Final: Cardiovascular Assessment Lect and DSA Flashcards
CVD includes:
Coronary Heart Disease
Stroke
Peripheral Artery Disease
What are major risk factors for CVD?
Smoking, Overweight, diet, physical inactivity, dyslipidemia
What are some nonmodifiable risk factors of CVD?
Age, Race, Sex, FH
What are three physical exam findings that would indicate stroke?
Facial paresis, arm weakness, and abnormal speech
When is carotid artery stenosis symptomatic?
When you have focal neurological deficits
-contralateral weakness, dysarthria, aphasia, spatial neglect
If a patient has carotid artery stenosis w/o symptoms, should they be screened?
No
-only for symptomatic or if they have risk factors for atherosclerosis (bruits)
What is considered a reliable indicator for perfusion in those with diabetes?
The Toe-brachial index
-smaller vessels are less likely occluded than if done in mid extremities
If a patient is suspected for claudication/risk for PAD and initial ABIs are negative, what should you do?
Exercise testing with post-exercise ABIs
What is virchows triad?
Stasis of blood flow
Vascular injury
Hypercoagulable states
What are some big risk factors for DVT/PE?
Hypercoaguable state (Factor V Laiden, Protein C/S def)
Malignancy
Pregnancy
OCs
Being hospitalized (stasis of blood flow)
Long International flights
What are some common symptoms of PAD?
Complaints of claudication/coldness
-pain (especially when standing), pale pallor, cold/warm areas, hair loss, weak pulses
When should you do orthostatic vital signs?
When concerned about:
- dehydration
- Blood loss
- syncope
How do you obtain orthostatic BP?
Lay down for 5 mins, obtain BP
Assist to seated position
After 1-2 mins, recheck
+if increase in 10bpm, or decrease 20mmHg or greater
What is the scale of measuring pulses?
0=absent 1=diminished, difficult to palpate 2=expected, easy to palpate 3=full, increased 4=bounding
What is normal JVP?
6-8cm
What are the 6 P’s of acute limb ischemia?
Paresthesia Perishing Cold Pulselessness Pain Paralysis Pallor
Means arterial occlusion
If a patient’s painful and cold legs do not change while walking and are relieved by stopping and made worse by walking uphill you would probably think
Vascular claudication and not neurologic
If walking downhill makes symptoms worse and walking increases weakness, what would be a good problem of pain?
Neurogenic causes
-spinal stenosis, cauda equina
How do you calculate the ABI?
Highest Pressure in Foot/Highest pressure in arms
If the ABI is greater than 1.4, what does this mean?
Claudication/Vessel hardening
Refer to vascular specialist
If the ABI is between 0.5-0.8, what does this mean?
Moderate Arterial disease
Refer to vascular specialist
If the ABI is less than 0.5, what does this mean?
Severe arterial disease
Refer to vascular specialist
What do varicose veins indicate?
Poor venous return due to incompetent valves in veins
-can lead to systemic HTN due to poor Venous return
What is stasis dermatitis?
It is the brown discoloration in the skin that develops as a result of poor fluid return from the lower extremities
-due to hemosiderin deposits staining skin red
What is “brawny edema” a term used to describe?
Advanced Stasis dermaitis
-has become thickened
What are some specific, but uncommon skin/eye signs of infectious endocarditis?
Janeway lesions
Roth spots
Osler Nodules
Splinter Hemorrhages
What causes lymphedema?
usually thought to be due to lymph node resection, but can be due to injuries or tropical infections
What is a non-pharmological way to treat lymphedema?
Compression stockings
Whats the number one cause of lymphedma world wide?
Filiarial infection
What is clubbing of the fingers a common sign of?
Poor oxygenation, most often due to lung disease
55 yo pt comes in complaining of productive cough, that is green/white. He has noticed some blood at times. On lung exam, bilateral crackles and wheezes are heard with prolonged expiration. The patient is also noted to by cyanotic. What is your best diagnosis?
Chronic bronchitis
-blue bloater
55 yo pt comes in complaining of SOB. On PE, skin appears warm and appropriate color. The patient is noted to be using accessory muscles when breathing and is tripoding. He has decreased breath sounds throughout and is tachypnic. What is your best diagnosis?
Emphysema
-pink puffer
