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EO 10.01 Flashcards

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1
Q

Varicose veins
S/S
(10)

A
  1. Tense and palpable veins but not necessarily visible
  2. Sense of fullness
  3. Fatigue
  4. Pressure
  5. Superficial pain
  6. Hyperesthesia in the leg
  7. Muscle cramps
  8. Edema
  9. Burning
  10. Itching
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2
Q

Varicose veins Causes

A
  1. Venous insufficiency from faulty valves
  2. Valvular dysfunction causes venous reflux leading to venous hypertension
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3
Q

What is Raynaud’s Syndrome

A

Vasospasm of parts of the hand in response to cold or emotional stress, causing reversible discomfort and colour changes in one or more digits

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4
Q

Raynaud’s Syndrome Signs/Symptoms

A
  1. Sensation of burning
  2. coldness
  3. Paresthesia
  4. Intermittent colour changes
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5
Q

Difference between Raynaud’s Syndrome Primary and Secondary

A
  1. Primary: 80% of cases occur without symptoms or signs of other disorders
  2. Secondary: 20% of cases have a causative underlying disease
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6
Q

Causes of Secondary Raynaud’s

A
  1. Connective tissue disorders
  2. Endocrine disorders
  3. Hematologic disorders
  4. Neoplastic disorders
  5. Neurologic disorders
  6. Trauma
  7. Vascular disorders
  8. Drugs
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7
Q

Risk factors for Raynaud’s Syndrome

A
  1. Autoimmune disorders
  2. Connective tissue disorders
  3. Smoking
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8
Q

Raynaud’s Syndrome Treatments

A
  1. Trigger avoidance
  2. Medication
  3. Treatment of secondary causes
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9
Q

Raynaud’s Syndrome Education

A
  1. Stop smoking
  2. Avoid aggravating factors
  3. Dress appropriately for climate
  4. Use relaxation techniques
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10
Q

Myocardial Infarction Patho

A

Acute obstruction of a coronary artery causing decreased blood flow leading to myocardial necrosis of the

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11
Q

Myocardial Infarction Causes

A
  1. Coronary thrombosis
  2. Coronary artery spasm
  3. Arteritis
  4. Embolic infarction
  5. Congenital coronary anomalies
  6. Oxygen supply - demand imbalance;
  7. carbon monoxide poisoning
  8. Cocaine-induced vasospasm
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12
Q

Most common Myocardial Infarction Cause

A

Coronary thrombosis

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13
Q

(AMI) After total occlusion, how long does myocardial necrosis take before it is complete

A

4-6 hrs

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14
Q

AMI

Flow to ischemic area must remain above what % of pre-occlusion levels for area to survive.

A

40%

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15
Q
  1. Total occlusion of what main coronary artery is catastrophic and results in death in minutes
    &
  2. What does it supply/how much
A
  1. Left main coronary artery
  2. Supplies 70% of Left Ventricular mass
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16
Q
  1. AMI predominantly affect where
    &
  2. Where can damage extend to
A
  1. Left Ventricle
  2. Right ventricle & Atria
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17
Q

RV infarction usually results from what obstructed arteries

A
  1. Right coronary
  2. Dominant left circumflex artery
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18
Q

What infarcts tend to be larger and result in a worse prognosis

A

Anterior infarcts

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19
Q

What infarcts involve the whole thickness of myocardium from epicardium to endocardium

A

Transmural Infarcts

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20
Q

What are Transmural infarcts usually characterized by

A

Abnormal Q waves on ECG

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21
Q
  1. Where do Nontransmural or subendocardial infarcts affect
  2. How do they present on ECGs
A
  1. Do not extend through the ventricular wall
  2. ST-segment and T-wave (ST-T) abnormalities
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22
Q

What infarcts usually involve the inner one third of myocardium

A

Subendocardial infarcts

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23
Q

AMI Risk Factors

A
  1. Dyslipidemia
  2. Family History
  3. Tobacco Use
  4. Diabetes
  5. Hypertension
  6. Age
  7. Lifestyle
  8. Obesity
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24
Q

