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Cardiovascular from PANCE Pearls Flashcards

(75 cards)

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1
Q

What is Angina

A

Substernal chest pain often brough on by exertion

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2
Q

What causes Angina

A

CAD
Coronary Artery Spasms
Pulmonary HTN
Hypertrophic Cardiomyopathy

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3
Q

What are risk factors for Angina

A

DM
Hyperlipidemia
HTN
Smoking

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4
Q

Sx of Angina

A

Substernal chest pain
May radiate to arm, lower jaw, back, shoulder
Short duration

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5
Q

Dx of Angina
Best non-invasive
Gold Standard

A

EKG: ST Depression with exertion, T wave inversion
Stress is best non-invasive screening
Coronary Angiograph is Gold Standard and Definitive dx

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6
Q

What is a Cath

A

Coronary Angiography

Outlines coronary artery anatomy, determines location and extent of CAD

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7
Q

What are indictions for PTCA (Percutaneous Transluminal Coronary Angioplasty) or PCI (Percutaneous Coronary Intervention

A

Used for 1 or 2 vessel disease not involving main left coronary artery + Normal or near normal left ventricular function

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8
Q

What are indications for CABG (Coronary Artery Bypass Graft)

A

Left main coronary artery disease
Sx 3 vessel disease
Left Ventricular EF

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9
Q

How does Nitroglycerin work

A

Increased myocardial blood supply, so increases oxygen and collateral blood flow
Decreases Demand which will reduce cardiac work and decrease preload

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10
Q

How do beta-blockers work

A

Increases myocardial blood supply
Decreases Demand
1st line drug for chronic management

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11
Q

How do Calcium Channel Blockers work

A

Increased myocardial blood supply
Decreases Demand
Used in patients not able to use beta-blockers

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12
Q

How does Aspirin work

A

Prevents platelet activation/aggregation

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13
Q

What is Acute Coronary Syndrome

A

Symptoms of acute MI due to acute plaque rupture and coronary artery thrombosis
Includes unstable angina, NSTEMI, and STEMI

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14
Q

What causes Acute Coronary Syndrome

A

Atherosclerosis caused by plaque rupture

Coronary artery vasospasms, usually due to cocaine, Prinzmetal’s variant angina

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15
Q

Sx of Acute Coronary Syndrome

A

Anginal Pain
Sympathetic stimulation: Anxiety, Diaphoresis, Tachycardia, N/V, Palpitations, Dizziness
Silent MI: atypical sx such a abdominal pain, dyspnea without chest pain

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16
Q

Dx of Acute Coronary Syndrome

A

EKG
Unstable Angina and NSTEMI: T wave inversion/ST Depression
STEMI: ST elevations

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17
Q

What does the location of Q waves or ST elevation tell you about where the MI occured

A

V1-V4: Anterior. Involves Left Anterior Descending
I, aVL, V5, V6: Lateral. Involves Cirucumfelx
I, aVL, V4, V5, V6: Anterolateral. Involves LAD or CFX
II, III, aVF: Inferior. Involves Right Coronary Artery
ST DEPRESSION in V1-V2: Posterior. Involves RCA, CFX

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18
Q

What are 2 main cardiac markers and what does the timing of their apperace mean

A

CK/CK-B: Peaks 12-24 hours, Baseline at 3-4 days

Troponin: Peaks 12-24 hours, Baseline 7-10 days

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19
Q

What is Prinzmetal’s Angina

A

Coronary Spasm that leads to transient ST elevations

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20
Q

Sx of Prinzmetal’s Angina

A

Ches pain at rest, usually in the mornings with hyperventilation, emotional stress or cold exposure. Not usually due to exertion

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21
Q

Dx of Prinzmetal’s Angina

A

EKG: Transient ST elevations (usually resolve wth CCB and NTG)
Angiography: No fixed stenosis seen

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22
Q

Tx of Prinzemtal’s Angina

A

CCB, NTG as needed

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23
Q

What is Heart Failure

A

Inability of the heart to pump sufficient blood to meet the metabolic deamns of the body at normal filling pressures

