Gp-Mksap-Cardio-07

Front 1

=== AORTIC DISEASE ===

Back 1

=== AORTIC DISEASE ===

Front 2

NOTE: All patients with Marfan syndrome and associated aneurysm should receive

Back 2

i) ß–blockers in the absence of a contraindication. (prevents dissection)
ii) yearly echos up to 4.5 cm, q6 mo 4.5–5.5, repair > 5.5

Front 3

what is an "endoleak?"

Back 3

incomplete exclusion of the aneurysm sac by the endograft with continued blood flow into the area

Front 4

Acute aortic syndromes

Back 4

aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer

Front 5

result from rupture of the vasa vasorum or “microtears” in the intima, resulting in a crescent of hematoma within the media without identifiable interruption of the intima

Back 5

Intramural hematomas

Front 6

H&P findings in acute aortic syndromes / dissection (4)

Back 6

Migratory pain, significant differences in arm BP, palpated pulse discrepancies or deficits, and aortic insufficiency murmur (Pain, murmur, BP, pulse)

Front 7

treatment of acute aortic syndrome not in shock

Back 7

IV B blocker to reduce HR to 60–80; IV antiHTNive (Na nitroprusside or fenoldopam) to dec MAP to lowest allowable with adequ visceral and cerebral perfusion

Front 8

Stanford classification of aortic injury

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type A originating within ascending aorta or arch, type B originate distal to left subclavian

Front 9

treatment of type a or type b aortic injury

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type A generally needs surgery; most type b should be treated medically

Front 10

Features of Loeys–Dietz syndrome?

Back 10

Aortic Dilatation
Bifid uvula or cleft palate

Hypertelorism

Craniosynostosis

Skeletal features similar to Marfan syndrome

Thin, translucent skina

Front 11

when to do interventional therapy for type B aortic syndromes?

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Occlusion of major aortic branch with visceral or limb ischemia; Progressive dilation or extension despite medical therapy; Contained rupture of type B dissection; Penetrating ulcer =20 mm in diameter and >10 mm in depth; Penetrating ulcer with intramural hematoma

Front 12

treatment of aortic atheroma

Back 12

atheroma > 4 mm proximal to the left subclavian artery is a risk factor for recurrent stroke.

statins; if with unexplained stroke – treat with warfarin to INR 2–3 or antiplatelets

Front 13

when is elective repair of asymptomatic AAA recommended

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at 5.5-6 cm or if expansion of greater than 0.5 cm/year is noted. (Symptomatic AAA should be treated urgently regardless of size)

Front 14

what size to repair asymptomatic thoracic and abdominal AA?

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thoracic > 6 cm

Abdominal > 5 cm

Front 15

treatment of symptomatic or asymptomatic large AAAs in patients with a life expectancy greater than 2 years

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Open surgical or endovascular aneurysm repair (EVAR)

Front 16

=== PERIPHERAL ARTERIAL DISEASE ===

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=== PERIPHERAL ARTERIAL DISEASE ===

Front 17

Who to screen for PAD?

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Age >= 50 + (DM | smoking)

Age >= 65

Exertional leg symptoms

Non-healing leg ulcers

Front 18

claudication pain based on level of obstruction

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claudication most often experienced just distal to the level of obstruction

aortoiliac disease = buttock or thigh pain, superficial femoral disease = upper calf pain, popliteal disease = lower calf pain

Front 19

atherosclerotic disease within the aortoiliac system, sx?

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Buttock and hip claudication, diminished femoral pulses, and erectile dysfunction

(Leriche syndrome)

Front 20

ABI interpretation

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ABI for each leg = ankle pressure for that side divided by the highest brachial pressure (regardless of side).
<0.90 = PAD;

< 0.40 = severe PAD;

>1.40 = calcified vessels and not interpretable

Front 21

toe–brachial index

i. When to use?

ii. interpretation?

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i. can be used if ABI > 1.4 as toe vessels less likely to be calcified

ii. <0.70 = PAD.

great toe systolic pressure >40 mm Hg = normal

Front 22

Patient with borderline-normal ABI, but sx suggestive of PAD, wtd

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do exercise test:

Decrease of ABI >= 20% after exercise => significant PAD

Front 23

a direct arterial vasodilator that has been shown to significantly increase pain–free walking distance in patients with claudication

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cilostazol

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symptomatic treatment of PAD

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EXERCISE
Cilostazol – (AVOID in HF)

Pentoxifylline – if intolerant of Cilostazol

cardiovascular risk reduction (smoking cessation, lower cholesterol, treat HTN

Front 25

NOTE: β–Blockers do not worsen PAD and

Back 25

should be used when appropriate for a cardiac indication.