ST-T abnormalities of ischemia include what

A
  1. ST-segment depression
  2. T-wave inversion
  3. ST-segment elevation
  4. Peaked T waves
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25
Name some of the S/S of AMI (There 19 in the slides)
1. Pain(arm, back, jaw, epigastrum, neck, chest) 2. Anxiety 3. Lightheadedness 4. pallor 5. weakness 6. syncope 7. Nausea 8. Vomiting 9. Diaphoresis 10. Chest heaviness/tightness 11. Cough 12. Dyspnea 13. Rales 14. Wheezing 15. S4 heart sound 16. Arrhythmias 17. Hypertension 18. Hypotension 19. Jugular venous distension  
26
Cardiac Markers
1. CK 2. CK-MB 3. Troponin I 4. Troponin T 5. Myoglobin
27
Immediate AMI Treatment
MONA 1. Morphine (painrelief) 2. O2 3. Nitroglycerine 4. ASA
28
General AMI Treatment
1. Relieve stress 2. Interrupt thrombosis 3. Reverse ischemia 4. Limit infarct size 5. Reduce cardiac workload 6. Prevent 7. Treat complications
29
QL5 Med Tech Chest Pain Protocol
1. Notify MO/PA/NP 2. Place position in semi-fowlers position 3. Oxygen via NRBM 4. IV TKVO – NS 5. 12-Lead ECG 6. Continuous monitoring 7. ASA 325-650mg
30
Rehabilitation and Post discharge Treatment (Dissecting Aortic Aneurysm)
1. Functional evaluation 2. Changes in lifestyle 3. Drugs
31
Rehabilitation and Post discharge Drugs (Dissecting Aortic Aneurysm)
1. Aspirin 2. β-blockers 3. ACE inhibitors 4. Statins
32
Rehabilitation and Post discharge Lifestyle Changes (Dissecting Aortic Aneurysm)
1. Regular exercise 2. Diet modification 3. Weight loss 4. Smoking cessation
33
What is DISSECTING AORTIC ANEURYSM
Surging of blood through a tear in the aortic intima causing a separation of the intima and media leading to creation of a false lumen
34
What is Deep Venous Thrombosis?
Development of single or multiple blood clots within deep veins of extremeties or pelvis. ## Footnote Slide 18 EO 010.01
35
Where can a Aortic Dissection occur
most commonly proximal ascending aorta or descending thoracic aorta But can also occur anywhere
36
What are the S/S of deep venous thrombosis?
1. Leg pain/cramps 2. Tenderness on palpation 3. Edema + erythema Can be asymptomatic. Extra credit: 4. Homan Sign (pain on dorsiflexion) 5. Lisker's sign (pain on percussion of medial tibia) 6. Bancroft/Moses Sign (pain on compression of calf against tibia) ## Footnote Slide 20, 21 EO 010.01
37
Aortic Dissection S/S
1. Abrupt, sharp or tearing pain 2. Shearing anterior chest pain radiating to interscapular region 3. Back pain 4. Syncope 5. Stroke 6. Abdominal pain 7. AcuteMI/angina 8. Hypo/hypertension 9. Wide pulse pressure 10. Murmur 11. Pulse deficits or asymmetry
38
Aortic Dissection Diagnosis
Transesophageal echocardiogram (TEE) CT angiography MRA Chest x-ray ECG Routine labs
39
Aortic dissection Treatment
Surgery Medications to decrease blood pressure Admission to ICU
40
What are some diagnostic tests for deep venous thrombosis?
1. D-Dimer 2. Constrast venography 3. Ultrasound ## Footnote Slide 22 EO 010.01
41
Aortic dissection Pt education
Activity Medications Surgical wound management
42
Tmt of deep venous thrombosis?
1. Bed rest (ha) 2. Medications like thrombolytics and anticoagulators 3. Surgical intervention ## Footnote Slide 24 EO 010.01
43
What is angina?
A condition that occurs when cardiac workload and myocardial oxygen demand exceends capacity of coronary arteries to supply oxygenated blood. Heart needs more oxygen than what is supplied, but no true blockage is present. ## Footnote Slide 61 EO 010.01
44
What are some causes of angina?
1. Atherosclerosis 2. Coronary artery spasm 3. Aortic stenosis 4. hypertrophic cardiomyopathy 5. Severe hypertension 6. Aortic insufficiency 7. Primary pulmonary hypertension ## Footnote Slide 62 EO 010.01
45
What are the 3 types of angina?
1. Classic 2. Variant 3. Unstable ## Footnote Slide 62 EO 010.01
46
S/S of angina?
1. Precordial pressure/heaviness 2. Discomfort up to crushing sensation on sternum 3. Dyspnea/choking sensation on exertion 4. Radiating pain ## Footnote Slide 63, 64 EO 010.01
47
What are some diagnostic tests for angina?
1. Monitoring 2. Imaging 3. Labs 4. Coronary arteriography 5. ECG ## Footnote Slide 65 EO 010.01
48
CAD Risk factors
High LDL, low HDL Type 2 diabetes Smoking Obesity Physical inactivity Poor power supply Poor stress management
49
CAD S/S
Chest pain below the sternum Exertional dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cardiac arrhythmias Systolic murmur Cardiomegaly Pedal edema
50
What is costocondritis?
Anterior chest wall pain associated with inflammation of the costochondral and costosternal regions ## Footnote Slide 98 EO 010.01
