Clinical Flashcards

Question

Name a Genetic disorders affecting the vascular system.

Answer 1

Marfan’s syndrome

Answer 2

* Autosomal dominant, manifectations include long thin arms and legs, asymmetric chest and scoliosis, arachnodactyly, dilatation/dissection of the ascending aorta, or descending thoracic or abdominal aorta * Evaluations: Ophthalmology, Cardiology, Respirology and gene testing for * Management and follow-up include guidelines, avoidance of contact sport and cardiac stimulant (coffee) and cascade testing for family

Answer 3

* Abnormal # of chromosome * Mocrodeletion/duplication * Single gene mutation * Storage Lysosomal

Answer 4

* Mocrodeletion/duplication * Single gene mutation * Energy dysfunction (mitochondrial) * Storage Lysosomal

Answer 5

* Mocrodeletion/duplication * Single gene mutation * Energy dysfunction (mitochondrial) * Storage Lysosonal

Answer 6

An imbalance between myocardial O2 supply and demand

Answer 7

It manifest in different ways: 1. Angina Pectoris (pain in the chest) 1. Stable Angina: fixed obstruction CAD (\>70%), with exertion HR, BP, contractility and myocardial O₂ demand ↑ 2. Unstable Angina: sudden ↑ in tempo and duration of the ischemic episode, precursor to acute MI 3. Variant Angina: at rest, caused by coronary vasospasm, ST-Elevation, endothelial/sympathetic activity problems 2. Silent ischemia Common in diabetic, woman and elderly 3. Myocardial Infarction (MI)

Answer 8

* “Pressure, elephant sitting on chest, discomfort or burning” NOT “stabbing, sharp, pleuritic (increases with inspiration) or worst with palpation” * Usually diffuse, radiates to chest, shoulder, neck, lower face and back * Associated with dyspnea, fatigue, weakness, SNS or PNS (nausea, tachycardia, sweats) * Precipitated by anything ↑ myocardial O₂ demand (activity, large meal, cold, emotions)

Answer 9

1. ECG (transient ischemia: ST depression and Y wave flat or inversion) 2. Stress Testing (EST): exercise on a treadmill and they are CLINICALLY (pain) and/or ELECTRIALLY positive (1 mm ST depression)

Answer 10

1. Nitrates Oral, patches Drug tolerance: we need a nitro-free interval for several hours (resets receptors) They don’t save life, they make patients feel better Side effects: headache, lightheadedness, and palpitations 2. Beta-adrenergic blockers First line chronic therapy ↓ MVO₂ (↓ contractility and HR) Contraindication with asthma (bronchospasm) and decompensated LV failure Side effects: fatigue and erectile dysfunction 3. Calcium channel blockers Potent vasodilators: ↓ MVO₂ ↑ myocardial O₂ supply

Answer 11

1. Antiplatelet therapy 1. Aspirin (all patients for life) 2. Clopidogrel 2. Lipid-lowering therapy 1. Statins: lower MI and death rates in patients with established CAD 3. ACE-I and ARBs Reduce rates of death, MI, and CVA in patients with CAD

Answer 12

When to consider 1. Symptoms of angina do not respond adequately to anti-anginal drug therapy 2. Unacceptable side-effects of medications 3. Non-invasive testing suggests high risk CAD for which revascularization is expected to improve survival Techniques 1. Percutaneous Coronary Intervention (PCI) STENTS Need anti-proliferative medication (prevents scaring down) 1. Coronary Artery Bypass Graft (CABG) surgery (better for diabetics) 1. Veins: saphenous vein, vulnerable to accelerated atherosclerosis 2. Arteries (IMA): internal mammary artery, better (used for the LAD)

Answer 13

**Symptoms**: Crescendo, rest, new onset severe angina, no response to nitro **Myocardial Biomarkers:** None **ECG**: ST depression and or T-wave inversion

Answer 14

**Symptoms**: Prolonged crushing chest pain, wider radiation, more severe **Myocardial Biomarkers**: Troponin I and T, starts after 3-4 hours, Peak 18-36 hours, can be seen for 10 days ish **ECG**: ST depression and or T-wave inversion