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24
Q

What causes Heart Failure

A

CAD

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25
What causes Left sided HF
CAD and HTN
26
What causes Right sided HF
Left sided HF | Pulmonary disease
27
What is the pathophysiology behind CHF
An insult leads to increased afterload, increased preload, decreased contractility Injured heart tries to make short term compensation tha promotes cardiovascular deterioration Sympathetic nervous system is activated, myocyte hypertrophy/remodeling, RAAS activation, fluid overload, ventricular remodeling
28
Sx of Left Sided HF
Increased venous pressure from fluid backing up into lungs Dyspnea, Orthopnea, Paroxysmal Nocturnal Dyspnea Pulmonary Cognestion: Rales, Rhonchi, pink frothy sputum HTN, Cheyne Stoke's Dusky pale skin, Diaphoresis
29
Sx of Right sided HF
Increased systemic venous pressure, see signs of systemic fluid retention Peripheral Edema Jugular Venous Distention Anorexia, N/V, Hepatosplenomegaly, RUQ tenderness, Hepatojugular Reflex
30
Dx of CHF
Echo: Can test Ejection Fraction CXR: Cephalization of flow, Kerley B lines, butterfly pattern, Cardiomegaly, Pleural Effusions Increased BNP (Ventricles release BNP during volume overload)
31
Tx of CHF
Ace-Inhibitors: 1st line. Decreased mortality Beta-Blockers: Decreased mortality Diuretics: Treats sx Digoxin: Treats sx
32
What are the meds that decreased mortality in CHF
Ace-I, ARB, Beta-Blocker, Nitrates, Some Diuretics (Hydralazine, Spironolactone)
33
What it the outpatient tx for CHF
Ace-I + Diuretic, eventually add Beta-Blocker | Implantable Cardioverter Defibrillator if EF
34
Hospital management of CHF
LMNOP | Lasix, Morphine, Nitrates, Oxygen, Position
35
What is Hypertensive Urgency
BP of 220/120 without end organ damage
36
Tx of Hypertensive Urgency
Reduced BP by 25% in first 24-48 hours using oral agents
37
What is Hypertensive Emergency
BP of 220/120 with acute end-organ damage | Encephalopathy, hemorrhage, Acute Coronary Syndrome, HF, Aortic Dissection, AKI, Proteinuria
38
Tx of Hypertensive Emergency
Reduce BP by 10% in the first hour then another 15% the next 2-3 hours using IV agents
39
What is Peripheral Arterial Disease
Atherosclerosis of the lower extremities
40
Sx of Peripheral Artery Disease
Intermittent Claudication: Pain/Discomfort with exercise/walking and relieved with rest Resting leg pain (advanced disease) Acute Arterial Embolism: Parasthesias, Pain, Pallor, Pulselessness, Paralysis, Poikilothermia, Livedo Reticularis (mottling with arteriolar occlusion) Gangrene, Ulcers
41
What will you see on physical exam with Peripheral Artery Disease
Decreased or absent pulses, Bruits Atrophic skin chanes (thin, shiny skin, hair loss, thickened nails) Pale on elevation, dusky red with dependency LATERAL malleolar Ulcers
42
Dx of Peripheral Artery Disease Screening Gold Standard
Ankle-Brachial Index is most useful screening Angiography: Gold standard Duplex Ultrasound
43
Tx of Peripheral Artery Disease
Platelet Inhibitors: Cilostazol, ASA, Plavix Revascularization: PTA, Bypass grafts, Endarterectomy Supportive: Foot care, Exercise Amputation if severe/grangrene
44
What is an Abdominal Aortic Aneurysm
Focal dilation of aortic diameter at least 1-1.5 times diamter measured at level of renal arteries >3.0cm is considered aneurysmal Usually occurs Infrarenally
45
What are risk factors for Anuerysms
``` Atherosclerosis Age >60yrs Smoking Caucasian Males Hyperlipidemia, DM, Marfan's ```
46
Sx of Aneurysm
Most are asymptomatic an are incidental findings Acute Leakage is rapidly fatal Severe back or abdominal pain, syncope, Hypotension, Pulsatile abdominal mass, Flank Ecchymosis Ripping chest pain = Thoracic Dissection
47
Dx of Aneurysm Initial test Gold Standard
Ultrasound is first test CT is test of choice for thoracic Angiogram is gold standard MRI/MRA
48
