further diagnostic testing

A

Abdominal pain, hypotension, palpable pulsatile mass

19
Q

What should you do if you suspect emergent AAA rupture

A

Emergent Laparoscopy

20
Q

What are two major diagnostic modalities you can use for AAA

A
  1. ) Ultrasound - test of choice, fast and accurate

2. ) CT - slower, so use in hemodynamically stable patients, or test of choice for preoperative planning

21
Q

What is the management for AAA and what is it based on

A

Based on size of aneurysm> 5cm = surgical resection with synthetic graft placement through endovascular access through femoral artery

22
Q

What is peripheral vascular disease

A

Occlusive athersclerotic disease of lower extremities

23
Q

What are common sites of peripheral vascular disease occlusions

A
  1. ) Superficial femoral artery in hunters canal - most common
  2. ) Popliteal artery
  3. ) Aortoiliac occlusive disease
24
Q

What is the most important risk factor in PVD

A

Smoking

25
Q

What are the two major types of symptoms a patient can get with PVD in progression

A
  1. Intermittent claudication - cramping leg pain reproduced by walking same distance, relieved by rest
  2. Rest pain - Distal metatarsals where arteries are smallest and way more prominent at night (awakens patient), hanging foot over bed relieves symptoms, this is severe ischemia
26
Q

What are the clinical signs of peripheral vascular disease

A

Absent pulses, muscular atrophy, decreased hair growth, decreased temperature, ischemic ulcerations on toes secondary to trauma

27
Q

What is the major procedure used to diagnosed peripheral vascular disease

A

Ankle-to-brachial index: Ratio of systolic BP at ankle to systolic BP at arm
Normal: 0.9 to 1.3
ABI > 1.3 = incompressible, severe disease (in diabetics)

28
Q

What is teh second and third procedure used to diagnose PVD

A

Pulse volume recordings

Arteriography - gold standard

29
Q

PVD has both a conservative management and surgical management. What is the conservative management

A
  1. Stop smoking, graduated exercise, avoid extreme cold + asprin and statin
  2. cilostazol - PDE inhibtor - suppressed platelet aggregation and dilates arterioles
30
Q

PVD has both a conservative management and surgical management. What is the surgical management and when should you do it

A

Do it when there is rest pain, ulcerations, refractory to conservative management

Angioplasty - balloon dilation, minimum risk, can be performed multiple times

Surgical bypass graft: 5 year patency of 70%

31
Q

How can you find out the location of PVD based on symptoms

A

Calf claudication - femoral or popliteal

Buttock and hip claudication with calves - aortoiliac

32
Q

Which group of people can you not depend on ABI (false readings)

A

Diabetics - calcified vessels

33
Q

What is acute arterial occlusion and its pathophysiology

A

Acute occlusion of artery usually by embolization, usually femoral artery

34
Q

What are the sources of emboli in acute arterial occlusion

A

Heart (85%), aneurysms, atheromatous plaque

35
Q

What are teh clinical features of acute arterial occlusion as denoted by the 6P’s

A

Pain - acute

Pallor, polar (cold), paralysis, paresthesias, pulselessness

36
Q

What should you use to diagnose acute arterial occlusion

A

Arteriogram (like PVD’s gold standard)

You should also use ECG to look for MI,
Afib and echo to check valves and clots

MI patients are at highest risk for LV thrombus and systemic embolization

37
Q

What is the main goal of treatment for acute arterial occlusion

A

Assess viability of tissues to salvage the limb

38
Q

How many hours of ischemia can skeletal muscle withstand from acute arterial occlusion

A

6 hours

39
Q

What are two major things you need to do for acute arterial occlusion treatment

A
  1. ) Anticoagulate immediately - IV heparin
  2. ) Emergent Surgical embolectomy via fogarty balloon, if this fails then bypass

Treat compartment syndrome if this occurs

40
Q

What is cholesterol embolization syndrome and its treatment

A

Shower of cholesterole crystals from plaques triggered by surgical/radiographic intervention/thrombolytics, causing blue/black toes and discrete areas of tissue ischemia

Treatment: Supportive, do not anticoagulate, control BP

41
Q

What is mycotic aneurysm and its treatment

A

Aneurysm from aortic wall damage secondary to infection

Treat with IV antibiotics and surgical excision

42
Q

What is Leutic heart and whats its treatment

A

Complication of sypilitic aortitis causing aneurysm of aortic arch with retrograde extension

Treatment with IV penicillin and surgical repair

Cardiology (9 decks)

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