2. Vascular Disease Flashcards
Define Abdominal Aortic Aneurysm and state 2 types
A localized dilation of the abdominal aorta to >1.5x its original diameter OR >3cm.
Can be fusiform (bulges on both sides) or saccular (bulges on one side)
State causes/RF of AAA
- Atheroma (RF: HTN, smoking, hypercholestrolaemia)
- Connective Tissue Disease (Ehler Danlos, Marfans)
- Trauma
- M (F = increased rupture risk)
Whats the difference between true and pseudo-aneurysms?
True aneurysm are dilatations involving ALL layers of the arterial wall
Pseudoaneurysms involve a collection of blood in the outer layer, which communicates with the lumen.
Symptoms and signs of AAA
Majority asymptomatic
Large –> pain or pulsating sensations in the back
Pulsatile and expansive abdominal aortic mass
Ruptured AAA Symptoms and signs
- Severe abdominal pain, radiating to the back/groin (often confused with renal colic)
- Bleeding can result in hypovolaemic shock (low BP/ high HR) which can result in collapse
- Retroperitoneal bleeding may result in Grey Turner’s or Cullen’s Sign
Investigations/Management of AAA
Who is screened?
USS (based on aneurysm size)
1) Small (3-4.4cm) - 1yr follow-up scan
2) Medium (4.5cm-5.4cm) - 3mths follow-up scan; conservative: stop smoking, lose weight, exercise; medical: statins, BP meds, aspirin
3) Large (>5.5cm) or growth >1cm/yr - surgical: open aortic surgery (young pts, longer recovery) OR endovascular repair (less peri-operative mortality, higher risk of further procedures)
All males over 65 screened
Aortic Dissection definition and classification
A tear in the tunica intima resulting in blood accumulation between the inner and outer tunica media (false lumen).
Type A - Tear in the ascending aorta Type B - Tear in the descending aorta (after the left subclavian branch)
Aortic Dissection RF (6)
Hypertension Atherosclerosis Connective tissue disorders - SLE, Marfan’s, Ehler’s Danlos Iatrogenic - angiography/angioplasty Congenital - coarctation of aorta Cocaine
Aortic Dissection Signs and Symptoms
S - Central O - Sudden C - Tearing R - Back A - depends on position of tear: Carotids - blackout, hemiparesis; Coronary - MI, angina; Renal - AKI, renal failure; Coeliac trunk - abdo pain
TC BP > 20mmHg discrepancy b/t arms Wide pulse pressure Radio-radial delay Murmur heard on back below scapula Signs of aortic insufficiencyL collapsing pulse, EDM
Investigations for aortic dissection
Investigations
Bloods
- FBC, U&Es (renal damage)
- X Match 10 units of blood
- Cardiac enzymes (troponin) – usually negative
CXR - Widened mediastinum and aortic notch visible
ECG - often normal, maybe some ischaemia
CT angiography - Visualisation of dissection and intimal flap
- If CT unavailable in acute setting, Transoesophageal Echo very sensitive
Management of Aortic Diseection
Beta blockers + analgesia
Ruptured – haemodynamic support and resuscitation
Type A – Open Surgery
Type B – Endovascular Repair/ conservative management
A 69 year old man with a background of hypertension complained of flank pain all day at work. He then has sudden onset abdominal pain that radiates to his back and groin. He arrives in an ambulance unconscious. The doctor notes Grey Turner’s and Cullen’s signs. What is the most likely diagnosis?
Renal colic
Myocardial Ischaemia
Ruptured AAA
Pancreatitis
Ruptured AAA
A 65 year old gentleman is coming in for screening for a AAA following a letter received in the post. What modality would be used as a screening tool?
Abdominal Ultrasound
Abdominal CT
Abdominal X-ray
Doppler Ultrasound
Abdominal Ultrasound
The same gentleman, 3 years later with a known AAA (last measured 5.2 cm) comes in complaining of severe abdominal pain. What investigation would you use to assess if it has ruptured?
Abdominal Ultrasound
Abdominal CT
Abdominal X-ray
Doppler Ultrasound
Abdominal CT
A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis?
Aortic Dissection
STEMI
Teitze’s Syndrome
Costochondritis
Aortic Dissection
Which of the following examination findings is not consistent with an aortic dissection?
BP 100/40
Ejection systolic murmur
Collapsing pulse
Radio-radio delay
Ejection systolic murmur
Define Peripheral Arterial Disease
Definition:Narrowing of arteries other than those supplying the brain/heart. Most commonly seen in the legs.
- Intermittent claudification
- Critical Limb Ischaemia
- Acute Limb Ischaemia
Intermittent Claudication Definition, RF
Symptoms
- Cramping muscular pain in the calf, thigh or buttocks precipitated by exercise and relieved by rest (Reproducible claudication distance)
- RF – smoking, HTN, DM, cholesterol
- M >50 yrs alongside CVD
Intermittent Claudication Signs
Reduced peripheral pulses “punched out” ulcers Hair loss Cyanosis Brittle toenails Beurger’s Angle < 20°
Leriche’s Syndrome Definition and signs
Blockage of the abdominal aorta as it bifurcates into the common iliac arteries
Triad
Bilateral Claudication
Erectile Dysfunction
Reduced Femoral Pulses