3. Diseases of Aorta and Pericarditis Flashcards
Most common arterial aneurysm in adults is…
Abdominal aortic aneurysm
Criteria for aortic aneurysm
Segmental dilation of all layers of layers of aorta
In adults aneurysm = dilation >3cm (more than 50% of regular diameter)
Abdominal aortic aneurysm risk factors
HTN
Smoking
Age
Male
Atherosclerosis
Abdominal aortic aneurysm symptoms
None if unruptured
Pain, pulsatile mass, low BP if ruptured
Abdominal aortic aneurysm diagnostics
Ultrasound for symptomatic
CT for stable/surgery plan
Screen men 65-75 who ever smoked with ultrasound OR men/women with 1st degree relative
Abdominal aortic aneurysm treatment
No surgery until >5.5cm
Thoracic aortic aneurysm cause
Collagen disorders (Marfans, Ehrlers-Danlos)
Thoracic aortic aneurysm symptoms
Half asymptomatic
Maybe chest pain from trachea, esophagus, RLN compression
Thoracic aortic aneurysm signs
Feel aortic impulse at right sternal border
Thoracic aortic aneurysm diagnostics
MRI and CT most common
Chest x-ray = widened mediastinum
Thoracic aortic aneurysm treatment
Beta blockers to control BP
Worry about rupture >5cm
Aortic dissection cause
Tear in aorta leads to hematoma between layers
Aortic dissection classifications
Stanford:
A- Ascending involved (connective disorder)
B- Descending only (age, HTN)
DeBakey
1 - whole aorta
2 - only ascending
3 - no ascending/arch involved
Aortic dissection risk factors
HTN
Age
Male
Atherosclerosis
Aortic dissection symptoms
Abrupt ripping pain in back/chest
Type A = syncope
Type B = pain in back, legs
Aortic dissection diagnostics
CT = method of choice
Aortic dissection treatments
Depends on status
Emergency = surgical repair
Stable = aggressive BP control with beta blockers
Takayasu arteritis cause
Inflammatory disease of aorta and branches
Autoimmune
Takayasu arteritis symptoms
Fever
Constitutional symps
Claudication
Light headed
Cyanosis
Takayasu arteritis risk factors
Asian female, age 10-40
Takayasu Arteritis signs
BP discrepancy between arms
Takayasu arteritis diagnostics
CBC - Normocytic normochromic anemia (body hordes iron)
MRA or CTA best imaging
Inflammatory markers
Takayasu arteritis treatment
Systemic glucocorticoids
Giant cell/temporal arteritis cause
Inflammation of temporal artery
Giant cell/temporal arteritis risk factors
Scandinavian, age 50+
Giant cell/temporal arteritis symptoms
POTENTIAL PERMANENT BLINDNESS
Headache
Fever
Jaw pain
Giant cell/temporal arteritis diagnostics
Arterial biopsy ESSENTIAL
Giant cell/temporal arteritis treatment
Start steroids ASAP
Coarctation of aorta cause
Localized narrowing of aorta (usually after left subclavian)
Congenital
Coarctation of aorta symptoms
DECREASED PULSE/BP IN LEGS COMPARED TO ARMS
Secondary hypertension (young, refractory, very high BP)
Coarctation of aorta diagnostics
Echocardiogram
Coarctation of aorta treatment
Surgical stent placement
Acute pericarditis cause
Viral infection (cocksackie, echovirus, epstein-barr, flu, covid)
Acute pericarditis risk factor
Recent viral infection
Acute pericarditis symptoms
Sharp, sudden chest pain
(Worse with inspiration and supine position)
Acute pericarditis signs
Diffuse ST elevation and PR depression
Friction rub
Pericardial effusion (new or worsening)
Acute pericarditis diagnosis criteria
NEED TWO OF FOUR SIGNS/SYMPTOMS
- Sharp, sudden chest pain
- Diffuse ST elevation and PR depression
- Friction rub
- Pericardial effusion
Acute pericarditis treatment
Ibuprofen/Aspirin + Colchicine (x 1 month)
Corticosteroids if can’t take NSAIDs
Avoid strenuous exercise
Untreated acute pericarditis can develop into ….
Constrictive pericarditis
Constrictive pericarditis cause
MOST COMMON = TB (worldwide)
Constrictive = Tightly Bound (TB)
In US, idiopathic/radiation
Fibrous scarring of both pericardial layers
Constrictive pericarditis signs
MOST COMMON = JVP
Edema (anasarca)
Pericardial knock
Constrictive pericarditis diagnosis
Echocardiography
Constrictive pericarditis treatment
Treat cause (TB)
NSAID + Colchicine
Pericardiectomy
Pericardial effusion cause
Excess fluid in pericardial space
Pericardial effusion risk factors
Fever/infection
Cancer (neoplasm)
Radiation
Pericardial effusion diagnostics
BEST = echocardiography
EKG may have short waves
Pericardial effusion treatment
Deal with initial cause
Maybe drain or biopsy fluid
Cardiac tamponade cause
Pericardial effusion that restricts heart filling and stroke volume
Emergency!
Cardiac tamponade cause
Traumatic/acute injury
Cardiac tamponade symptoms
Chest pain
Dyspnea
Cardiac tamponade signs
BECK’S TRIAD:
Low BP
Distended JVP
Muffled heart sounds
Paradoxical pulse
Tachycardia
Cardiac tamponade diagnostics
EKG = ELECTRICAL ALTERNANS
Echocardiography
Cardiac tamponade treatment
URGENT drainage!
Cardiac tumors cause
Benign tumors (myxomas)
Most often in left atrial wall
Cardiac tumor symptoms
Constitutional
Cardiac tumor signs
Split S1
Early diastolic plop
(Mitral regurge)
(Embolism)
Cardiac tumor diagnosis
Echocardiography
Cardiac tumor treatment
Surgery
Cardiac trauma cause
MOTOR VEHICLE ACCIDENT
Commotio cordis = baseball to chest
Cardiac trauma is most often seen in this chamber of the heart …
Right ventricle
Aortic injury cause
Deceleration = tear in aorta after left subclavian
Cardiac trauma diagnosis
Echocardiography = impaired wall motion