Cardiology Final Exam

abnormal narrowing of arteries other than those that supply the heart/brain

PAD

what is the leading cause of PAD?

atherosclerosis

what is the greatest risk factor for PAD?

cig smoking

with PAD, involvement of what vessels is common in elderly and diabetics?

distal/smaller

PAD classically occurs where?

at bifurcations

what are the 3 classic bifurcation locations for PAD?

aortoiliac

femoral-popliteal

infrapopliteal or tibial

what is the MC sx of PAD?

intermittent claudication

(cramping pain in legs w/ walking & relieved w/ rest)

in what condition may pt's dangle their legs over the side of the bed to relieve leg pain?

PAD

chronic ischemic pain at rest, ulcers, or gangrene (> 2wks)

critical limb ischemia -- EMERGENCY

PAD typically presents w/ decreased or absent pulses _____ to the obstruction

or with the presence of ____ over the narrowed artery

distal

bruits

what is the intial test of choice for PAD?

ankle brachial index

what ABI values is considered diagnostic for PAD

< 0.90

what ABI values indicate the pt needs to see a specialist?

> 1.4 or < 0.8

pts with ______ or _____ may have falsely elevated ABIs as a result of arterial claudification

diabetes or end-stage renal disease

what are the names of the 2 scales that assess PAD severity?

fontaine stages

rutherford

what are the 2 goals of PAD treatment?

lower CV risk

improve walking ability

arterial occlusion that results in the sudden cessation of blood flow to an extremity

acute limb ischemia

EMERGENCY

in acute limb ischemia (PAD), what is the MCC/source?

emboli

heart, aorta, large arteries

in acute limb ischemia (PAD), what can an emboli in the heart cause?

a-fib

what sx is diagnostic for acute limb ischemia (PAD)?

sudden pain in limb w/ decreased pulses

in acute limb ischemia (PAD), the extent of pain in limb w/ decreased pulses depends on what?

which artery is affected

what are the 6 P's for acute limb ischemia?

pain

pallor

pulseless

poikilothermia (cool)

paresthesia

parlysis

compression of neurovascular structures supplying the UE

associated w/ pain, numbness, weakness, and swelling

thoracic outlet syndrome

the following are causes of what?

- compression between scalene muscles and 1st thoracic rib

- sagging of shoulder girdle (aging, obesity, pendulous breasts)

- proximity of clavicle to 1st rib

- abnormal insertion of pec minor muscle

thoracic outlet syndrome

what is being compressed based on the following sx? (TOS)

- shoulder/arm pain, weakness, paresthesias

nerves

what is being compressed based on the following sx? (TOS)

- claudication

- raynauds phenomenon

- ischemic tissue loss/gangrene

artery

what is being compressed based on the following sx? (TOS)

- thrombosis of subclavian and axillary

- "paget-schoetter syndrome"

vein

the diagnosis for TOS consistis of the following regimen

- maneuvers to provoke ______

- maneuvers to cause a subclavian ______

- maneuvers to diminish _____

symptoms

artery bruit

arm pulses

what are the 5 maneuvers that used done for TOS?

adson

reverse adson

costoclavicular compression

wright

roos

causes pre/syncope related to cerebral hypoperfusion that occurs during arm use

subclavian steal syndrome

subclavian steal syndrome is most commonly due to blockage of what?

L subclavian

what is the dx study for subclavian steal syndrome?

if insufficient?

arterial US

CT angiography

what is always the 1st line tx for subclavian steal syndrome?

tx underlying cause

what is the MC reason for carotid artery bifurcation?

atherosclerotic occlusive plaque

in carotid artery disease, 85% of strokes are what kind?

ischemic

(bc of hypoperfusion from artery occlusion)

carotid bifurcation is an area of _____ flow velocity and _____ shear stress

low; low

transient monocular blindness (temporary loss in 1 eye) often described as a window shutter coming down or grey vision

what is this a common sx of?

amaurosis fugax

stroke in CAD

what is the tx for CAD if pt has 50-69% stenosis and is ASYMP? (2)

intensive medical therapy (ACE/ARB, anti-platelet, statin)

surveillance carotid US

what is the tx for CAD if pt has 70-99% stenosis and is ASYMP? (2)

intensive medical therapy (ACE/ARB, anti-platelet, statin)

carotid revascularization

T/F pts with CAD 50-69% stenosed and asymptomatic are NOT recommended to have revascularization

true - no revascularization

what is the tx for CAD in pts who are symptomatic and with 70-99% stenosis and a 2-year life expectancy?

carotid endarterectomy

what is the tx for CAD in pts who are symptomatic and with 50-69% stenosis and a 3-year life expectancy?

carotid endarterectomy

the following CAD pts are better candidates for _____ rather than open surgery

- unsuitable lesion for surgery

- radiation-induced stenosis

- conditions w/ increased risk of anesthesia

stenting

when treating CAD<, the periprocedural risk of stroke/death is higher with _____ than with _____

CAS (stenting)

CEA (endarterectomy)

pathologic dilation of a segment of a blood vessel =

aneurysm

normal abdominal aorta =

abdominal aortic aneurysm =

2cm

3cm

a true aneurysm involves what layers of the vessel wall?

all 3 (intima, media, adventitia)

what is it called when the intimal and medial layers of vessel wall are disrupted but not adventitia layer?

psuedoaneurysm

aneurysm that forms where your aorta carries blood into your abdomen

AAA

aneurysm that affect an artery in your brain =

what is the MC type?

cerebral

saccular (sac of blood [that looks like a berry] attaches to an artery)

aneurysm that forms in the upper part of your aorta (in your chest)

thoracic aortic aneurysm

aneurysm that forms in the artery that brings blood to your intestines

mesenteric artery aneurysm

traumatic aneurysms (after non/penetrating chest trauma) most commonly affect what?

descending thoracic aorta

all ____ aneurysms are at risk for expansion and rupture

most are fusiform (spindle shaped & entire circumference of aortic wall)

AAA

what is the risk of rupture for AAAs that are > 5cm?

