 |
Term
| How do you treat Aortic Dissection? |
|
Definition
¨Get into ICU, Give pain meds, Reduce blood pressure fast!!! SBP under 120, HR under 60
(Metoprolol, Esmolol, Labetalol)
Sodium Nitroprusside + Beta-blockers¤
Stanford Type A (PROXIMAL) = >SURGICAL THERAPY (Aortic repair)
Follow-up CT scans
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Term
¤Pain, redness, swelling along vein
¤Vein feels like a palpable cord
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|
Definition
(Thrombo)phlebitis
associated with
¤Infection of vein
Potassium or ETOH or infection
Tx for superficial: warm compress
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Term
¨Treatment based upon etiology/cause for phlebitus
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Definition
¤Pain medications/anti-inflammatories
¤Anticoagulants (if due to deep vein thrombosis)
¤Antibiotics (if due to infection)
¤Removal of catheter if possible
¤Warm compresses/Support stockings/wraps
¤Surgical removal/stripping may be necessary
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Term
¤PAIN OUT OF PROPORTION TO PHYSICAL EXAM
¤Peritoneal signs (guarding, rebound) à rupture, peritonitis
Soft abdomin, tarry stool
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Definition
| Acute Mesenteric ischemia |
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Term
Chronic Acute Mesenteric ischemia is associated with?
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|
Definition
Post prandial pain
Sitophobia (fear of eating) |
|
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Term
“Thumbprinting”, Portal venous gas, or Pneumatosisintestinalis
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|
Definition
Acute Mesenteric Ischemia
Check Lactate levels
low WB cell counts
tx with
Papaverine (opiate, vasodilator), helps with erictile problems |
|
|
Term
| How do you differentiate Colonic ischemia with Acute Mesenteric? |
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Definition
| No rectal bleeding in Acute Mesenteric!!! |
|
|
Term
¨Claudication symptoms of feet, legs, arms, and hands with some patients presenting with gangrene or ulcerations (ischemic).
young males < 45 years of age |
|
Definition
¨Beurger disease
Treatment:
¤Smoking cessation
¤Vascular surgery (sometimes amputation)
¤Iloprost (prostaglandin inhibitor inhalent) |
|
|
Term
| What is the difference between Raynaud's syndrome and Raynaud's phenomenon? |
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Definition
Raynaud's phenomenon refers to the secondary while Sydrome is primary
Can be caused by Lupus, vasospasms |
|
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Term
White, Blue, and Red?
Dilated tortuous nail beds, use otoscope
sclerodactyly |
|
Definition
Raynaud's phenomenon
Treatment:
¨Treatment:
Diltiazem
¤Avoidance of triggers (gloves in winter)
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Term
Young asian females vasculitis of Aorta
Bruits over subclavian artery |
|
Definition
Takayasu Arteritis
Pulseless disease |
|
|
Term
- What causes blindness, Pain in shoulder/hips,
- females over 50
- Temporal headache, jaw claudication,
- unilateral blindness
- 40% also have Polymyalgiarheumatica
|
|
Definition
Giant Cell Arteritis (look up)
Dx with ESR and CRP!!!
BP differences
Gold standard: Temporal artery biopsy
Tx with high dose of corticosteroids
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Term
¨If the arterial blood bipasses the capillaries. What dx and what syndrome are you considering?
|
|
Definition
- Arteriorvenous malformations
- ¨Diagnosis by contrasted MRI or CT scan
- ¤Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome)
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Term
| What triad do you use for determining the risk of a pulmonary embolism? |
|
Definition
|
|
Term
¤Horse Chestnut Seed Extract works for?
