What is an aortic dissection?
Sudden “ripping” or “tearing” CP radiating to back
- older, history of HTN, smoking, Marfan syndrome
- PE will show asymmetric pulses/BP, CXR = widened mediastinum
How do you dx an aortic dissection?
CT or transesophageal echocardiogram
What is the tx for an aortic dissection?
reducing BP, surgery
What is an aortic aneurysm?
flank pain, hypotension, pulsatile abdominal mass
What is the screening for an aortic aneurysm?
ultrasound, if male >65 and ever a smoker
What is the tx for an aortic aneurysm?
- immediate surgical repair (even if asymptomic) if >5.5 cm or expands >0.6 cm per year
- monitor annually if > 3 cm, monitor every 6 months if > 4 cm
- beta-blocker
What is an arterial embolism/thrombosis?
caused by a sudden arterial occlusion
- The P’s of arterial embolis: Pain, Pallor, Pulselessnes, Paresthesia, Paralysis, Poikilothermia
- atrial fibrillation and mitral stensosi are common causes of thrombus formation
- angiograhpy is considered the gold standard for diagnosis
- acute arterial occlusion: treat with IV heparin if not limb threatening then call the vascular surgeon for angioplasty, graft or endarterectomy
What is arterial/venous ulcer disease?
edema, atrophic shiny skin, brawny induration, stasis dermatitis, brown hyperpigmentation, varicosities, ulcers above the medial malleolus
-ABI, trendelenburg tests, ultrasound
What is the tx for arterial/venous ulcer disease?
sclerotherapy, vein stripping, compression hose
What is stable angina?
predictable, relieved by rest and/or nitroglycerine
What is unstable angina?
previously stable and predictable symptoms of angina that are more frequent, increasing or present at rest
What is prinzmetal variant angina?
coronary artery vasospasms causing transient ST-segmetn elevations, not assocaited with clot
What is claudication?
reduction in blood flow to the leg muscles, most commonly be an atherosclerotic plaque
- pain in the leg with walking
- relieved within a few minutes of rest
- reproducible a the same walking distance each time
What is PAD?
defined as an ABI <0.9
- the ABI confirms the diagnose of PAD
- normal ABI 1.2 -1.0
- mild disease 0.9 - 0.7
- moderate disease 0.7-.04
- severe disease/rest pain <0.4
How is PAD/PVD dx?
angiography is considered the gold standard for diagnosing
What are the treatment options for PAD/PVD?
- Platelet inhibits: cilostazol, aspirin, clopidogrel
- treat lipids - statins
- revascularization with PTA, bypass grafts, stenting
- exercise - walking to the point of claudication
- beta blockers are contraindicated in isolated PAD - it will worsen claudication
- Treatment options for sever PVD
1. surgical craft bypass
2. angioplasty - balloon dilation
3. endarterectomy - remove disease intima and media
4. surgical patch angioplasty (place patch over stenosis)
What are examples of arrhythmia?
atrial fibrillation, inappropriate sinus tachycardia, sick sinus syndrome/bradycardia
What is the hx with arrhythmias?
palpitations, syncope
What is the PE of arrhythmias?
irregular rhythm, pauses
How are arrhythmias dx?
ECG, event recorder, holter monitor, stress testing
What are examples of myocardial?
cardiomyopathies, coronary ischemia
What is the hx of myocardial?
depose on extertion, paroxysmal nocturnal dyspnea, orthopnea, chest pain or tightness, prior coronary artery disease or atrial fibrillation
What is the PE of myocardial?
Edema, JVD, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S4
How is myocardial dx?
ECG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography
