Cardiovascular

Question 1

What is an aortic dissection?

Answer 1

Sudden “ripping” or “tearing” CP radiating to back

• older, history of HTN, smoking, Marfan syndrome
• PE will show asymmetric pulses/BP, CXR = widened mediastinum

Question 2

How do you dx an aortic dissection?

Answer 2

CT or transesophageal echocardiogram

Question 3

What is the tx for an aortic dissection?

Answer 3

reducing BP, surgery

Question 4

What is an aortic aneurysm?

Answer 4

flank pain, hypotension, pulsatile abdominal mass

Question 5

What is the screening for an aortic aneurysm?

Answer 5

ultrasound, if male >65 and ever a smoker

Question 6

What is the tx for an aortic aneurysm?

Answer 6

• immediate surgical repair (even if asymptomic) if >5.5 cm or expands >0.6 cm per year
• monitor annually if > 3 cm, monitor every 6 months if > 4 cm
• beta-blocker

Question 7

What is an arterial embolism/thrombosis?

Answer 7

caused by a sudden arterial occlusion

• The P’s of arterial embolis: Pain, Pallor, Pulselessnes, Paresthesia, Paralysis, Poikilothermia
• atrial fibrillation and mitral stensosi are common causes of thrombus formation
• angiograhpy is considered the gold standard for diagnosis
• acute arterial occlusion: treat with IV heparin if not limb threatening then call the vascular surgeon for angioplasty, graft or endarterectomy

Question 8

What is arterial/venous ulcer disease?

Answer 8

edema, atrophic shiny skin, brawny induration, stasis dermatitis, brown hyperpigmentation, varicosities, ulcers above the medial malleolus
-ABI, trendelenburg tests, ultrasound

Question 9

What is the tx for arterial/venous ulcer disease?

Answer 9

sclerotherapy, vein stripping, compression hose

Question 10

What is stable angina?

Answer 10

predictable, relieved by rest and/or nitroglycerine

Question 11

What is unstable angina?

Answer 11

previously stable and predictable symptoms of angina that are more frequent, increasing or present at rest

Question 12

What is prinzmetal variant angina?

Answer 12

coronary artery vasospasms causing transient ST-segmetn elevations, not assocaited with clot

Question 13

What is claudication?

Answer 13

reduction in blood flow to the leg muscles, most commonly be an atherosclerotic plaque

• pain in the leg with walking
• relieved within a few minutes of rest
• reproducible a the same walking distance each time

Question 14

What is PAD?

Answer 14

defined as an ABI <0.9

• the ABI confirms the diagnose of PAD
• normal ABI 1.2 -1.0
• mild disease 0.9 - 0.7
• moderate disease 0.7-.04
• severe disease/rest pain <0.4

Question 15

How is PAD/PVD dx?

Answer 15

angiography is considered the gold standard for diagnosing

Question 16

What are the treatment options for PAD/PVD?

Answer 16

• Platelet inhibits: cilostazol, aspirin, clopidogrel
• treat lipids - statins
• revascularization with PTA, bypass grafts, stenting
• exercise - walking to the point of claudication
• beta blockers are contraindicated in isolated PAD - it will worsen claudication
• Treatment options for sever PVD
  1. surgical craft bypass
  2. angioplasty - balloon dilation
  3. endarterectomy - remove disease intima and media
  4. surgical patch angioplasty (place patch over stenosis)

Question 17

What are examples of arrhythmia?

Answer 17

atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardia

Question 18

What is the hx with arrhythmias?

Answer 18

palpitations, syncope

Question 19

What is the PE of arrhythmias?

Answer 19

irregular rhythm, pauses

Question 20

How are arrhythmias dx?

Answer 20

ECG, event recorder, holter monitor, stress testing

Question 21

What are examples of myocardial?

Answer 21

cardiomyopathies, coronary ischemia

Question 22

What is the hx of myocardial?

Answer 22

depose on extertion, paroxysmal nocturnal dyspnea, orthopnea, chest pain or tightness, prior coronary artery disease or atrial fibrillation

Question 23

What is the PE of myocardial?

Answer 23

Edema, JVD, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S4

Question 24

How is myocardial dx?

Answer 24

ECG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography

Question 25

What are examples of restrictive?

Answer 25

constrictive pericarditis, pericardial effusion/tamponade

Question 26

What is the hx of restrictive?

Answer 26

chest pain, dyspnea

Question 27

What is the PE of restrictive?

Answer 27

paradoxical pulse (exaggerated variation in blood pressure with respiration)

Question 28

How is restrictive dx?

Answer 28

EKG showing low voltage QRS along with electric alternates (see media section), echocardiogram with increased pericardial fluid, radiograph: water bottle heart

Question 29

What are examples of valvular?

Answer 29

aortic insufficiency/stenosis, congenital heart disease, mitral valve insufficiency/stenosis

Question 30

What is the hx of valvular?

Answer 30

dyspnea on exertion

Question 31

What is the PE of valvular?

Answer 31

Murmur, JVD

Question 32

How is valvular dx?

Answer 32

echocardiography

Question 33

What is peripheral arterial disease?

Answer 33

intermittent claudication, ankle-brachial-index <0.9

• lower extremity loss of hair, brittle nails, pallor, cyanosis, claudication, hypothermia
• ulcers are pale to black, well circumscribed and painful, located laterally and distally
• anteriography is the gold standard for diagnosis

Question 34

What is the tx for peripheral arterial disease?

Answer 34

• definitive treatment: arterial bypass

- medical treatment: antiplatelets, anti lipids, manage risk factors, cilostazol aspirin, plavix

Question 35

What is structural cardio-pulmonary?

Answer 35

• aortic stenosis - angina, syncope, and CHF- 3 years life expectancy if left untreated (if experiencing syncope)
• cardiomyopathy - HOCM (young athletes with a positive family history has sudden death or syncopal episode)
• pulmonary hypertension
• acute MI

Question 36

What is pericarditis?

Answer 36

chest pain that is relieved by sitting and/or leaning forward
-pericardial friction rub heard best with patient upright and leaning forward

Question 37

What is orthostatic hypotension?

Answer 37

drug-induced, volume depletion, cariogenic shock

Question 38

What is cardiac arrhythmia?

Answer 38

Brady (sick sinus, AV block), tachycardia (SVT, VT), prolonged QT

Question 39

What is vasovagal?

Answer 39

a drop in pressure with a sudden slowing of the heart

-this type of syncope is often triggered by pain or emotional shock

Question 40

What is subclavian steal syndrome?

Answer 40

arm pain and syncope with use of the left arm

Question 41

What is presentation of varicose veins?

Answer 41

dilated tortuous superficial veins, venous stasis ulcers, ankle edema, lower extremity pain after sitting/standing

Question 42

What is the tx of varicose veins?

Answer 42

leg elevation and compression stockings