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Myocarditis/Cardiomyopathy/Endocarditis > Foundation-Vascular > Flashcards

Foundation-Vascular Flashcards

(70 cards)

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1
Q

What is the most common location of aortic aneurysm

A

AAA=infrarenal abdominal aorta

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2
Q

What is TAA generally caused by?

A

Cystic medial necrosis

–>Familial TAA

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3
Q

What is the triad of a ruptured AAA (diagnostic)

A
  1. Hypotension
  2. Back or abdominal pain
  3. Pulsatile abdominal mass
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4
Q

What is diagnostic of TAA (ascending thoracic aorta)

A

Pressure on adjacent structures

  1. Hoarseness- laryngeal nerce
  2. Resp. sx’s- Trachea
  3. LE pain- thrombi
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5
Q

What is the gold standard diagnostic for aortic aneurysms?

A

Ultrasound

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6
Q

What is the treatment for an unstable pt with ruptured aneurysm?

A

immediate surgical intervention

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7
Q

Who do we screen for Aortic Aneurysms?

A
  1. Men aged 65-75 who have ever smoked

2. People aged >60 who have a positive FHx for AAA

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8
Q

Stanford classification for Type A dissection

A

Involved ascending aorta and aortic arch

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9
Q

Stanford classification for Type B dissection

A

Involved descending aorta

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10
Q

What population do we see aortic dissections at an earlier age than normal? And what age?

A
  • Marfan’s Syndrome- Connective tissue dz

- Mean age = 36

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11
Q

What is the top risk factor for aortic dissection?

A

HTN= 70%

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12
Q

What population are aortic dissections the most common in?

A

middle-aged to older males with a history of hypertension

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13
Q

Do aortic dissections usually happen in the presence or absence of aneurysms?

A

Absence

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14
Q

What complaint is more often reported with Type A dissection?

A

Chest Pain

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15
Q

What complaint is more often reported with Type B dissection?

A

Back and abdominal pain

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16
Q

What murmur would you expect to hear on examination that would clue you in this might be an aortic dissection?

A

New high frequency diastolic blowing murmur of AR

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17
Q

Is hypotension shock more common with Type A or Type B dissection?

A

Type A

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18
Q

Is HTN more common with Type A or Type B dissection?

A

Type B

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19
Q

What imaging has the highest sensitivity and specificity for aortic dissection diagnosis?

A

CT with IV contrast, TEE, MRI =95%

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20
Q

What is the study of choice in a hemodynamically unstable patient?

A

TEE

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21
Q

What is the treatment of choice in Type A dissections?

A

Resect ascending aorta and replace with graft

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22
Q

What is the treatment of choice in Type B dissections?

A

Medical management if possible

Stenting

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23
Q

What condition is characterized as a chronic vasculitis of large and medium-sized vessels?

A

Giant Cell Arteritis or temporal arteritis

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24
Q

What is the mean age of diagnosis in giant cell arteritis?