51
What are some causes of costochondritis?
1. Trauma 2. Overuse (over/unusual physical activity, URTI (coughing)) 3. Unknown ## Footnote Slide 99 EO 010.01
52
S/S of costochondritis?
1. Sharp pain in multiple locations, worse on mvmt 2. Chest tightness 3. Non-supportive edema and tenderness at rib articulations 4. Erythema and warmth at tender spots ## Footnote Slide 100 EO 010.01
53
What are some diagnostic tests for costochondritis?
None specifically, must rule out cardiac chest pain. Imaging might not be helpful. Get a thorough history. ## Footnote Slide 101 EO 010.01
54
Tmt of costochondritis?
1. NSAIDs 2. Oral Analgesics 3. Lidocaine/corticosteroid injections into joints ## Footnote Slide 103 EO 010.01
55
CAD Diagnostic Tools
ECG Exercise test Laboratory Triglycerides Complete cholesterol Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Imaging Angiography Echocardiography
56
What is hypertension?
Sustained elevation of resting systolic blood pressure greater than or equal to 140/90 ## Footnote Slide 33 EO 010.01
57
CAD DDX
Angina Thromboangiitis obliterans Cardiomyopathy Myocarditis Pulmonary embolism Pericarditis
58
What are primary vs secondary hypertension?
Primary is hypertension with no known cause, hemodynamic and physiological compenonents varying and unlikely to have singular cause. Secondary hypertension is hypertension caused by other pathologies such as kdiney disease, Cushing's syndrome, hyperthyroidism, etc ## Footnote Slide 34 EO 010.01
59
What is Acute Pericarditis
Acute pericarditis develops rapidly, provoking an inflammatory reaction
60
What can hypertension lead to?
1. Coronary artery disease 2. MI 3. Stroke 4. Renal failure 5. Cardiomyopathy 6. Heart failure 7. Aortic dissection ## Footnote Slide 36 EO 010.01
61
What is Chronic Pericarditis
Chronic pericarditis (defined as persisting > 6 months) develops slowly; its main feature is effusion. Acute disease can become chronic.
62
What is Constrictive Pericarditis
Constrictive pericarditis, which is not common, results from marked inflammation and fibrous thickening of the pericardium. Thick, rigid pericardium markedly disrupts ventricular filling, reducing stroke volume and cardiac output.
63
What are risk factors of hypertension?
1. Fx 2. Obesity 3. EtOH 4. Excess Na+ 5. Stress 6. Physical inactivity ## Footnote Slide 37 EO 010.01
64
S/S of hypertension?
1. Dizziness 2. Flushed face 3. Retinopathy 4. Increase S2 5. Headaches ## Footnote Slide 38 EO 010.01
65
Pericarditis can also be caused by? (2 things)
Pericardial Effusion Cardiac Tamponade
66
What causes pericarditis?
Infection Autoimmune disease Inflammatory disorder Uremia Trauma MI Medicines
67
Tmt of hypertension?
1. Weight loss/exercise 2. Smoking cessation 3. Dietary changes 4. Biofeedback and relaxation 5. Drug therapy for primary or secondary ## Footnote Slide 41 EO 010.01
68
Acute Pericarditis S/S
Chest pain Pericardial friction Dyspnea Chest pain can be relieved by sitting with the upper body bent forward Chest pain may be aggravated by torso movements Coughing, breathing, swallowing food
69
Diffuse Esophageal Spasm S/S
Substernal chest pain, accompanied by dysphagia for liquids and solids. Very hot or very cold liquids can exacerbate pain. In the absence of dysphagia, a sharp pain may also occur, similar to that of angina pectoris. This pain is often described as a twinge in the substernal region and may be associated with exercise.
70
Diffuse Esophageal Spasm Diagnostics
Barium X-rays Esophageal scintigraphy Esophageal manometry
71
Diffuse Esophageal Spasm DDX
Angina MI Hiatal hernia Esophagitis Esophageal perforation Aortic dissection Pericarditis
72
Diffuse Esphageal Spasm Tx
Calcium channel blockers Pneumatic expansion and bottlenecking Narcotic analgesics Surgical myotomy along the entire length of the esophagus. Botulinum toxin injections in the lower esophageal sphincter: a new approach
73
Diffuse Esophageal Spasm Patient Edu
Patient education will vary depending on how the disorder is managed. May include information on medications Surgery information
74
What is classic angina?
Sense of choking/pressure in the precordium, brought on by exertion or anxiety.
75
What is variant angina?
Angina occuring at rest after exercise or at night. Known as Pinzmetal's.
76
What is unstable angina
Angina that is new or changing in character, or both. Can signal impending MI.
77
What are some risk factors for angina?
1. Hypercholesterolemia 2. Hypertension 3. Tobacco abuse 4. Diabetes 5. Male 6. Age 7. Obesity
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