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|
Definition
|
|
Term
| How does a PE affect your heart? |
|
Definition
¤Blocks blood flow to lung resulting in hypoxia, decreased preload to left heart à heart failure, death
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Term
| When you are worrid about a venous thrombosis, and the pt has a Wells score of 1, what should you do? |
|
Definition
D-Dimer, If elevated perform Ultrasound
If it's moderate or high = > emergency bed side u/s
Venogram is gold standard(old)
Wells core is powerfu, tells you if PE Is likely or not (4 is the magic number)
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Term
|
Definition
¨CT Pulmonary Angiography (CTPA):
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Term
| What the heck is a VC scan? |
|
Definition
| It's a inhaled radiolabled uptake exam looking for radiolalbled lungs. We detect many, confirm a couple. |
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|
Term
| What is the number 1 murmor of pulmonary edema? |
|
Definition
¤
¤Reality à Sinus tachycardia
Classic à S1Q3T3
¨ABG
¤Increased A-a gradient
¤Hypoxemia with hypocapnia
¨Chest Xray
¤Westermark Sign
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|
Term
| Why would you use an inferior vena cave filter? |
|
Definition
¨If anticoagulation CANNOT be done:
¤Inferior Vena Cava Filter
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|
|
Term
| How long is bridge therapy last for heparin heparin? |
|
Definition
|
|
Term
| What extra sound could you hear in a patient with CHF, mitral regurg, or an MI? |
|
Definition
|
|
Term
| In which diseases would you expect to hear an S4? |
|
Definition
| Aortic stenosis, cardiomyopathy, HTN, CAD |
|
|
Term
| What are three triggers of atrial fibrillation? |
|
Definition
| Alcohol, surgery, thyrotoxicosis |
|
|
Term
| What does the Chads2 scoring system tell you? |
|
Definition
Risk of clotting
1= aspirin
3= Warfarin, Pradaxa, Xarelto |
|
|
Term
| Which murmurs get louder with inspiration? |
|
Definition
| Tricuspid regurg and physiologic S2 split |
|
|
Term
| In what conditions would you expect a low voltage EKG? |
|
Definition
| Restrictive cardiomyopathy, cardiac tamponade, pericardial effusion, COPD, obesity |
|
|
Term
| According to Starling's Law, what is cardiac output directly related to? |
|
Definition
| Amount of blood returning to the heart |
|
|
Term
| What does an opening snap indicate? |
|
Definition
|
|
Term
| What diastolic murmur has a high pitched blowing decresendo and can best be heard sitting up and leaning forward? |
|
Definition
|
|
Term
| What is the most common cause of mitral stenosis? |
|
Definition
|
|
Term
| When do you use the Duke criteria? |
|
Definition
|
|
Term
| What conditions are mitral regurg associated with? |
|
Definition
|
|
Term
| What test do you use to determine the severity of aortic stenosis? |
|
Definition
|
|
Term
| Angina pectoris is most commonly secondary to _________ |
|
Definition
|
|
Term
| Chest pain in response to physical or emotional stress and goes away with rest or medication |
|
Definition
|
|
Term
| Chest pain that occurs with no provocation and does not go away with rest or medication |
|
Definition
|
|
Term
| Caused by a spasm in a coronary artery in which the artery temporarily narrows |
|
Definition
| Prinzmetal/variant angina |
|
|
Term
| Describe the chest pain experienced with angina pectoris |
|
Definition
| Pressure, squeezing, fullness or pain in the center of the chest |
|
|
Term
| Name the three populations most likely to experience atypical symptoms with angina pectoris |
|
Definition
| Females, elderly, and diabetics |
|
|
Term
| Irreversible myocardial injury resulting in necrosis of a significant portion of myocardium |
|
Definition
| Acute myocardial infarction |
|
|
Term
| What is the most common cause of MI |
|
Definition
| Thrombus overlying atherosclerotic plaque |
|
|
Term
| What are some signs and symptoms of MI |
|
Definition
| ST elevation, irregular heartbeat, S3 or S4, JVP, new murmur secondary to valve dysfunction, rales, chest pain that may radiate to the arm or jaw, sweating, nausea, vomiting, syncope, dyspnea, |
|
|
Term
| What diagnostic testing would you do if you suspect a MI |
|
Definition
| CXR, Echo, ECG, cardiac enzymes, myoglobin, creatine kinase-MB, troponin, cardiac cath |
|
|
Term
| What is the treatment for MI |
|
Definition
| MONA or MONA-B, thrombolytic therapy, heparin, statins, glycoprotein IIA/IIb inhibitors, CABG, angioplasty |
|
|
Term
| What is the most common cause of acute pericarditis? |
|
Definition
| Viral (coxsackie, echovirus, influenza, EBV, HIV) |
|
|
Term
| What EKG findings indicate acute pericarditis? |
|
Definition
