MTB 5 Flashcards
What is Constrictive Pericarditis
Combination of physical findings + calcification on CXR
Calcification and fibrosis that prevents filling of right side of heart if chronic
Physical findings of Constrictive Pericarditis
Right heart failure - Edema - Ascites - HSM - JVD K's - Kussmaul sign, Knock
Causes of Constrictive Pericarditis in the U.S.
Viruses
Cardiac Surgery
Chest Radiation
Idiopathic
Causes of Constrictive Pericarditis in developing countries
TB
What is Kussmaul sign
Increase in JVD on inhalation
What is “knock” on PE
Extra heart sound in diastole from ventricular filling
Best initial test for Constrictive Pericarditis
CXR shows calcification and fibrosis
Most accurate test for Constrictive Pericarditis
MRI
CT
TX for Constrictive Pericarditis
- Diuretics - used first to decompress filing, relieve edema
- Surgical removal of pericardium
Peripheral Artery Disease Etiology
Stenosis of peripheral arteries
- DM
- HTN
- HLD
- Smoking
Presentation of Peripheral Artery Disease
Leg pain in the calves on exertion = femoral popliteal
Pain relieved by rest
Pain when walking up or down hills
Severe
- Loss of hair follicles, sweat glands, sebaceous glands
- Smooth and shiny skin
Presentation of spinal stenosis
Worse when walking down hills b/c leaning back
Best initial test for Peripheral Artery Disease
ABI
> 10% difference or ABI < 0.9
Most accurate test for Peripheral Artery Disease
Angiogram
TX for Peripheral Artery Disease
- ASA
- Stop smoking
- Cilostazol
- Enroll pts in supervised exercise program, minimum of 12 weeks w 20-45 mins, 3X/week
- Surgery if all else fails
Presentation of Femoral Artery Aneurysm
Pulsatile Groin mass below inguinal ligament
Anterior thigh pain - nerve compression
What is Popliteal Artery Aneurysm ass’d with
AAA
What are the different types of bypasses done in PAD
- Femoral - popliteal Bypass - if arteries above and below knee affected
- Femoral-Tibial Bypass - arteries of lower legs/foot
- Aorto-Femoral Bypass - major Abd Artery (Aorta) large arteries branching off affected
Best initial test in suspected Aortic Dissection
CXR shows mediastinal widening
Aortic Dissection Presentation
Pain in b/t scapula
Difference in BP b/t arms
Most accurate test in suspected Aortic Dissection
Angiography
TX for Aortic Dissection
- Control BP
- B-blocker - IV Labetolol BEFORE nitroprusside
- Nitroprusside - reflex tach
- Surgery
MOA of Beta blockers on Aortic Dissection
Decreases shearing forces
Decrease HR
Decrease stress on aortic wall
When do we repair AAA
If diameter > 5 cm
Rapidly enlarging
Worst form of heart disease in pregnancy
- Peripartum Cardiomyopathy w persistent ventricular dysfunction
- Eisenmenger Syndrome
Peripartum Cardiomyopathy
After delivery
Abs made against myocardium
TX for Peripartum Cardiomyopathy
1. Drugs ACEi/ARB Beta blockers Spironolactone Diuretics Digoxin 2. Cardiac Transplant
What is Eisenmenger Syndrome
R to L shunt from Pulm. HTN
VSD –> L to R shunt –> Pulm HTN