A

Age 72

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25
What is a hallmark indication of giant cell arteritis?
almost never occurs in ppl <50 y.o.
26
Describe "cord like sensation" when palpating the temporal artery
-Dilated and thickened, allowing it to roll between fingers
27
What are the presenting symptoms in giant cell arteritis?
- New onset HA - Abrupt onset of visual disturbances - Symptoms of polymyalgia rheumatica - Unexplained fever or anemia - Elevated ESR or CRP
28
What is the most feared complication of giant cell arteritis?
Visual loss
29
What condition is giant cell arteritis associated with?
Polymyalgia rheumatica
30
Define Polymyalgia rheumatica
- Systemic inflammatory dz - Pain in shoulder and pelvic girdle - Elevated SED and CRP with this
31
What is the imaging of choice for giant cell arteritis?
Ultrasound- get color flow image of arteries
32
Treatment for giant cell arteritis?
Glucocorticoid therapy | =Prednisone
33
At what age does PAD increasingly progress?
Age 40
34
What is the classic presentation of PAD?
Intermittent claudication | -Reproducible cramping pain in legs induced by exercise and relieved by rest
35
What peripheral artery dz (what artery) does calf muscle pain suggest?
femoropopliteal diesease
36
What peripheral artery dz (what artery) does buttocks and thigh pain suggest?
aortoiliac disease
37
What are the characteristics of severe PAD?
- Pain at rest - Skin atrophy - Hair loss - Cyanosis - Ischemic ulcers - Gangrene
38
Describe Buerger Test
Rubor on dependency - Elevated=pale - Dependent= dusky redness
39
Describe arterial ischemic ulcers
- Deep ulcers over bony prominences (toes) | - Sharp borders
40
What is the gold standard diagnostic test for PAD?
Contrast arteriography - MRA - CTA - angiography
41
How do you measure Ankle-Brachial Index (ABI)?
- ankle systolic BP/brachial systolic BP= ratio | - detected with a doppler probe
42
What is mild PAD based on ABI results?
<0.9
43
What is severe PAD based on ABI results?
<0.4
44
List Pharmacologic therapy for PAD
1. Anti-platelet drugs- ASA, Plavix | 2. Direct vasodilation- Cilostazol (Pletal)
45
Surgical intervention for PAD?
1. Bypass 2. Endovascular- Angioplasty/stenting 3. Thromboendarterectomy- removal of plaque
46
What is the mortality rate in a pt with PAD for MI and stroke?
6x higher
47
Where do most acute arterial occlusions originate from?
Heart - Arterial thrombus from a-fib - Left ventricular thrombus after MI - Debris from prosthetic valves/infected valves
48
What are the 6 P's of acute arterial occlusion?
1. Paresthesia 2. Pain 3. Pallor 4. Pulselessness 5. Paralysis 6. Poikilothermia- cool to palpation
49
Treatment of acute arterial occlusion-Emergent!
1. IV Heparin bolus, followed by infusion 2. Thrombolytic therapy 3. Surgery- revascularization
50
Define Phlebitis
Superficial venous thrombophlebitis= superficial phlebitis
51
What is the etiology of phlebitis?
1. Spontaneous - Great Saphenous vein - Pregnancy/postpartum 2. Trauma to vein - IV therapy, PICC line
52
Physical exam finding of SF thrombophlebitis
**Palpable, nodular cord | Induration, erythema
53
Treatment of SF thrombophlebitis
Elevation, warm compress, NSAIDS
54
When would you prescribe Abs for SF thrombophlebitis
1. High fever | 2. Purulent discharge
55
What is venous insufficiency due to?
Incompetent valves- can't pump low oxygen blood back to the heart
56
Sx's of venous insufficiency
1. Pruritis 2. LE swelling-pitting edema** 3. Eczema phenomenon** 4. Inflammation
57
What are risk factors for venous insufficiency
1. Standing/sitting for prolonged period of time** 2. Female 3. Pregnancy 4. Hx of DVT
58
Define hemosiderin deposits seen in venous insufficiency
Skin hyperpigmentation
59
What are characteristic of ulcers in venous insufficiency (venous stasis ulcers)?
- Shallow - Irregular borders - Inside the ankle
60
What is one of the main treatment goals in venous insufficiency
Reduce edema!! | -->ulcers won't heal until edema is controlled
61
Dilated, elongated, tortuous, subcutaneous veins describes what?
Varicose veins
62
Varicose Veins Epidemiology
1. Increasing incidence with age | 2. Increased in pregnancy due to increased blood volume
63
Treatment options for varicose veins
1. Associated stasis dermatitis= topical corticosteroids 2. Chemical ablation(sclerotherapy) 3. Surgery- phlebectomy
64
What is Virchow's triad and what condition is it associated with?
1. Venous stasis 2. Vessel wall injury 3. Coagulation abnormality * DVT
65
Clinical presentation of DVT
1. >1-2 cm circumferential difference in legs** 2. Swelling, pain and discoloration of LE 3. Palpable cord, increased warmth 4. +Homan's sign
66
DVT Treatment
Anticoagulation- 3, 6, or 12 mos. | =Low molecular-weight Heparin- Lovenox
67
Etiology of SVC obstruction (complete or partial)
From neoplastic (tumor) or inflammatory conditions in mediastinum
68
Clinical presentation of SVC obstruction
1. Acute onset of sx's | 2. Swelling of neck, fact and UE's**
69
What life threatening condition can SVC obstruction lead to?
cerebral and laryngeal edema
70
What EMERGENT treatment would you perform for SVC obstruction
Balloon angioplasty of obstruction and stent placement-->otherwise treat the neoplasm with chemo/radiation

Myocarditis/Cardiomyopathy/Endocarditis (3 decks)

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