| Diffuse ST segment elevations w/o reciprocal changes |
|
|
Term
| What study is most diagnostic for acute pericarditis w/ pericardial effusion? |
|
Definition
|
|
Term
| What is used to Tx acute pericarditis? |
|
Definition
| NSAIDs, also colchicine and oral corticosteroids if NSAIDs don't work |
|
|
Term
| What procedure is performed if pericardial effusion from pericarditis is recurrent? |
|
Definition
|
|
Term
| What determines if a pericardial effusion will be symptomatic? |
|
Definition
|
|
Term
| What are the usual S/S of a pericardial effusion? |
|
Definition
| Most asymptomatic, usually no signs - may have a rub. (If large - muffled heart sounds and inability to palpate PMI) |
|
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Term
| What are the etiologies of a pericardial effusion? |
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Definition
| Any disease causing acute pericarditis - most commonly uremia, neoplastic, radiation. |
|
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Term
| If a pericardial effusion grows too large - filling of the right then left heart is impaired. This is called what? |
|
Definition
|
|
Term
| Rapid accumulation of cardiac tamponade results in what classic triad? |
|
Definition
| Hypotension, JVD, muffled heart sounds |
|
|
Term
| What is the diagnostic study of choice for cardiac tamponade? |
|
Definition
|
|
Term
| What is the treatment of choice for cardiac tamponade? What else should be done? |
|
Definition
| TOC - pericardiocentesis. Other - hydration, vasopressors. |
|
|
Term
| What procedure should be done for a recurrent or loculated effusion of cardiac tamponade? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the characteristic findings in all bundle branch blocks? |
|
Definition
|
|
Term
| What medications can cause sink sinus syndrom? |
|
Definition
|
|
Term
| In chronic venous insufficiency ulcerations typically present where? |
|
Definition
|
|
Term
| In PAD ulcerations typically present where? |
|
Definition
|
|
Term
| What are the three P's associated with acute arterial occlusion? |
|
Definition
| Pain, pallor, pulselessness |
|
|
Term
| Does gangrene present in PAD or venous insufficiency? |
|
Definition
|
|
Term
| Severe atherosclerosis of abdominal aorta and iliac arteries causing claudication symptoms in buttock, thighs, and hip. May be associated with ED |
|
Definition
| leriche syndrome (aortoiliac occlusion disease) |
|
|
Term
| Swelling in lower extremities which is not helped by diuretics can be attributed to... |
|
Definition
|
|
Term
| What are some non-invasive treatments for venous insufficiency |
|
Definition
| Leg elevation, compression stockings, and ecsin |
|
|
Term
| What is the most common cause of mitral stenosis in the U.S. ? |
|
Definition
|
|
Term
| What valvular disease is heard as an opening snap in diastole? |
|
Definition
|
|
Term
| What valvular disease is associated with mitral valve prolapse? |
|
Definition
|
|
Term
| How do you use to evaluate valvular disease? |
|
Definition
|
|
Term
| What class of medication should you consider for mitral stenosis? |
|
Definition
| Diuretics (Need to dry out lungs. Fluid is backing up from the left atrium. |
|
|
Term
| What class of medication should you consider for mitral regurgitation? |
|
Definition
| Need to decrease the afterload so ACEI, nitrates, diuretics |
|
|
Term
| What is the most common cause of essential hypertension? |
|
Definition
| idiopathic (no identifiable cause) |
|
|
Term
| What should be suspected when BP control is not achieved with multidrug therapy? |
|
Definition
| secondary hypertension (look for cause of HTN) |
|
|
Term
| What is the target BP to attain in the first hour of treatment of hypertensive crisis? |
|
Definition
| 20% of MAP or 170/100-110 |
|
|
Term
| What is the most common cause of cardiogenic shock? |
|
Definition
|
|
Term
| What is orthostatic hypotension defined as? |
|
Definition
| sustained drop in SBP >20 or DBP >10 within 3 minutes of standing |
|
|
Term
| Define aortic aneurysm vs dissection |
|
Definition
aneurysm: dilatation of blood vessel due to weakening of blood vessel wall
dissection: blood into the intimal layer->false lumen parallel to true lumen |
|
|
Term
| What is the most common clinical symptom of an aortic dissection? |
|
Definition
| chest pain (‘tearing’ quality) or back pain (btn scapulae) |
|
|
Term
| Name some common physical exam findings for an aortic aneurysm vs a dissection. |
|
Definition
aneurysm: pulsatile mass below umbilicus
Dissection: JVD, HTN->hypotension, Pulsus paradoxus |
|
|
Term
| What are the diagnostic evaluation tests in order for an aortic aneurysm? |
|
Definition
#1 CT Angiography (C/I=renal failure (contrast), but do it in EM!)
