cardiology III

Question 1

Acute Arterial occlusions: Cerebrovascular
90% emboli originate proximal internal carotid artery
Bruits heard at mid neck

Answer 1

Cerebrovascular occlusion: sudden weakness, numbness, aphasia, unilateral vision loss.
Duplex US -test of choice
CTA or MRA

Question 2

Cerebrovascular Dz. - Carotid Stenosis
> 50% stenosis in symptomatic pt.
-80% stenosis in asymptomatic pt.
30-50% stenosis requires surveillance & reduce risk factors

Answer 2

Cerebrovascular Dz. Trmt:
Carotid Endarectomy- open carotid & take out clot
risk: senory or cranial nerve injury
        post op neck hematoma
Carotid Angioplasty - stenting

Question 3

Visceral Artery Insufficiency: Intestinal agina

Post prandial pain, weight loss due to fear of eating

Answer 3

Visceral artery insufficiency trmt: Abdominal US

Question 4

Acute Mesenteric Ischemia: males > 70 yrs

ischemic colitis

Answer 4

Trmt: abdominal US

Question 5

Giant Cell Arteritis: headache, scalp tenderness, amourosis fugax, diplopia, jaw claudication, throat pain.
Nodular temoporal artery
Anterior ischemic optis neuropathy -> blindness

Answer 5

Giant Cell Diagnostics: ESR> 50, elevated ALK PHOS
Temporal Artery Biopsy
TRMT: Prednisone 60 mg/day PO x 1 month

Question 6

Peripheral Arterial Disease: occlusive atherosclerotic lesions in extremties.
Sxs: claudication, foot pain relieved by dependncy
pain, numbness in foot w/ walking, painful lateral ulceration and gangrene of toes, pallor w/elevation, absent pedal pulses, cool, atrophic, hairless extremity.

Answer 6

Males, smoking, hypertension, diabetes mellitus, Claudication

Question 7

Peripheral Arterial Dz: AORTA-ILLIAC
claudication relieved w/rest, weakness in legs, limb fatigue, weak pulses, aorta-femoral-iliac bruits.
Sxs: claudication relieved w/ rest, leg weakness, femoral distal pulse weak or absent, aorta, femoral, illiac bruits. Lesions extend pain into thighs & buttocks.

Answer 7

Peripheral - aorta/iliac: ABI

Question 8

Peripheral arterial Dz:FEMORAL-POPLITEAL behindknee
Intermittent short distance claudication, foot pain at rest relieved w/dependency, rubor of foot w/blanching upon elevation, loss of hair, thin skin, muscle atrophy, foot - round ulcers. reduced pulses.

Answer 8

Peripherial-Femoral: ABI

Question 9

Peripheral Arterial Dz TIBIAL (behind foot)
may have claudication, severe rest pain in forefoot relieved by dependency, pain,numbness w/walking,
ulceration, of toes, pallor w/elevation, absent pedal pulses, cool atrophic hairless.

Answer 9

Peripheral - Tibial: ABI

Question 10

Phlebitis/thrombophlebitis: superficial viens irration/infection - saphenous most common. catheter site, varicose vein, thromboangiitis obliterans.
Sxs: induration, redness, tenderness, palpable cord, edema, fever, chills, pain.

Answer 10

Phlebitis/Thrombophlebitis trmt: apply heat, Nsaids, vein ligation, helparin to limit additional thrombus, IV ABX, surgical excision.

Question 11

Varicose veins: dilated tortuous veins. Pregnancy, FmHx, prolong standing. Incompetent valves.
Sxs: dull, achy, heaviness, fatigue, brownish pigmentation.

Answer 11

Duplex US

Trmt: compression stockings, elevation, radiofrequency albation, sclerotherapy.

Question 12

Deep Venous Thrombosis: unilateral leg pain, tenderness, pain w/dorsiflexion, increased circumference >3cm.
virchows triad:stasis,vascular injury,hypercoagulable.

Answer 12

DVT: Duplex US -test of choice, Spiral CT
Treatment: Anticoagulation, IVC Filter, LMWH: Lovenox
unfractionated for pts w/kidney dz. Warfarin.
Heparin until INR > 2.0 INR 2.0-3.0 Q 6 wks.

Question 13

Chronic Venous Insufficiency: inadequate valve leaflets, scarred, thickened, dilated vein. causes high hydrostatic force.
Sxs: pronounced edema, brown pigmentation, dermatitis, induration, varicosities,
painless medial ulceration: large, weepy, stinky, lateral ulcers, wet, painless.

Answer 13

Mgmt: bed rest, elevation, graded compression stockings, exercise, wet saline compresses for weepy stasis dermatitis, Unna boot, Ace wrap, hyperbaric chamber for wound trmt.

Question 14

Syncope: transient loss of consciousness.
Sxs: nausea, diaphoresis, tachycardia, pallor.
Enhanced vasovagal response:
Impaired vasoconstrictive response > 20 mmHg decline in BP
Cardiogenic: bradycardia, tachycardia, afib, vtach

Answer 14

EKG: ambulatory monitoring, BP - HR observation, Electrophysiology- structural heart dz.

Trmt: avoid predisposing situations,
betablockers, therapy -arrhythmias, pacing, volume expanders.