Answer 15

**Symptoms**: Prolonged crushing chest pain, wider radiation, more severe **Myocardial Biomarkers**: Troponin I and T, starts after 3-4 hours, Peak 18-36 hours, can be seen for 10 days ish **ECG**: ST elevation and Q wave later

Answer 16

FIRST: * Admission to an intensive care setting: continuous ECG monitoring for arrhythmias * Bed rest to minimize myocardial oxygen demand * Supplemental oxygen if hypoxemia to improve oxygen supply * Analgesics (e.g. morphine) to reduce chest pain and anxiety THEN: 1. Anti-ischemic: 1. Nitrates: venodilation, vasodilation, IV, are helpful with heart failure and hypertension 2. Calcium channel blockers: used when contraindication of beta-blockers, should NOT be prescribed to patients with severe LV dysfunction 3. Beta-blockers: ↓ sympathetic drive, ↓ MVO₂, ↓ mortality venodilation, vasodilation, intravenous, CCB 1. Anti-thrombotic therapy to prevent further growth and facilitating resolution of the partially occlusive thrombus 1. Antiplatelet (aspirin + P2Y₁₂ antagonist such as clopidogrel, prasugrel or ticagrelor + Glycoprotein (GP) IIb/IIIa receptor antagonists) 2. Anticoagulant (unfractionated heparin, LMWHs) We start with conservative treatment and then we do invasive (angiogram) decided by **TIMI score ≥3**

Answer 17

FIRST: * Admission to an intensive care setting: continuous ECG monitoring for arrhythmias * Bed rest to minimize myocardial oxygen demand * Supplemental oxygen if hypoxemia to improve oxygen supply * Analgesics (e.g. morphine) to reduce chest pain and anxiety THEN: 1. Fibrinolytic drugs (NSTEMI and U/A patients DO NOT BENEFIT from fibrinolytic therapy) 2 first hours, not if bleeding 2. Percutaneous coronary mechanical revascularization (best option if 90 minutes) + dual antiplatelet therapy (aspirin + P2Y₁₂ antagonist) 3. Aspirin, Heparin, Beta-blockers, Nitrates + Adjunctive therapies 1. ACE inhibitors 2. Cholesterol-lowering statins

Answer 18

1. Age \> 65 2. \> 3 CAD risk factors 3. Prior stenosis \> 50% 4. ST deviation 5. \> 2 anginal events in \< 24 h 6. ASA in last 7 days 7. Elevated cardiac markers

Answer 19

* Aspirin + Second antiplatelet drug (clopidogrel/ticagrelor/prasugrel) * Beta-blocker * HMG-CoA reductase inhibitor (statin) * ACE-inhibitors (or ARBs if intolerant) * Nitroglycerine puffer (to be used as needed for angina) * Risk factor modification

Answer 20

It measures the pressure gradient between two chambers Bernoulli ∆P = 4V²

Answer 21

It is used to estimate the effective area of a region of interest, most commonly the effective area of a stenotic valve orifice Continuity A₁V₁=A₂V₂ _{V is velocity}

Answer 22

Doppler shift is used to interrogate regions in the heart, especially valves, to obtain quantitative information about the velocity and direction of blood flow. Color Doppler is used to depict Doppler measures of blood flow velocity, direction and turbulence according to a color scale; image shows case of aortic regurgitation (AR). Red is moving toward the probe and blue away from and the color is the velocity.

Answer 23

High frequency echo used for small structures such as valvular vegetations, left atrial appendage thrombi, PFO and aortic dissection flaps.

Answer 24

Gamma waves, injected into the body and are amost proportional to blood flow (plateau). We can see it on a camera because of the principle of Flow = ∆P/R. We can identify fixed defects (MI, scar) and reversible defects (ischemia at stress but not rest).

Answer 25

To evaluate metabolism (glycogen consumsion)

Answer 26

Based on continuous X-RAYs. We go through the radial artery, trace back to the aorta, inject iodine and take pictures of the arteries. We can do it while we to a PCI (stents) and valve replacements (TAVR). * Complications: death, MI, stroke (1/1000), arrhythmia, anaphylaxis, neuropathy (1/25), and minor bleeding + infections (1/100) * Coronary Flow reserve (CFR): flow at maximal vasodilation/flow at rest (4-5X) \*\* THO: We can diagnose mitral stenosis and regurgitation with ECG.

Answer 27

1. High spatial and contract resolution 2. Accurate measurements 3. Tissue characterization 4. No radiation or iodinated contrast

Answer 28

1. Time consuming 2. Not always feasible 3. Susceptible to artefacts 4. Very rare risk with severe renal dysfunction patients

Answer 29

We can change the sequence and highlight different things (fat, water, late gadolinium enhancement). It measures: volume, perfusion, function, blood flow, oedema, fibrosis, ischemia and scars (late gadolinium). Therefore, they are used for myocarditis, pericarditis, cardiac masses, myocardial viability in ischemic cardiomyopathies, aortic pathologies, RV pathologies, congenital heart disease… Reference are mostly for weak or thick hearts.

Answer 30

Not the gold standard, a lot of artefacts because of movements (slow HR needed). Calcium in the arteries is usually in the wall and is not the same as stenosis of the arteries, which is in the lumen. A coronary CT calcium scan is a risk classification test to know if the patient is at risk of CAD (low radiation, low contrast, low resolution). The angiogram on the other hand is high resolution, radiation and contrast to visualize the patency of the coronary artery lumen.

Answer 31

Focal increase in vessel size by 50% compared with normal. True aneurysm includes dilatation of all three layers of aorta. They are associated to cystic medical degeneration (congenital syndromes), artherosclerosis, infections of arterial wall and vasculitis.

Answer 32

Most often asymptomatic and incidental discovery. Possible symptoms are awareness of pulsatile mass, compression of adjacent structures, congestive heart failure and back pain or GI symptoms.

Answer 33

1. Optimization of risk factors 2. Medication (beta-blocker and ACE-inhibitors) 3. Interventions (surgery, percutaneous endovascular repair)

Answer 34

* Dissection: tear in the intima into the media * Acute intraumural hematoma: haemorrhage in the wall without intimal tear * Penetrating artherosclerotic ulcer: erosion of a plaque into the aortic wall * Aortic rupture: a cause of any of the above and in blows

Answer 35

* Classification: type A (ascending) and type B (does not include ascending) * Complications: pericardial tamponade, hemothorax, stroke, MI, renal failure, aortic regurgitation * Diagnostic: CT, transesophageal, echo, resonance angiography * Treatment: reduce BP (beta-blockers and nitroprusside), surgery for type A and medical therapy for type B if stable

Answer 36

* Most common cause is atherosclerosis, increases with age. * Symptoms: claudication, bruit, ulcerations (DIABETICS), infections, necrosis, atrophy, cyanotic, hair lost. * Diagnosis: ankle-brachial index higher sBP of PT or DP / higher sBP Brachial, should be \>1 * Treatment: risk factors, antiplatelet and anticoagulants, supportive care, exercise, revascularization, amputation

Answer 37

* **6 “P”:** **Pain; Pallor; Paralysis; Parasthesia; Pulselessness; Poikilothermia (aka cold)** * Caused by an emboli * Treatment includes re-establishment of flow

Answer 38

1. Takayasu Arteritis: Affects aorta and its major branches 2. Giant Cell Arteritis: (Temporal Arteritis): Medium to large arteries, commonly involves cranial vessels 3. Thromboangiitis Obliterans: (Buerger disease): Inflammation of small and medium arteries, as well as veins and nerves involving distal vessels of upper and lower extremities. CAUSED BY SMOCKING.

Answer 39

* Vasospastic disease of the digital arteries * Benign, affect more woman * It can be primary or secondary (more severe, arterial occlusive disease) * Avoid clod, calcium channel blockers, other medications

Clinical Flashcards

(63 cards)