#2 MRA
#3 TEE (for renal failure) |
|
|
Term
| What is the most common "preventable" cause of an AAA? |
|
Definition
| #1 Atherosclerosis: HTN, Fam Hx, Smoking |
|
|
Term
| Discuss the EM management, prognosis, and f/u of an aortic dissection. |
|
Definition
#1 IV Beta-Blockers (Metoprolol, Esmolol, Labetalol)
#2 If severe HTN, Sodium Nitroprusside + Beta-blockers (until its down)
prognosis of ascending aorta dissection: 1-2% mortality risk per hr during first 24-48 hrs.
F/U: CT scans to check on dissection and beta-blockers (can clot itself w/ time) |
|
|
Term
| Describe the epidemiology of aortic stenosis. |
|
Definition
-more common in men, older pts w/ dyslipidemia; slow progression
-symptomatic in 60’s-70’=bicuspid and 80’s-90’s=tricuspid valves
-congenital or acquired |
|
|
Term
| Define the normal and critical aortic area. |
|
Definition
Norm=3-4 cm2
mod=1.0-1.5 cm2
critical < 1.0 cm2 |
|
|
Term
| What are the common historical and physical findings for aortic stenosis? |
|
Definition
-angina, syncope, dyspnea
murmur: radiates to the carotids, S4 gallop heard best by pt sitting and leaning forward |
|
|
Term
| What is the best diagnostic evaluation test for aortic stenosis? |
|
Definition
|
|
Term
| Name the general medical management for aortic stenosis. |
|
Definition
-afterload reducers (diuretics and ACEI)
-for angina=Beta-blockers, but preload must not be reduced (already not getting blood out of valve)
-control BP (JNC 7), but avoid hypotension |
|
|
Term
| What is the surgical management of choice for aortic stenosis? |
|
Definition
|
|
Term
| Name some historical and physical exam findings for aortic regurgitation (think about pathophysiology). |
|
Definition
-Orthopnea, PND, DOE, Palpitations
-reduced CO->fatigue and weakness
-increased O2 demand from LVH and decreased coronary blood flow (blood isn’t getting out of heart)->Angina |
|
|
Term
| Name some signs and symptoms of EM aortic regurg. |
|
Definition
Symtomss: extreme SOB, cyanosis (Not subtle)
Signs: cardiogenic shock, S3 gallop, and a low pitched and short diastolic murmur |
|
|
Term
| Vasculitis of subclavian, axillary, and aorta that can cause occular blindness? |
|
Definition
|
|
Term
| What disease is presented by temporal headaches and jaw claudication? |
|
Definition
|
|
Term
| What is the major lab finding in patients with Giant Cell Arteritis? |
|
Definition
| Increase in ESR- Erythrocyte Sedimentation Rate |
|
|
Term
| What is the Gold Standard procedure in patients with Giant Cell Arteritis? |
|
Definition
|
|
Term
| What is the treatment for Giant Cell Arteritis? |
|
Definition
| High dose corticosteroids |
|
|
Term
| What disease presents with clinical features such as: Arachnodactly, subluxation of the lens? |
|
Definition
|
|
Term
| Patients with Marfan syndrome are at risk for what other medical problems? |
|
Definition
| pneumothorax, Mitral Valve prolapse/Aortic regurg ., Aortic Aneurysms/Dissection |
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