Emboli1 Flashcards
What percent of peripheral arterial emboli are from the heart
80%
What is the MC etiology of cardiogenic emboli
atrial fib (used to be rheumatic heart disease)
What is the 2nd MC etiology of peripheral emboli
MI
Other cardiac etiologies of emboli
valvular abnormalities, vegetations on prosthetic valve replacement, cardiac tumors (atrial myxomas)
Noncardiac etiologies of emboli are more likely to cause micro or macroembolization
microembolization (occlusion of terminal vessels)
The MC source of micrembolization
atheromatous debris from aortoiliac ds greater than aortic aneurysm
Classic sx’s for acute limb ischemia
pain, pallor, pulselessness, poikilothermia, parasthesias, paralysis
What will a pulse exam show in n acute embolic event
Water hammer pulse proximal to the occlusion with no pulses below the occlusion
What diagnostic tests should be performed when an embolic event is suspected
US and ABI
What tissue is the most sensitive to ischemia
neural tissue (neurologic status is a good marker for degree of ischemia)
Will revascularization of a nonsalvageable limb restore function
no
What labs should be drawn in a patient with an embolic event
check for a hypercoagulable state: anticardiolipin antibiodies, antiphospholipid antibodies, antiplatelet factor IV antibodies and fibrinogen
What is the best test to check for cardiac abnormalities
TEE with bubbles
what is the initial medical tx in embolic events
heparinization
what is the bolus dose of heparin and the infusion rate
bolus dose: 80-100Ukghr; infusion rate: 10-15 Ukghr
What is the definition of an acute embolism
less than 2 weeks
Does pharmacologic lysis work well with acute embolism
yes
On angiogram of the lower extremity when should one suspect compartment syndrome
if tibial vessels appear tapered on the angiogram and they do not respond to vasodilator therapy
Following revascularization what other procedure should be performed
4 compartment fasciotomy
What labs should be checked post-op following revascularization +or- fasciotomy
K, CK, myoglobinuria, acidosis
What is the first choice of noninvasive imaging in patients with acute limb ischemia
CTA
What are the benefits of catheter directed thrombolysis as an intermediate therapy
restores flow, reveals lesion, increases perfusion
What is the MC cause of graft failure within the first 30 days
technical error (Assuming the patient isn�t hypercoagulable)
What is the MC finding on imaging in a patient within 30 days of bypass who presents with graft failure
distal anastomotic stricture
What is the MC finding on imaging in a patient with native graft and 30 day graft failure
perivascular hematoma
Why do perivascular hematomas occur
improper vein preparation
What labs should be checked at baseline and every 4-6hrs when using tPA
fibrinogen, platelets, hematocrit, PT
When should the tPA infusion rate be halved
for every fibrinogen greater than 150mgdL
When should tPA infusion be stopped
if fibrinogen less than 100mgdL due to risk of bleeding
