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Yr 5 Cardiology > Emergencies > Flashcards

Emergencies Flashcards

1
Q

How do aneurysms occur?

A

Progressive, permenant dilatation
>50% of its original diameter
True aneurysm= all layers of arterial wall

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2
Q

What are the different types of aneurysms?

A

Fusiform: AAA

Sac like: Berry aneurysm

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3
Q

Where are common sites for aneurysms?

A

Aorta
Iliac
Femoral
Popliteal

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4
Q

What size constitutes a AAA?

A

Abdominal aorta >3cm

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5
Q

What are risk factors for an aneurysm?

A 
Heart disease
HTN
>50yo
Male
Smoking
hyperlipidaemia
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6
Q

How do AAA present?

A

Asymptomatic
Abdo pain radiates to back/groin/iliac fossa
Expansile, pulsatile abdo mass
RUPTURE: Acutely unwell, Drowsy, confused, ↓GCS, syncope, shock, ↓BP and absent leg pulse

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7
Q

How is a AAA investigated?

A

Urgent USS: <5.5cm + unruptured = USS screening
Bloods: FBC, Clotting, U&E, LFTs, G&S/CM, ESR
AXR: Loss of psoas shadow & dilated abdominal aorta

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8
Q

How is a AAA managed?

A

Watch & wait
USS Screening: 3-4.4cm = annually, 4.5-5.4cm = 3monthly
>5.5cm/Sx/>1cm growth per year = elective surgery (EVAR)
Rupture = immediate repair

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9
Q

How does an aortic dissection occur?

A

Intramural bleeding → disruption of medial layer of aortic wall creating a false lumen and true lumen

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10
Q

Where are aortic dissections usually found?

A

Ascending aorta

Aortic arch

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11
Q

What are the risk factors for aortic dissection?

A 
Male
50-70
HTN
Smoker
Cardiac surgery
Drug abuse
Trauma
CT: Marfan's, Ehler's Danlos
Genetic: Turners, Noonan's
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12
Q

How does an aortic dissection present?

A

Sudden onset tearing chest pain radiating to back
Unequal radial pulses (indicates forward tear)
Dyspnoea/syncope
Murmur-Aortic regurg
Pleural effusion

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13
Q

How is aortic dissection classified?

A

Stanford=
Type A: ↑aorta +/- arch & ↓aorta - 70%
Type B: No ↑aorta. Involves the ↓thoracic (distal to L subclavian artery) and/or abdominal aorta.
OR
DeBakey=
Type 1: Originates in ↑aorta, involves the aortic arch +/-↓thoracic aorta.
Type 2: Just ↑aorta
Type 3: Distal to L subclavian artery, extends through the thoracic aorta (3A) or extends beyond the visceral segment (3B).

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14
Q

How is an aortic dissection investigated?

A

CT ANGIO = DIAGNOSTIC
CXR
ECG: LV ischaemia
ECHO (TOE): Aortic root leak/effusion/regurg

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15
Q

What can be seen on a CXR of someone with an aortic dissection?

A

Widened mediastinum
Double knuckle aorta
Tracheal deviation (away)
Pleural effusion (L>R)

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16
Q

How is aortic dissection treated?

A

IV access + analgesia
Crossmatch 10u of blood
Maintain sBP 100-120 w/Labetalol or Esmolol
Surgery (usually Type A): Stent or graft

17
Q

What are the complications of an aortic dissection?

A

Paraplegia: Anterior spinal artery loses blood supply from aorta
Pericardial tamponade
MI: Backwards tear = Inf MI
Renal/mesenteric/limb ischaemia

18
Q

What are the causes of a tamponade?

A 
Pericarditis
Dissection
Haemodialysis
Warfarin
Trans-septal puncture
Trauma- bleed into pericardial space
19
Q

What is Beck’s triad?

A 
Seen in tamponade
↑JVP, muffled heart sounds + hypotension (despite fluid resus)
Other signs:
Pulsus parodoxus
Kussmaul sign (related to JVP)
20
Q

How is tamponade treated?

A

Pericardiocentesis

21
Q

What is SVCO?

A

Tumour encroaches & obstructs SVC

22
Q

What are the causes of SVCO?

A 
Malignancy >90%
Goitre
Mediastinal fibrosis
Infection (TB)
AA
Idiopathic
23
Q

What cancers can cause SVCO?

A 
Lung 75%
Mediastinal lymphoma 
Oesophageal Ca
Germ cell tumours
Thymoma (?Myasthenia)
24
Q

How does SVCO present?

A 
Dyspnoea + Cough ± Stridor
Headache worse on coughing
Facial oedema
Distended neck &amp; chest veins + ↑JVP 
Cyanosis (facial)
Hoarse voice
Visual disturbance
Pemberton's test +ve
25
Q

How is SVCO investigated?

A

URGENT CXR- look for mass

Contrast CT thorax

26
Q

What signs will be seen on a +ve Pemberton’s test?

A

Facial cyanosis/ plethora
↑JVP
Stridor

27
Q

How is SVCO managed?

A

Dex 16mg w/PPI
Balloon venoplasty + SVC STENT
Tx cause- Chemo/RT

28
Q

What is the prognosis with SVCO?

A

Depends on cause
GOOD = SCC
POOR = Mesothelioma

29
Q

Where is acute mesenteric ischaemia most commonly found?

A

Small bowel following superior mesenteric artery/vein thrombus

30
Q

What are the risk factors for acute mesenteric ischaemia?

A 
↑age
AF
Emboli RF's
CV RF's
Cocaine use
31
Q

How does acute mesenteric ischaemia present?

A 
Acute severe tender abdo (central + constant)
Soft abdomen w/no signs
Rapid hypoV (SHOCK)
Fever
32
Q

How is acute mesenteric ischaemia investigated?

A

MESENTERIC ANGIO or CT/MRI = DIAGNOSTIC (also for chronic mesenteric ischaemia)
Bloods: ↑Hb (plasma loss), ↑WCC
ABG: Persistent metabolic lactic acidosis
AXR: Gasless abdomen

33
Q

How is acute mesenteric ischaemia managed?

A

IV Fluid resus- ASAP!
Abx: Met + Gent
LMWH
Surgery: Urgent to remove necrotic bowel

34
Q

What are the complications of acute mesenteric ischaemia?

A

Septic peritonitis: Rebound tenderness + guarding

35
Q

How does chronic mesenteric ischaemia present?

A

AKA intestinal angina
Post-prandial colicky pain
Weight loss
Upper GI bruits +/- PR bleed +/- malabsorption

36
Q

How is chronic mesenteric ischaemia managed?

A

Surgery

Percutaneous transluminal angioplasty

37
Q

How does ischaemic colitis present?

A

Post-prandial abdo pain
N&V
AXR shows thumb-printing
Hx of CVD/MI/AF/HTN

38
Q

How does a patient with AF typically present when considering acute mesenteric ischaemia?

A 
AF w/acute tender painful abdo
Soft on exam
Lactic acidosis
HypoV
Hx of CVD
Degree of illness out of proportion to exam findings

Yr 5 Cardiology (8 decks)

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