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Myocarditis/Cardiomyopathy/Endocarditis > Foundation-Vascular > Flashcards

Foundation-Vascular Flashcards

1
Q

What is the most common location of aortic aneurysm

A

AAA=infrarenal abdominal aorta

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2
Q

What is TAA generally caused by?

A

Cystic medial necrosis

–>Familial TAA

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3
Q

What is the triad of a ruptured AAA (diagnostic)

A
  1. Hypotension
  2. Back or abdominal pain
  3. Pulsatile abdominal mass
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4
Q

What is diagnostic of TAA (ascending thoracic aorta)

A

Pressure on adjacent structures

  1. Hoarseness- laryngeal nerce
  2. Resp. sx’s- Trachea
  3. LE pain- thrombi
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5
Q

What is the gold standard diagnostic for aortic aneurysms?

A

Ultrasound

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6
Q

What is the treatment for an unstable pt with ruptured aneurysm?

A

immediate surgical intervention

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7
Q

Who do we screen for Aortic Aneurysms?

A
  1. Men aged 65-75 who have ever smoked

2. People aged >60 who have a positive FHx for AAA

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8
Q

Stanford classification for Type A dissection

A

Involved ascending aorta and aortic arch

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9
Q

Stanford classification for Type B dissection

A

Involved descending aorta

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10
Q

What population do we see aortic dissections at an earlier age than normal? And what age?

A
  • Marfan’s Syndrome- Connective tissue dz

- Mean age = 36

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11
Q

What is the top risk factor for aortic dissection?

A

HTN= 70%

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12
Q

What population are aortic dissections the most common in?

A

middle-aged to older males with a history of hypertension

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13
Q

Do aortic dissections usually happen in the presence or absence of aneurysms?

A

Absence

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14
Q

What complaint is more often reported with Type A dissection?

A

Chest Pain

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15
Q

What complaint is more often reported with Type B dissection?

A

Back and abdominal pain

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16
Q

What murmur would you expect to hear on examination that would clue you in this might be an aortic dissection?

A

New high frequency diastolic blowing murmur of AR

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17
Q

Is hypotension shock more common with Type A or Type B dissection?

A

Type A

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18
Q

Is HTN more common with Type A or Type B dissection?

A

Type B

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19
Q

What imaging has the highest sensitivity and specificity for aortic dissection diagnosis?

A

CT with IV contrast, TEE, MRI =95%

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20
Q

What is the study of choice in a hemodynamically unstable patient?

A

TEE

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21
Q

What is the treatment of choice in Type A dissections?

A

Resect ascending aorta and replace with graft

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22
Q

What is the treatment of choice in Type B dissections?

A

Medical management if possible

Stenting

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23
Q

What condition is characterized as a chronic vasculitis of large and medium-sized vessels?

A

Giant Cell Arteritis or temporal arteritis

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24
Q

What is the mean age of diagnosis in giant cell arteritis?

A

Age 72

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25
Q

What is a hallmark indication of giant cell arteritis?

A

almost never occurs in ppl <50 y.o.

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26
Q

Describe “cord like sensation” when palpating the temporal artery

A

-Dilated and thickened, allowing it to roll between fingers

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27
Q

What are the presenting symptoms in giant cell arteritis?

A
  • New onset HA
  • Abrupt onset of visual disturbances
  • Symptoms of polymyalgia rheumatica
  • Unexplained fever or anemia
  • Elevated ESR or CRP
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28
Q

What is the most feared complication of giant cell arteritis?

A

Visual loss

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29
Q

What condition is giant cell arteritis associated with?

A

Polymyalgia rheumatica

30
Q

Define Polymyalgia rheumatica

A
  • Systemic inflammatory dz
  • Pain in shoulder and pelvic girdle
  • Elevated SED and CRP with this
31
Q

What is the imaging of choice for giant cell arteritis?

A

Ultrasound- get color flow image of arteries

32
Q

Treatment for giant cell arteritis?

A

Glucocorticoid therapy

=Prednisone

33
Q

At what age does PAD increasingly progress?

A

Age 40

34
Q

What is the classic presentation of PAD?

A

Intermittent claudication

-Reproducible cramping pain in legs induced by exercise and relieved by rest

35
Q

What peripheral artery dz (what artery) does calf muscle pain suggest?

A

femoropopliteal diesease

36
Q

What peripheral artery dz (what artery) does buttocks and thigh pain suggest?

A

aortoiliac disease

37
Q

What are the characteristics of severe PAD?

A
  • Pain at rest
  • Skin atrophy
  • Hair loss
  • Cyanosis
  • Ischemic ulcers
  • Gangrene
38
Q

Describe Buerger Test

A

Rubor on dependency

  • Elevated=pale
  • Dependent= dusky redness
39
Q

Describe arterial ischemic ulcers

A
  • Deep ulcers over bony prominences (toes)

- Sharp borders

40
Q

What is the gold standard diagnostic test for PAD?