20-40%

what is the imaging of choice for asymp AAAs?

what is the imaging of choice for symptomatic AAAs?

US

CT

what is the tx for asymp AAA that is < 5.5 cm?

conservative (watchful waiting)

what is the tx for asymp AAA that is > 5.5 cm?

elective AAA repair

what is the tx for symptomatic AAAs of any size?

urgent AAA repair

what are the 3 common symptoms in pts with a ruptured AAA?

severe pain

hypotension

pulsatile abd mass

what is the tx for an unstable pt with a known AAA rupture?

immediate surgery

what is the tx for a stable pt w/ a suspected AAA rupture?

urgent abd imaging --> surgery

aneurysms that affect arteries other the aorta or brain =

what is the MC type?

peripheral aneurysms

popliteal

femoral artery aneurysms are typically PSEUDOaneurysms with the 2 main causes being what?

percutaneous vascular injection

pt self-injecting

what is the MC type of VISCERAL aneurysm?

splenic artery aneurysms

permanent localized dilation of the thoracic aorta having at least a 50% increase in diameter compared to normal

thoracic aneurysms

what percent of TAAs involve the aortic root/ascending aorta?

what percent of TAAs involve the descending aorta?

60%

40%

where are 80% of AAAs located?

infrarenal arteries

what is the imaging of choice for thoracic aneurysms?

CT

an ASYMP ascending TAA indicates repair if the end-diastolic aortic diameter is what?

> 5.5 cm

an ASYMP descending TAA indicates repair if the pt is an average sized adult w/ a diameter of what?

> 5.5 cm

separation of layers of the aortic wall

usually due to entry of blood between intima and media layers --> resulting in a tear in the intimal layer and progressed dissection

aortic dissection

T/F aortic dissection is associated with average mortality rates, have a decent chance of survival if they make it to the ER in time

false - very high mortality; often dead before recaching ER

the following combinations of symptoms should clue you in to what diagnosis?

- chest pain + neurologic finding

- chest + abdominal pain

- chest pain + limb weakness

aortic dissection

what are the 4 main sx of aortic dissection?

BP discrepency in UE

pulse defecit

HTN

diastolic murmur

what are the 2 imaging studies that are used to dx aortic dissection?

CT w/ contrast

TEE

what is the tx of a type A aortic dissection?

of a type B aortic dissection?

surgical repair

medical management

inflammatory occlusive vascular disorder involving small/medium sized arteries/veins in the distal UE and LE

thromboangiitis obliterans (buerger disease)

thromboangiitis obliterans is a triad of what?

claudication of affected extremity

raynauds

migratory superficial vein thromophlebitis

smooth, tapering lesions in distal vessels + collateral vessels at sites of occlusion are characteristic of what condition?

thromboangiitis obliterans

what are the 2 tx options for thromboangiitis obliterans?

smoking cessation

amputation

hyperplastic disorder usually in women, that affects small/medium arteries

fibromuscular dysplasia

fibromuscular dysplasia usually involves what arteries?

renal

carotid

what condition is identified on angiograph as a "string of beads"?

fibromuscular dysplasia

what is the medical tx for fibromuscular dysplasia? (2)

what is the surgical tx for fibromuscular dysplasia? (2)

ACE/ARB, antiplatelet/anticoagulant

stenting, angioplasty

rare type of autoimmune vasculitis or blood vessel inflammation that affects predominately females 20-40 yro

takayasu arteritis

ACUTE lower extremity venous disease = (2)

DVT

superficial thrombophlebitis

CHRONIC lower extremity venous disease = (2)

varicose veins

chronic venous insufficiency

periods of high venous pressure related to prolonged standing or heavy lifting

MC in women after pregnancy

varicose veins

what is the hallmark sx for varicose veins? (2)

progressive venous reflux & venous HTN

dilated tortuous superficial veins in the LE =

varicose veins

varicose veins are usually seen in which vein?

greater saphenous

what is the tx for varicose veins?

who should it not be used in?

20-30 mmHg compression stockings

pts w/ arterial disease

what are the 2 surgical tx's for varicose veins (if painful or cosmetic issue)

foam scleropathy

surgical vein stripping

condition typically involving LE edema, trophic skin changes, and discomfort due to venous HTN

chronic venous insufficiency (CVI)

what condition may look like cellulitis but will have blanching erythema with pain

chronic venous insufficiency

what are the main symptoms of chronic venous insufficiency? (4)

pitting edema

taut/shiny skin

brown pigmentation

ulcers above ankles

what is the name of the system used to classify CVI and what are the components of the following?

C0 =

C1 =

C2 =

C3 =

C4 =

C5 =

C6 =

CEAP

0= no varicose veins

1= small vv (telangiectasis)

2= large vv

3= edema

4= skin changes w/o ulcers

5= skin changes w/ healed ulcers

6= skin changes w/ active ulcers

what is the tx for CVI?

who should it not be used in?

20-30 mmHg compression stockings

pts w/ arterial disease

what is typically used to tx ulcers in pts w/ CVI?

unna boot (nonelastic circumferential bandages)