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Cardiology Boards > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

Signs / symptoms of chronic limb ischemia

A 
Rest pain
Ischemic ulcers
Gangrene
Elevation pallor
Dependent rubor
Sx > 2 weeks
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2
Q

Thromboangiitis Obliterans (Buerger’s Disease) features

A 
Age < 40
Smoker
M > F
Distal and proximal arteries and veins
Superficial thrombophlebitis
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3
Q

Treatment for thromboangiitis obliterans

A

Smoking cessation

Iloprost for pain

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4
Q

ABI calculation

A

Highest ankle pressure / highest brachial systolic pressure

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5
Q

Normal ABI

A

1 - 1.4

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6
Q

Abnormal ABI

A

<0.9

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7
Q

Borderline ABI

A

0.91 - 0.99

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8
Q

Non-compressible ABI

A

> 1.4

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9
Q

Exercise ABI for symptomatic patients indicated for

A

Borderline or normal ABI

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10
Q

Positive exercise ABI

A

Decrease in ABI by 20%

Decrease in ankle pressure > 30 mm Hg

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11
Q

TASC classification for aorta-iliac and femoral-popliteal PAD A

A

Short focal stenosis or occlusion

Endovascular

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12
Q

TASC classification for aorta-iliac and femoral-popliteal PAD B treatment

A

Endovascular repair

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13
Q

TASC classification for aorta-iliac and femoral-popliteal PAD C treatment

A

Surgery unless high risk

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14
Q

TASC classification for aorta-iliac and femoral-popliteal PAD D

A

Long stenosis or occlusion

Surgery

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15
Q

Indications for intervention for stable PAD

A

Lifestyle limiting symptoms +
Inadequate response to exercise and OMT or
favorable risk benefit ratio

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16
Q

Chronic critical limb ischemia treatment

A

<2 year survival -> balloon

>2 year survival -> bypass

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17
Q

Acute limb ischemia features

A 
Pain
Pulselessness
Pallor
Parasthesias
Poikylothermia
Paralysis
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18
Q

Acute limb ischemia duration

A

<2 weeks after symptom onset

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19
Q

Acute limb ischemia causes

A

Embolism
Thromobis
Dissection
Trauma

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20
Q

Acute limb ischemia stage 1

A

Viable

+ Doppler

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21
Q

ALI stage 2a

A

Salvageable
+/- Doppler
+/- Sensory loss

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22
Q

ALI stage 2b

A

Threatened
No doppler
Paresthesias
Muscle weaknes

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23
Q

ALI stage 3

A 
Non-viable
No doppler
Profound sensory loss
Paralysis
-> Amputation
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24
Q

ALI treatment

A

Endovascular < 2 weeks (Cather lyrics +/- device)

Surgical if > 2 weeks

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25
Q

Lytics contraindicated:

A

Recent surgery
Intracranial neoplasm / injury
Bleeding risk
Infected graft

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26
Q

Who to screen with US for AAA

A

Physical exam features of enlarged aorta, atheroembolism, peripheral aneurysm
1st deg FH in men > 60
Men smoking hx 65-75
Symptomatic PAD

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27
Q

Surveillance for AAA with US or CTA < 4 cm

A

3 years

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28
Q

Surveillance for AAA with US or CTA 4-4.9 cm

A

12 months

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29
Q

Surveillance for AAA with US or CTA 5-5.4 cm

A

6 months

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30
Q

Indications for AAA surgery

A 
Diameter > 5.5 cm
Expansion > 1 cm in 1yr
Symptomatic
Rupture / contained rupture
Infectious or inflammatory
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31
Q

Endoleak 1 from AAA EVAR

A

Leak at graft attachment

Need to fix

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32
Q

Endoleak 2 from AAA EVAR

A

Retrograde flow from collateral arteries

May resolve on follow-up imaging

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33
Q

Endoleak 3 from AAA EVAR

A

Leak in endograft components

Need to fix

34
Q

Genetic causes of TAA

A 
Marfan
Loeys-Dietz
Ehlers-Danlos
BAV
Familial non-syndromic
35
Q

Acquired causes of TAA

A 
GCA
Takayasu
Infectious 
HTN
Toxic 
Idiopathic
36
Q

TAA preventive repair cut-off for Turner’s

A

Aortic index >= 2.5

37
Q

TAA preventive repair cut-off for Loeys-Dietz

A

> 4.0 cm

38
Q

TAA preventive repair cut-off for Marfan’s

A

> = 5.0

39
Q

TAA preventive repair cut-off for BAV

A

> 5.5

40
Q

High risk features for TAA when considering repair

A

FH or personal history of dissection
Rapid enlargement
Planned pregnancy

41
Q

Intramural hematoma

A

Hematoma in medial layer of aortic wall
May cause dissection
Manage like dissection

42
Q

Penetrating aortic ulcer

A

Aortic plaque becomes ulcerated

Usually descending aorta

43
Q

Management of penetrating aortic ulcer

A

HTN, anti-platelet, statins
Surveillance imaging
Surgery

44
Q

Surgical indications for penetrating aortic ulcer

A

Ascending aorta
Persistent symptoms
True or pseudo-aneurysm formation
Aorta > 5.5 cm

