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Cardiology Boards > Vascular > Flashcards

Vascular Flashcards

1
Q

RAS intervention

A

Pulmonary edema/unexplained HF (class I) or refractory HTN - with no other identifiable reason - ok to intervene on >70% stenosis in renal artery

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2
Q

ABI

A 
right ABI=(higher right ankle pressure)/Higher arm pressure
1-1.29=normal
>=1.3=non-compressible
.9-.99=borderline
0.41-0.89=mild to mod
<=0.4=severe
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3
Q

Screening for PAD

A
  1. Excertion leg symptoms
  2. Age >65yo
  3. Age >50yo with h/o tobacco use OR DM
  4. Non-healing LE wounds
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4
Q

Screening for AAA

A
  1. Men >60yo with 1st deg relative with AAA

2. Men >65-75yo who EVER smoked

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5
Q

Pulmonary embolism Clinical presentation

A

Chest pain, dypnea, hypoxia, sinus tach in setting of normal chest xray and clear lungs

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6
Q

Acute ischemic stroke - lytics

A 
Can treat 3-4.5 hrs...
Always rTPA (never streptokinase)
0.9mg/kg max 90mg
Contraindications:
1) Recent stroke/TIA w/in 3 months
2) BP>185/110
3) Active internal bleeding
4) heparin w/in 48hrs
5) Plt <100
6)Current NOAC use
7) INR>1.7
8) FSG <50
9) Multi-lobar infarction
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7
Q

Dx of PAD

A

If normal resting ABI
then need exercise ABI (treadmill)
TBI if ABI is non-compressible (ie >1.3)

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8
Q

Sx PAD therapy

A

Supervised excercise - improved 6MWT
Cilostozol CONTAINDIC with HF
PENTOXYphline ok but not great

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9
Q

RAS - indication for intervention (IIa)

A

previously well controlled HTN now escaped
recurrent CHF exacerbations
Flash pulm edema out of proportion to LV systolic dysfucntion or burden of CAD
unexplained discrepancy in kidney size
unexplained dec’d kidney fxn
early (before 30) or late (after 55) onset HTN
U/A

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10
Q

RAS pathophys

A

kidney 1 RAS->kidney sense lower vol, kidney 2 secretes renin (angiotensin->aldosterone) - sodium retention->inc’d BP

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11
Q

Burger’s dz (thromboangiitis obliterans)

A

non-atherosclerotic dz of small and med sized upper and LE vessels - multiple limbs, corkscrew collaterals
YOUNG MALE SMOKER
multiple limbs, ischemic ulcers, normal A1c (diabetes excludes burgers), abn of ONLY distal vessels (prox sparing)
Tx: tobacco cessation

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12
Q

Giant Cell arteritis

A

If clinically suspected treat with steroids right away (older adult with inflammatory illness and headaches, scalp tenderness jaw claudication, blindness)
1) >50 years of age, 2) recent onset of localized headaches, 3) temporal artery tenderness or pulse attenuation, 4) erythrocyte sedimentation rate >50 mm/h, and 5) arterial biopsy showing necrotizing vasculitis. W>M, >55yo
MRA to check etiology (mural enhancement of aortic arch

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13
Q

Takayasu arterities

A

Young adult with subacute inflamm illness and h/a and interarm BP diff

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14
Q

Massive PE

A

Hypotension
Saddle PE
RV failure -> lytics - if contraindication then catheter directed thrombolysis

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15
Q

PE Risk Stratification

A 
RV dilation/hypokinesis
TR
Pulm HTN with tricuspid jet >2.6m/s
RV>0.9 LV diameter
decreased TAPSE <17mm
Dilation and loss of collapse of IVC with inpiration
D-septum (systolic)
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16
Q

Symptomatic Carotid stenosis

A

benefit of carotid endarectomy best within 2 weeks of symptomatic carotid stenosis episode (ie TIA/CVA) >70% STENOSIS

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17
Q

Chronic mesenteric ischemia

A 
Weight loss (post prandial pain)
Abd bruit
food avoidance
Indication for intervetnion
-wt loss
Tx:
Lifestyle mod
smoking cessation
lipid tx
glucose control
BP control
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18
Q

Carotid stenosis guidelines

A

Normal - <125cm/s
<50% - <125cm/s, ICA/CCA <2.0, ICA EDV <40
50-69% - 125-230cm/s, ICA/CCA 2.0-4.0, ICA EDV 40-100
>70% - >230cm/s, ICA/CCA >4.0 PSV ratio, ICA EDV>100
Near occlusion - high/low/undetectable PSV, variable ICA/CCA ratio, variable ICA EDV

