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Surgery EOR (billie) > Renal vascular disease, Valvular heart disease, Varicose veins > Flashcards

Renal vascular disease, Valvular heart disease, Varicose veins Flashcards

1
Q

what isthe MC patient demographic for renal artery stenosis

A

> 45 years old with atherosclerotic disease

CKD, CM, tobacco, and HTN are also risks

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2
Q

what are the signs/symptoms of renal artery stenosis

A
  • hypertension (refractory or new onset)
  • abdominal bruit in upper quadrants
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3
Q

what is the diagnostic modalities used for renal artery stenosis

what will they show

A
  • Doppler US - asymmetric kidneys (if unilateral) or * small hyperechoic kidneys (if bilateral)
  • renal angiography is GOLD standard!
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4
Q

what is the treatment for renal artery stenosis

A
  • angioplasty or surgical bypass
  • medical managament of HTN
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5
Q

what is nephrosclerosis and what causes it

A

sclerosis of arteries and arterioles caused by hypertension

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6
Q

what is the treatment of nephrosclerosis

A

multiple antihypertensives:
thiazides + ACE/ARB common

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7
Q

what is cholesterol atheroembolic disease

A

emboli to the kidneys

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8
Q

what are the s/s of cholesterol atheroembolic disease

A
  • worsening HTN and renal function
  • fever, abdominal pain, weight loss
  • levido reticularis and localized gangrene
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9
Q

How do you definitively diagnose cholesterol atheroembolic disease

A

kidney biopsy

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10
Q

what is the treatment for cholesterol atheroembolic disease

A

no specific effective therapy
but says to start statin and give supportive tx.

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11
Q

Presentation of aortic stenosis

A
  • angina, syncope, CHF
  • mid systolic, right 2nd intercostal, rad to carotids
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12
Q

what is the diagnostic of choice for ALL valvular heart diseases

A

echo

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13
Q

what is the treatment for patients with aortic stenosis

A
  • TAVR
  • warfarin +/- ASA if mechanical valve
  • plavix+ASA if not mechanical
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14
Q

what is the presentation of aortic regurgitation

A
  • exertional dyspnea, fatigue, angina
  • diastolic at 2nd-4th left intercostals radiating to apex
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15
Q

what is the treatment for aortic regurgitation

A
  • surgery for symptomatic and severe or with LV changes
  • ACE/ARB
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16
Q

what is the presentation of mitral stenosis

A
  • fatigue, extertional dyspnea, peripheral edema
  • diastolic murmur heard at apex with opening snap following S2
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17
Q

what will echo show in mitral stenosis

A

hockey stick sign

18
Q

what is the treatment for mitral stenosis

A
  • BB
  • diuretics
  • refer for surgery if severe presentation
19
Q

what is the presentation of mitral regurgitation

A
  • fatigue, dyspnea on exertion, and peripheral edema
  • holosystolic murmur at apex, radiates to axilla and back
20
Q

what is the treatment for mitral regurgitation

A
  • ACE/ARB or hydralazine for afterload reduction
  • surgical is definitive
21
Q

what is the presentation of mitral valve prolapse

A
  • nonspecific chest pain
  • mid systolic click followed by late systolic murmur
22
Q

what is the treatment for mitral valve prolapse

A

no intervention required unless symptoms are severe or they develope severe mitral regurgitation

23
Q

what is the presentation of tricuspid stenosis

A
  • hepatomegaly, ascites, peripheral edema, fatigue, elevated JVP
  • diastolic murmur along LLSB
24
Q

what is the treatment for tricuspid stenosis

A
  • treat heart failure symptoms with loop diuretics or aldosterone antagonists
  • valve replacement indicated if patient is symptomatic
25
Q

what is the presentation of tricuspid regurgitation

A
  • edema, JVD, ascited, hepatomegaly
  • pansystolic murmur LLSB
26
Q

treatment of tricuspid regurg

A
  • treat HF with diuretics/aldosterone antags
  • valve replacement
27
Q

what murmur is present in pulmonic stenosis

A

systolic murmur at LUSB with opening click following S1

28
Q

what is the treatment for pulmonic stenosis

A
  • mild - none
  • symptomatic (moderate/severe) - valve replacement
29
Q

what is the murmur for pulmonic regurg

A
  • diastolic at second left intercostal space
30
Q

what is the treatment for pulmonic regurg

A
  • treat the cause of the pulm HTN
  • valve replacement only if there is irreversible damage to valve.
31
Q

what anticoagulation is used for mechanical valves

A

lifelong warfarin

32
Q

what is the goal INR for warfarin

A

2.5-3.5

33
Q

what is the anticoagulation for a tissue valve replacement

A

ASA for 10+ years

34
Q

when you see aschoff body, what should you think of

A

rheumatic heart disease

35
Q

which valve does rheumatic heart disease MC effect

A

mitral

followed by atrial

36
Q

what is the major criteria for rheumatic heart disease

A

2 major OR 1 major and 2 minor

37
Q

what is the treatment of rheumatic heart disease

A

PCN

38
Q

what is the presentation of varicose veins

A
  • dull, aching heaviness or feelings of fatigue in the legs caused by prolonged periods of standing.
  • palpable, dilated and tortuous veins of thigh/calf
39
Q

what can varicose veins progress to

A

chronic venous insufficiency

40
Q

what diagnostic modality should be used for varicose veins

A

clinical diagnosis HOWEVER if planning surgery use duplex US

41
Q

what is the treatment for varicose veins

A
  • nonsurgical = compression stockings
  • sclerotherapy
  • laser therapy
  • endovascular ablation
  • vein stripping (last resort)
42
Q

what are complications of sclerotherapy

A
  • phlebitis
  • necrosis
  • infection

Surgery EOR (billie) (17 decks)

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