A

Contrast arteriography

  • MRA
  • CTA
  • angiography
41
Q

How do you measure Ankle-Brachial Index (ABI)?

A
  • ankle systolic BP/brachial systolic BP= ratio

- detected with a doppler probe

42
Q

What is mild PAD based on ABI results?

A

<0.9

43
Q

What is severe PAD based on ABI results?

A

<0.4

44
Q

List Pharmacologic therapy for PAD

A
  1. Anti-platelet drugs- ASA, Plavix

2. Direct vasodilation- Cilostazol (Pletal)

45
Q

Surgical intervention for PAD?

A
  1. Bypass
  2. Endovascular- Angioplasty/stenting
  3. Thromboendarterectomy- removal of plaque
46
Q

What is the mortality rate in a pt with PAD for MI and stroke?

A

6x higher

47
Q

Where do most acute arterial occlusions originate from?

A

Heart

  • Arterial thrombus from a-fib
  • Left ventricular thrombus after MI
  • Debris from prosthetic valves/infected valves
48
Q

What are the 6 P’s of acute arterial occlusion?

A
  1. Paresthesia
  2. Pain
  3. Pallor
  4. Pulselessness
  5. Paralysis
  6. Poikilothermia- cool to palpation
49
Q

Treatment of acute arterial occlusion-Emergent!

A
  1. IV Heparin bolus, followed by infusion
  2. Thrombolytic therapy
  3. Surgery- revascularization
50
Q

Define Phlebitis

A

Superficial venous thrombophlebitis= superficial phlebitis

51
Q

What is the etiology of phlebitis?

A
  1. Spontaneous
    - Great Saphenous vein
    - Pregnancy/postpartum
  2. Trauma to vein
    - IV therapy, PICC line
52
Q

Physical exam finding of SF thrombophlebitis

A

**Palpable, nodular cord

Induration, erythema

53
Q

Treatment of SF thrombophlebitis

A

Elevation, warm compress, NSAIDS

54
Q

When would you prescribe Abs for SF thrombophlebitis

A
  1. High fever

2. Purulent discharge

55
Q

What is venous insufficiency due to?

A

Incompetent valves- can’t pump low oxygen blood back to the heart

56
Q

Sx’s of venous insufficiency

A
  1. Pruritis
  2. LE swelling-pitting edema**
  3. Eczema phenomenon**
  4. Inflammation
57
Q

What are risk factors for venous insufficiency

A
  1. Standing/sitting for prolonged period of time**
  2. Female
  3. Pregnancy
  4. Hx of DVT
58
Q

Define hemosiderin deposits seen in venous insufficiency

A

Skin hyperpigmentation

59
Q

What are characteristic of ulcers in venous insufficiency (venous stasis ulcers)?

A
  • Shallow
  • Irregular borders
  • Inside the ankle
60
Q

What is one of the main treatment goals in venous insufficiency

A

Reduce edema!!

–>ulcers won’t heal until edema is controlled

61
Q

Dilated, elongated, tortuous, subcutaneous veins describes what?

A

Varicose veins

62
Q

Varicose Veins Epidemiology

A
  1. Increasing incidence with age

2. Increased in pregnancy due to increased blood volume

63
Q

Treatment options for varicose veins

A
  1. Associated stasis dermatitis= topical corticosteroids
  2. Chemical ablation(sclerotherapy)
  3. Surgery- phlebectomy
64
Q

What is Virchow’s triad and what condition is it associated with?

A
  1. Venous stasis
  2. Vessel wall injury
  3. Coagulation abnormality
    * DVT
65
Q

Clinical presentation of DVT

A
  1. > 1-2 cm circumferential difference in legs**
  2. Swelling, pain and discoloration of LE
  3. Palpable cord, increased warmth
  4. +Homan’s sign
66
Q

DVT Treatment

A

Anticoagulation- 3, 6, or 12 mos.

=Low molecular-weight Heparin- Lovenox

67
Q

Etiology of SVC obstruction (complete or partial)

A

From neoplastic (tumor) or inflammatory conditions in mediastinum

68
Q

Clinical presentation of SVC obstruction

A
  1. Acute onset of sx’s

2. Swelling of neck, fact and UE’s**

69
Q

What life threatening condition can SVC obstruction lead to?

A

cerebral and laryngeal edema

70
Q

What EMERGENT treatment would you perform for SVC obstruction

A

Balloon angioplasty of obstruction and stent placement–>otherwise treat the neoplasm with chemo/radiation

Myocarditis/Cardiomyopathy/Endocarditis (3 decks)

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