Tx of Aneurysm
3-4cm: Monitor via ultrasound every year 4-4.5cm: Monitor via ultrasound every 6 months >4.5cm: Vascular Surgeon Referral >5.5cm: Immediate surgical repair
49
What is an Aortic Dissection
A tear in the innermost layer of aorta (Intima)
50
What leads to an Aortic Dissection
Intimal wall tear leads to propagation of tear
51
Risk factors for Aortic Dissection
HTN, Age, Vasculitis, Trauma, Collagen Disorders
52
Sx of Aortic Dissection
Sudden onset of severe, tearing chest/back pain Variation in pulses between left and right arm HTN New Aortic Regurgitation
53
Dx of Aortic Dissection | Gold Standard
CXR: Wide mediastinum CT scan with contrast MRI Aniography is Gold Standard Trans Esophageal Echocardiography
54
Tx of Aortic Dissection
If in ascending: Surgery | If descending: Medical management with Labetalol
55
What is Giant Cell Arteritis
A vasculitis
56
What should you associate with Giant Cell Arteritis
Polymyalgia Rheumatica
57
Sx of Giant Cell Arteritis
New onset, unilateral tempral headache Jaw Claudication with Mastication Acute Vision changes (if not treated will lead to blindness!) Fatigue, weight loss, anorexia, fevers, night sweats
58
Dx of Giant Cell Arteritis
Increased ESR, Increased CRP | Temporal Artery Biopsy: See Mononuclear Lymphocyte Infiltration, Ultinucleated Giant Cells
59
Tx of Giant Cell Arteritis
High Dose Corticosteroids: 40-60mg/day x6 weeks | Methotrexate and Azathioprine
60
What is Superficial Thrombophlebitis
Inflammation of superficial vein and or thrombus | Associated with IV cath, Trauma, pregnancy, varicose veins
61
Sx of Superficial Thrombophlebitis
Local Phlebitis: Tenderness, pain, induration, edema, erythema along coure of superficial vein
62
Dx of Superficial Thrombophlebitis
Venous Duplex Ultrasound: Noncompressible vein with clot and vein wall thickening
63
Tx of Superficial Thrombophlebitis
Supportive: Elevation, Warm Compress, NSAIDS, compression Stockings If Aseptic: NSAIDS, Heparin, Warfarin Septic: IV Abx (Penicillin + Aminoglycosides) Phelebectomy if extensive
64
What is a Deep Venous Thrombosis
Most important consequence of PE
65
What are risk factors for DVT
Vrichow's Triad: Venous Stasis, Endothelial Damage, Hypercoagulability
66
Sx of DVT
Unilateral swelling/edema of lower extremity Calf Pain/Tenderness Homan's Sign: Calf Pain with dorsiflexion while knee is flexed Phlebitis: Local warmth, erythema, palpable cord
67
Dx of DVT
Venous Duplex Ultrasound: 1st line D-Dimer: Negative r/o DVT, Positive need more workup Venography: Gold Standard
68
Tx of DVT
Anticoagulation: UF Heparin, LMW Heparin, Warfarin | IVC Filter
69
What are Varicose Veins
Dilated, Tortuous Superficial Veins secondary to defective valve structure and function of superficial veisn
70
Sx of Varicose Veins
Often asymptomatic but cause cosmetic damage Dull ache or pressure sensation worse with prolonged standing and relieved with elevation VENOUS STASIS ULCERS: Severe varicosities resulting in skin ulceration
71
Tx of Varicose Veins
Conservative: Elevation, Compression Stockings, Avoid Prolonged Standing Sclerotherapy, Radiofrequency or laser ablation
72
What is Chronic Venous Insufficiency
Vascular incompetency of either deep and or superficial veins
73
Sx of Chronic Venous Insufficiency
Leg pain: Burning, Aching, Throbbing Pain worse with prolonged standing/sitting Improves with leg elevation or walking Leg edema, Stasis Dermatitis Brownish Hyperpigmentation Venous stasis ulcers are usually MEDIAL MALLEOLUS
74
Dx of Chronic Venous Insufficiency
Ankle/Brachial Index Trandelenburg Test: Slow filling at ankle suggests perforator competency Ultrasound
75
Tx of Chronic Venous Insufficiency
Elevation, Compression Stockings Ulcer Treatment: Wet to dry dressings, skin grafting, hyperbaric oxygen if severe, control edema Venous valve transplant

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