Emboli1

Question 1

What percent of peripheral arterial emboli are from the heart

Answer 1

80%

Question 2

What is the MC etiology of cardiogenic emboli

Answer 2

atrial fib (used to be rheumatic heart disease)

Question 3

What is the 2nd MC etiology of peripheral emboli

Answer 3

MI

Question 4

Other cardiac etiologies of emboli

Answer 4

valvular abnormalities, vegetations on prosthetic valve replacement, cardiac tumors (atrial myxomas)

Question 5

Noncardiac etiologies of emboli are more likely to cause micro or macroembolization

Answer 5

microembolization (occlusion of terminal vessels)

Question 6

The MC source of micrembolization

Answer 6

atheromatous debris from aortoiliac ds greater than aortic aneurysm

Question 7

Classic sx’s for acute limb ischemia

Answer 7

pain, pallor, pulselessness, poikilothermia, parasthesias, paralysis

Question 8

What will a pulse exam show in n acute embolic event

Answer 8

Water hammer pulse proximal to the occlusion with no pulses below the occlusion

Question 9

What diagnostic tests should be performed when an embolic event is suspected

Answer 9

US and ABI

Question 10

What tissue is the most sensitive to ischemia

Answer 10

neural tissue (neurologic status is a good marker for degree of ischemia)

Question 11

Will revascularization of a nonsalvageable limb restore function

Answer 11

no

Question 12

What labs should be drawn in a patient with an embolic event

Answer 12

check for a hypercoagulable state: anticardiolipin antibiodies, antiphospholipid antibodies, antiplatelet factor IV antibodies and fibrinogen

Question 13

What is the best test to check for cardiac abnormalities

Answer 13

TEE with bubbles

Question 14

what is the initial medical tx in embolic events

Answer 14

heparinization

Question 15

what is the bolus dose of heparin and the infusion rate

Answer 15

bolus dose: 80-100Ukghr; infusion rate: 10-15 Ukghr

Question 16

What is the definition of an acute embolism

Answer 16

less than 2 weeks

Question 17

Does pharmacologic lysis work well with acute embolism

Answer 17

yes

Question 18

On angiogram of the lower extremity when should one suspect compartment syndrome

Answer 18

if tibial vessels appear tapered on the angiogram and they do not respond to vasodilator therapy

Question 19

Following revascularization what other procedure should be performed

Answer 19

4 compartment fasciotomy

Question 20

What labs should be checked post-op following revascularization +or- fasciotomy

Answer 20

K, CK, myoglobinuria, acidosis

Question 21

What is the first choice of noninvasive imaging in patients with acute limb ischemia

Answer 21

CTA

Question 22

What are the benefits of catheter directed thrombolysis as an intermediate therapy

Answer 22

restores flow, reveals lesion, increases perfusion

Question 23

What is the MC cause of graft failure within the first 30 days

Answer 23

technical error (Assuming the patient isn�t hypercoagulable)

Question 24

What is the MC finding on imaging in a patient within 30 days of bypass who presents with graft failure

Answer 24

distal anastomotic stricture

Question 25

What is the MC finding on imaging in a patient with native graft and 30 day graft failure

Answer 25

perivascular hematoma

Question 26

Why do perivascular hematomas occur

Answer 26

improper vein preparation

Question 27

What labs should be checked at baseline and every 4-6hrs when using tPA

Answer 27

fibrinogen, platelets, hematocrit, PT

Question 28

When should the tPA infusion rate be halved

Answer 28

for every fibrinogen greater than 150mgdL

Question 29

When should tPA infusion be stopped

Answer 29

if fibrinogen less than 100mgdL due to risk of bleeding