19
Q

Renal artery Stenosis (atherosclerotic

A

Ostial (contiguous with aorta)

a/w dec’d renal fxn

20
Q

Fibromusclar dysplasia RAS

A 
younger/middle aged women with HTN
middle or distal segment
no impaired renal fxn
abdominal bruit
inc'd velocity on doppler
beaded appearance
POBA without stenting best therapy for HTN
21
Q

Large artery vasculitis

A

periarterial enhancement on CT/MRI

22
Q

Cryptogenic stroke with PFO and carotid dz

A

If only on ASA - need statin + BP control
NO advantage to PFO closure
Only A/C if concurrent AF

23
Q

PFO

A

does not infer inc’d future stroke risk

24
Q

PFO closure

A

2nd event after on appropriate medical therapy (ASA/statin)

No flow complication (ie RH enlargement, pulm HTN, AF) - does happen in ASD

25
Q

AAA rupture risk

A 
Any Sx patient
Asx patients:
>5.0cm 20%
>6.0cm 40%
repair if >5.5 or growth >1cm in 1 year
Serial imaging  4.0-5.4 q6-12mo
26
Q

Endoleaks

A

Type 1: leak from seal at prox or distal end
Type 2: Leak from branch vessel entering grafted area (ie lumbar, mesenteric, testicular) - MC?
Type 3: leak from anastomasis between graft parts
Type 4: Leak through graft material

27
Q

Aorta replacement

A

> 5.5 cm or >0.5cm/year growth

If concominent aortic valve surgery replace aorta if >4.5cm

28
Q

Sx Carotid stenosis

A

check carotid duplex

need CEA within 2 weeks

29
Q

Screening Fhx Aortic dissection

A 
screen for BAV with echo
Image entire aorta if 1st deg relative died of Ao Diss
Marfan's - fibrillin
Loey Dietz - TGFB1
Turner's XO
Ehrler danolos - COL3A-1
BAV
30
Q

Intramural hematoma

A

Crescent shaped eccentric hyperenhancing thickening of aortic wall on non-contrast CT (need non-contrast to dx)

31
Q

Aneuysm

A

1.5x normal

32
Q

CLI

A

Tyrosine kinase inhibtiors ie nilotinib - cause increased thromobitic events
(oral contraceptives cause VENOUS thormbois not arterial)

33
Q

PE

A 
if low probability - check D -dimer - 99% NPV
ECG - sinus tach, S1, Q3T3
RBBB/iRBBB
AF
Strain pattern V1-4\
CTA chest
V/Q scan
Not MRA (low sensitivity)
34
Q

May Thurger syndrome

A

iliac vein compression syndrome - young adult
overlying artery compresses iliac vein
missed on LE duplex’
causes leg swelling, varicosities, DVT, stasis ulcers,

35
Q

FMD

A

Young woman with HTN and no other features (no buffalo hump, flushing, diarrhea, palpitations, murmurs, pulse delays)

Check renal duplex -> CT/MR if non-dx

Dexasome suppression if buffalo hump
CT/TTE - coarctation
metanephrines - pheo

36
Q

RAS

A 
inc in Cr with ACE/ARB use
atherosclerotic CV dz elsewhere
age
abdominal bruit
recent loss of BP control
37
Q

RAS

A

p/w HTN crisis or pulmonary edema

38
Q

Screening for Aortic aneurysm

A

marfans
6 mo after dx - yearly if stable
>4.5 - more frequent
replacement at

39
Q

Aortic aneurysm replacement

A

> 5.5 in all

>5.0 in marfans (>4.5 if other aortic surgery needed ie AVR)

40
Q

CLI

A

need revasc

41
Q

Cilastozol

A

contraindicated with HF (use pentoxaphyline)

42
Q

Takaysu Arteritis

A

Large vessel arteritis young woman
interarm BP diff
Aorta or primary branches (ie carotid, SC)

Tx: Glucocorticoids before thinking about surgery

Carotid - more mid and distal narrowing (as opposed to proximal in atherosclerosis)

43
Q

Giant cell arteritis

A

Large vessel - older patients >50yo
CVA, h/a, ocular sx, inflamm syndrome, jaw claudication, blindness

Tx: high dose steroids

Cardiology Boards (40 decks)

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