45
Q

Suspect carotid dissection

A

CVA preceded by neck pain or Horner’s syndrome

46
Q

4Ts for HIT assessment

A

Thrombocytopenia >50% fall, nadir 20-100
Timing 5-10 days or <1 day with prior heparin
New thrombosis, skin necrosis
No other causes

47
Q

Duration for provoked PE

A

3 months

48
Q

Duration for unprovoked PE

A

Lifelong

49
Q

Definition of unstable. massive PE

A

Shock / hypotension with SBP < 90 or >= 40 drop for >= 15 minutes

50
Q

Treatment for massive PE

A

Lytics, catheter directed therapy, surgical therapy

51
Q

Contraindications to thrombolytics

A

Brain pathology, bleeding risk

52
Q

Submassive PE definition

A

RV dysfunction or positive cardiac markers

53
Q

APLS classification criteria

A

Clinical event - thrombosis, thrombocytopenia, fetal loss, valve destruction, skin ulceration
Lab testing - anticardiolipin, b2gp1, lupus anticoagulant

54
Q

Definitive APLS criteria

A

> = 1 clinical + >=1 lab

Labs must persist at 3 months

55
Q

Treatment for APLS

A

Heparin -> warfarin

56
Q

Lymphedema causes

A

Congenital
Cancer or related surgery / radiation
Recurrent infection

57
Q

Lymphedema features

A

Waxy skin
Non-painful
Non-dependent edema

58
Q

Treatment for lymphedema

A

Compression
Manual drainage
Intermittent pneumatic pumping

59
Q

Indications for tPA for acute ischemic stroke

A

Within 4.5 hours of symptoms

NIHSS >= 6

60
Q

Contraindications to tPA for acute ischemic stroke

A 
Intracerebral hemorrhage, recent GIB
<3 months stroke, head trauma, brain / spine surgery
Brain / spine tumor
PLT < 100, INR > 1.7
Anticoagulation
Endocarditis
Aortic dissection
61
Q

Window for mechanical thrombectomy for acute ischemic stroke

A

Early window up to 6 hours

Up to 24 hours with perfusion imaging

62
Q

Indication for mechanical thrombectomy for acute ischemic stroke

A

Large occlusion in anterior circulation

63
Q

Goal BP for tPA

A

<185 / 110

64
Q

Therapy for stroke NIHSS <= 3

A

DAPT within 24 hours for 21 days

65
Q

US carotid stenosis >= 50%

A

Peak systolic velocity >= 125

ICA / CCA 2-4

66
Q

US carotid stenosis >= 70%

A

Peak vel >= 230

ICA / CCA >= 4

67
Q

Carotid stenosis symptoms

A

Within 6 months
Ipsilateral amaurosis fugax
Contralateral motor / sensory symptoms
Aphasia

68
Q

Carotid stenosis revasc

A

50-99% if symptoms
Unclear if asymptomatic
Not CTOs
CEA > CAS

69
Q

Medical therapy for asymptomatic carotid stenosis

A

ASA
Statin
Anti-HTN

70
Q

Medical therapy for symptomatic carotid stenosis

A

ASA or plavix or ASA + dipyridamole

71
Q

Contraindication to CEA to know

A

Contralateral laryngeal nerve palsy

72
Q

Carotid dissection features

A
  • Middle aged, spontaneous or traumatic
  • Pain, Horner’s, ischemic symptoms
  • No RCTs of intervention but treat medically
  • Anticoagulation or anti platelet therapy (non-inferior)
73
Q

Carotid FMD features

A
  • 2nd most common location
  • Association with SCAD
  • Pulsatile tinnitus, HA, TIA /s troke
  • May cause dissection
  • Antiplatelet therapy and BP control, rarely intervene
74
Q

US for renal artery stenosis

A

Peak systolic velocity > 300

75
Q

Diagnosis of renovascular hypertension

A
  • New increase in BP
  • Failure medical therapy
  • Increased Cr after ACE-I
  • Progressive increase in Cr with ischemic neuropathy
  • FMD in young woman
  • Recurrent flash pulmonary edema / refractory CHF
76
Q

Treatment of renal artery stenosis

A

Stenting for postal atheromatous disease if renovascular hypertension

77
Q

Stage I PAD

A

Viable

limb not immediately threatened, no sensory loss, no muscle weakness, audible arterial and venous

78
Q

Stage II PAD

A

Threatened

mild to moderate sensory or motor loss, inaudible arterial Doppler, audible venous Doppler.

79
Q

Stage III PAD

A

non viable

  • major tissue loss or permanent nerve damage inevitable, profound sensory loss, anesthetic,
  • profound muscle weakness or paralysis (rigor), inaudible arterial and venous Doppler.
80
Q

May Thurner Syndrome

A

Iliofemoral DVT due to R common iliac overlying and compressing left common iliac vein against lumbar spine

81
Q

Preferred anti-platelet for stroke secondary prevention

A

Plavix

82
Q

Rapid VKA reversal

A

4F PCCs
1000u for any bleed
1500u for intracranial bleed
INR 2-4 25 U/kg, 4-6 35 U/kg, >6 50 U/kg

Cardiology Boards (11 decks)

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