4-uWorld Flashcards
(16 cards)
Who meets criteria for revascularization peripheral arterial disease?
-Patient who fail exercise and medical therapy
-Disabling claudication prevents daily activities
-Acute limb ischemia i.e. ankle-brachial index around 2.5
What increases the likelihood of septic embolization in infective endocarditis?
> 10 mm
Not having started antibiotics
What is the medication therapy for PAD
Aspirin (More efficacious when used with dipyridamole)
-Reduces PAD surgery
Plavix: Alternate to aspirin, more efficacious
-Reduces PAD progression
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IF Symptoms still persist, And antiplatelet does not help symptoms:
Cilostazol:1st-line for claudication/Symptom relief
Arterial vasodilator and platelet aggregation inhibitor
Improves cramping symptoms thus allowing for greater walking distance
Contraindicated in CHF
Pentoxyfilline-2nd lind For claudication/Symptom relief
Improved claudication symptoms
What lifestyle changes are used for helping PAD claudication symptoms
Smoking cessation
Graded exercise therapy
Additionally it is reasonable to add medication therapy
In infective endocarditis, Once antibiotics are started, this happens to the risk of septic embolization___
Risk of septic embolization decreases!
Your patient just had a infective endocarditis vegetation–7 mm embolize, he has a new acute infarct on the left frontal lobe, this is an indication for surgical intervention yet?
It must be >10 mm in the setting of prior systemic embolic event
In this case no, No surgical intervention
Which complication of infective endocarditis has a greatest mortality rate?
I.e. it should be followed with early surgical intervention
Acute heart failure sign
What is not the cause of cor pulmonale?
Left-sided heart failure or disorders
Congenital heart disease
What is typically the cause of cor pulmonale?
Lung disease or chest wall disease
What kind of procedures are considered high bleed risk***
Open heart surgery
Abdominal vascular surgery
Intracranial or spinal surgery
Major cancer surgery
Urological surgery
What kind of procedures is considered low bleed risk?
Left heart cath
Arthrocentesis
Outpatient dental surgery
Cataract surgery
Excision skin biopsy
Minor outpatient procedures
You have patient who has a mechanical valve on warfarin, what should be done about the warfarin if they are about to go through a minor risk procedure?
Continue the warfarin, no holding, no INR waiting, no heparin bridging
name the complications of a left heart cath
What is the diagnostic imaging of choice to work this up if you suspect some kind of complication?
Retroperitoneal hematoma or hemorrhage
Arterial dissection
Arterial thrombosis
Arterial pseudoaneurysm
Formation of AV fistula
Doppler ultrasound to assess for hematoma or pseudoaneurysm, presence of pulsatile mass with systolic bruit over mass
What are the complications of pseudoaneurysm that could result from left heart cath?
The pseudoaneurysm is at a risk for expansion and rupture
What is an indication to percutaneous mitral balloon valvulotomy?
Very severe mitral stenosis with either the following
Symptomatic: Orthopnea, dyspnea
Pulmonary hypertension i.e. PA systolic pressure >50 mmHg
Contraindications to percutaneous mitral balloon valvulotomy
moderate to severe mitral regurgitation-(Not used for MR, valvulotomy is for MS!!!!)
Valve calcification very extensive
Left atrial thrombus
