Vascular disorders/diseases Flashcards
12, 13, 14, 15, 16, 17, 44, 45, 46
What is the most common side effect of the nitrate products?
headache. (due to cerebral vasodilation)
high doses can cause postural hypotension, facial flush, tachycardia
True/False. Vessels can develop tolerance to nitrate products?
True, develops rapidly and become desensitized. Need to provide a daily 8-12 hour “nitrate-free” interval to restore sensitivity.
Why are nitrate products used in the treatment of angina pectoris?
cause a rapid reduction in myocardial oxygen demand, which will rapidly relieve symptoms. They do this by inhibiting the coronary vasoconstriction or spasm, which increases perfusion (decrease preload and oxygen consumption)
What is the route of administration of nitroglycerin?
Sublinquinal or transdermal, due to significant first pass metabolism at the liver
True/False - Nitroglycerin does not relieve symptoms of Typical Angina.
False - one of the definitions of typical angina is that it is relieved by rest or nitroglycerin. If it does not relieve symptoms, then it could be atypical or non cardiac.
How quickly does nitro provide relief of symptoms?
75% of patients have pain relief within 3 minutes
If symptoms don’t improve with nitro within 5 minutes, what is the next plan of action?
Emergency medical services should be contacted and continue to take additional SL tablets (1 every 5 minutes for total of 3 tabs) until EMS arrives
What medications are contraindicated with nitro?
PDE-5 inhibitors (viagra, etc:))
What is the first line drug for chronic stable angina?
beta-blocker
What effect do beta-blockers have on myocardial oxygen demand?
REDUCE IT. Decrease heart rate due to reflex tachycardia, BP, and myocardial contractility
Beta-blockers are contraindicated in what?
vasospastic angina (due to unopposed alpha stimulation)
What are the cardioselective (preferred) beta-blockers?
metoprolol, atenolol
Can beta-blockers be used in combination with nitrates and calcium-channel blockers?
yes, can be used a mono therapy or later with the others if symptoms don’t improve
Which medication type is first line for vasospastic angina, and 2nd line for chronic stable angina?
calcium-channel blockers
Which type of calcium channel blocker can be used in combination with beta-blockers?
Dihydropyridines (amplodipine, nifedipine, felodipine).
Non-dihydropyridines cannot be given because they are negative inoptropes and can be harmful in heart failure if ejection fraction is less than 35%
When is a 325mg ASA indicated?
Only in patients who cannot take Warfarin if they have Afib, or acutely when having coronary event, but never chronically besides that.
A patient with a history of Afib presents with sudden onset of the 5 P’s: Pain, pallor, paresthesias, pulselessness, and paralysis” of the lower extremity. Is this an emergency?
Yes! Symptoms of an acute arterial occlusion!
As soon as the diagnosis of an acute arterial occlusion is made, what is the immediate first step for treatment?
IV heparin! Helps keep the clot from propagating and also helps with pain symptoms
A patient complains of a brief moments of confusion, dizziness, and headache. On physical exam you find bruits in the mid-cervical area, what is the likely diagnosis?
Occlusive cerebrovascular disease (TIA). a 1/3 of all stokes are arterial
Patient complains of severe abdominal pain after eating meals and as a result has lost 10 pounds by avoiding meals due to the pain. No PE findings. What is likely diagnosis?
Mesenteric Insufficiency aka “intestinal angina”
52 year old man, 20 pack year of smoking complains of severe cramping pain in his right calf when walking. He sits down and the pain goes away. On PE his distal right pulse is weak/absent. What is his likely diagnosis?
Occlusive disease of the common iliac artery.
Tell the guy to quit smoking!
32 year old man with a 15 year pack year history presents with lesions on the tips of his toes and pain in the toes at rest. On PE his feet are cold, prolonged cap refill and dependent rubor are noted. What is likely diagnosis?
Thromboangitis Obliterans “Buerger Diease”
He has to quit smoking or you’re amputating that baby!
Patient presents with a dull ache in her right half, no edema, no discoloration. States she just got home from a 12 hour flight last night and has been on oral contraceptives for 8 years. Whats her likely diagnosis?
DVT - order Doppler!
What is the difference in presentation between chronic venous insufficiency and a varicose vein that is deep to the skin?
Both can have a brownish pigmentation of the skin. But the chronic insufficiency will have obvious pitting edema and probably large ulcerations around the ankle. The skin will also be taut and shiny.
You work in a hospital and a patient is complaining of pain near their PICC line site and you notice a red, linear induration coming off the insertion site. What are you worried about?
Superficial Venous Thrombophlebitis
