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Cardiovascular > Peripheral Artery Disease and Pericardial Disease > Flashcards

Peripheral Artery Disease and Pericardial Disease Flashcards

1
Q

PAD presentation example

A
  • lower leg pain; can be bilateral; one side can hurt more than the other
  • exercise-induced pain, relieved by rest (intermittent claudication)
  • hanging of foot over bed = gravity helps blood flow
  • High BP and heart failure = good signs of PAD
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2
Q

Is intermittent claudication necessary for PAD diagnosis?

A

No; only experienced by 1/3 of patients

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3
Q

PAD vs CAD treatment

A

PADs are not getting proper care; higher mortality than breast cancer

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4
Q

PAD physical exam

A

Auscultate abdomen and femoral arteries = look for bruits

Palpate for abdominal aortic aneurysm, and normal pulses

Inspect foot for ulcers, xanthomas, etc.

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5
Q

General appearance of PAD leg

A 
Hair loss
Thickened/brittle toenails
Smooth/shiny skin
Loss of subcutaneous fat
Gangrene
Ulceration
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6
Q

Non-invasive evaluation techniques of PAD

A

Most commonly used initial test:
Ankle-Brachial Index
Ankle-Toe index

Further:
Ultrasonography - identifies location

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7
Q

What is the equation for ankle-brachial index

A

ABI = Highest ankle systolic pressure/highest brachial systolic pressure

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8
Q

What do ABI values mean

A

Low ABI = PAD; degree of ABI reduction correlates w/ disease severity

ABI >1.30 is also abnormal

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9
Q

Treatment of PAD

A
  • Biggest = risk factor modification
  • Exercise
  • Antiplatelet therapy
  • phosphodiesterase inhibitors; Cilostazole
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10
Q

Risk modification in PAD

A
  • Smoking cessation
  • Exercise
  • Lower LDL = <140/90; use ACE inhibitors/beta-blockers
  • Control diabetes
  • Antiplatelet therapy - aspirin or clopidogrel
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11
Q

Smoking and PAD

A
  • 2-5X increased risk of PAD

- 84-90% of patients w/ claudication are current or ex-smokers

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12
Q

Diabetes and PAD

A
  • 2 to 4X increase of PAD

- Significant risk reduction per 1% reduction of HgA1c

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13
Q

PAD-specific drugs

A
  • Pentoxifylline; not very effective
  • Cilostazole; phosphodiesterase inhibitor = inhibits platelets (cAMP), vasodilation (cGMP); more effective

Do not use warfarin; no benefit

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14
Q

Cilostazole; contraindications

A

Do not give to those w/ HF = increased mortality

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15
Q

Benefits of walking program

A
  • formation of collaterals
  • improvement of vasodilation, muscle metabolism, walking efficiency
  • Much longer and more prolonged walking distances
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16
Q

General PAD treatment plan

A
  • Aspirin or Clopidogrel
  • Statin
  • Walking program
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17
Q

When is revascularization indicated w/ PAD

A
  • lifestyle-limiting symptoms

- Continued disability

18
Q

When to consider aortic dissection?

A

All patients w/:

  • chest, back, abdominal pain
  • syncope
  • perfusion deficit symptoms; CNS = depression, ischemia, etc.
19
Q

Acute aortic dissection risk factors/assesment

A
  • High risk condition - marfans, CT disorder, family history of aortic disease/valve disease, etc.
  • High risk pain = acute onset, ripping/tearing/sharp in nature
  • High risk exam = deficient pulse, low BP, focal neurologic deficit, murmurs
20
Q

Which drug increases risk of dissection?

A

Cocaine

21
Q

Aortic dissection treatment prior to surgery

A
  • DO NOT drain/pericardiocentesis
  • DO NOT increase HR
  • IV metoprolol to lower HR; do not use w/ aortic insufficiency
  • CCBs if can’t tolerate beta blocker
  • IV ACE inhibitors/vasodilators after BP is controled
  • DO NOT GIVE VASODILATORS BEFORE BP/HR CONTROL - reflex tachycardia increases stress
22
Q

Pericardial Characteristics/Anatomy

A
  • Visceral pericardium reflects back near great vessels to become parietal pericardium
  • Pericardial space = normally contains 50mL serous fluid
  • Derived from mesoderm
  • Phrenic nerve runs in the pericardium
23
Q

Irritation of the phrenic nerve causes what?

A

Hiccups

24
Q

Function of the pericaridum

A
  • Maintains heart position
  • Barrier to infection
  • Secretes prostaglandin = coronary vascular tone
  • Restrains cardiac volume
25
Q

Pericardium compliance

A

Normal - minor volume changes lead to signficant complaince changes; resistant to change

Chronic volume increase - expands; more compliant

26
Q

Acute pericarditis; etiology

A
  • Most are idiopathic

- Viral

27
Q

Common viruses to cause acute pericarditis

A
  • Coxasckie B - causes myopericarditis
  • HIV - africa
  • Tuberculosis - africa
28
Q

Acute pericarditis; symptoms

A

Sharp, pleuritic pain

-substernal, epigastric, left chest, trapezius muscle

29
Q

Acute pericarditis; physical exam

A

Three component friction rub; ventricular systole, atrial systole, diastole
-at LSB with patient leaning forward

30
Q

Acute pericarditis ECG

A

Dynamic;

  • ST elevation
  • PR depression
  • Low voltage QRS
  • Electrical alternans
31
Q

Acute pericarditis CXR

A

Pleural effusion
CHF
Big heart

32
Q

Acute pericarditis Echo

A

-not required for diagnosis

33
Q

Acute pericarditis treatment

A
  • NSAIDs = sufficient to treat
  • NSAIDs + Colchicine = better recovery and decreased recurrence
  • Steroids = rapid response; increased recurrence
  • For secondary pericarditis - treat primary disorder
34
Q

Colchicine mechanism

A
  • anti-inflammatory
  • Inhibits microtubule assembly; preferentially targets leukocytes
  • -inhibits intercellular granular movement and secretion
35
Q

Acute pericarditis diagnosis

A

Two of the following:

  • friction rup
  • typical sharp chest pain
  • Suggestive ECG
  • New or worsening pericardial effusion
36
Q

What is incessant pericarditis?

A

Pericarditis that is persistent

Pericarditis that shows symptom free intervals of less than 6 weeks and then returns

37
Q

Treatment for incessant pericarditis?

A

NSAIDs + Colchicine

38
Q

SE of Cholchicine

A

Major GI side effects

Hepatotoxic

39
Q

Non-inflammatory causes of pericardial effusion

A

Hydropericardium - serous transudate; associated w/ CHF, hyponatremia, CKD, liver disease

-Hemopericardium - trauma, MI, myocardial rupture, dissection

40
Q

Most common cardiac manifastation of HIV

A

Pericardial effusion - seen in advanced stages

  • most are small, asymptomatic
  • Larger effusions occur secondary to infection or neoplasm (kaposi’s, etc)
41
Q

What to do after obtaining pericardial ECG?

A

Catheterization tests

42
Q

What is a feature of pericarditis?

A

Pulsus paradoxes - fall of >30 mmHg or more in BP w/ inspiration

Cardiovascular (12 decks)

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