Front 26

NOTE: Combination treatment with an antiplatelet agent and warfarin, and warfarin monotherapy (adjusted to an INR of 2.0–3.0), is

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no more effective than antiplatelet therapy alone and carries a higher risk of life–threatening bleeding. (PAD)

Front 27

Interventional therapy of PAD?

i. common femoral

ii. deep femoral

iii. superficial femoral

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i. endarterectomy (no stent) +/- surgical patch repair

ii. open surgery

iii. surgery(> 5cm), stent, balloon, etc

Front 28

indication for amputation of limb?

Back 28

Profound anesthesia
Profound paralysis
Inaudible doppler

Front 29

indication for immediate revascularization

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sensory loss–More than toes
weakness – Mild to moderate
Doppler Inaudible

Front 30

indication for prompt revascularization

Back 30

sensory loss– minimal / toes
weakness – None
Doppler Inaudible

Front 31

=== CANCER & CARDIO ===

Back 31

=== CANCER & CARDIO ===

Front 32

Radiation therapy, cardiac complications?

Back 32

Acute pericarditis / effusion - (2-5 mnths)

Pericardial Fibrosis - RV failure

CAD - incr risk even w/o risk factors

Valvular fibrosis + regurg

Myocardial fibrosis (worse with antracycline)

Fibrosis of conduction paths - block

Front 33

Radiation–induced constrictive pericarditis presentation?

Back 33

typically manifests with right–sided findings of heart failure disproportionately greater than that of left

Front 34

Cardiac surveillance after radiation tx?

Back 34

asymptomatic: echocardiography 10 years after irradiation

if pt CAD or risk factors for it before RXT: nuclear perfusion stress test 5 years after therapy

Front 35

cardiotoxicity of trastuzimab vs anthracyclines?

Back 35

Unlike cardiomyopathy caused by anthracyclines, trastuzumab–induced ventricular dysfunction is largely reversible and not typically progressive.

Front 36

doxorubicin cardiotoxicity?

Back 36

Heart failure (1.6%–5%):
– Higher in elderly women
– Typically irreversible
– Improved by aggressive treatment (resynchronization therapy)
– LV dysfunction (progression slowed by standard treatment)
– Dilated CM

Front 37

Suggested HF monitoring after chemo?

Back 37

EF < 55%, follow ACC guidelines

If symptomatic, do NST. Also rpt echo q6 mo if diastolic dysfunction.

If no sx, rpt echo q12 mo with diastolic dysfunction, q5yrs w/o

Front 38

Chemo Meds with late onset cardiotoxicity?

Back 38

Anthracyclines: doxo, dauno, epi rubicin

Mitoxantrone

Cyclophosphamide

Cisplatin

5-FU

Trastuzumab

IL-2, IF-alpha

Front 39

Risk factors for development of doxorubicin-induced dilated cardiomyopathy

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cumulative dose of doxo > 550 mg/m2,

age > 70 years at time of chemo

the addition of another cardiotoxic agent,

radiation therapy to the thorax,

HTN

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u

Back 40

u

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u

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u

Front 42

========== CVD & PREGNANCY =========

Back 42

========== CVD & PREGNANCY =========

Front 43

Pregnancy normal vs pathologic findings:
i) SOB
ii) Palp
iii) CP
iv) Murmur

Back 43

normal / path
i) Mild DOE / orthop/PND
ii) APC, PVC / fib, flutter, VT
iii) none / any
iv) Systolic 1–2 / systolic >=3 Or any diastolic

Front 44

Pregnancy normal vs pathologic findings:
i) tachy
ii) BP
iii) Edema
iv) gallop

Back 44

i) 20–30% inc / > 100
ii) drop by 10 mm / symptomatic
iii) mild peripheral / pulm edema
iv) S3 / S4

Front 45

Prognosis, pregnancy with valve dz?

Back 45

– obstructive cardiac lesions develop symptoms during pregnancy
– regurgitant valve lesions: tolerate pregnancy reasonably well.

Front 46

Peripartum cardiopmyopathy, tx?

Back 46

– (β–blockers, digoxin, hydralazine, nitrates, and diuretics) start ASAP
– HOLD ACE/ARB, spironolact until after delivery

EF <35%: warfarin



Also IVIG, pentoxyphiline, bromocriptine

Front 47

drug of choice during pregnancy:
i)anti–platelet
ii) beta blocker
iii) vasodilator
iv) ventricular arrythmias
v) class I anti–arrythmic

Back 47

i) ASA
ii) Labetalol
iii) hydralazine
iv) Lidocaine
v) quinidine