Acute Aortic Syndromes Flashcards
Free rupture of Aorta often caused by occlusion of coronary Ostia
Catastrophic Dissection
Sudden onset of severe chest pain w/ back pain, abdominal pain syncope, stroke, and MI
Catastrophic dissection
Characterized by chest, back, or abdominal pain classified as abrupt onset, severe (10/10) intensity, and a “ripping or tearing” quality
Aortic dissection
Characterized by pulse deficit, new aortic regurgitation, and hypotension
Aortic Dissection
Most aortic aneurysms occur in the
Infrarenal abdominal aorta
By definition is a localized or diffuse dilation of an artery w/ a diameter at least 50% greater than its normal size
Aneurysm
Over the age of 65, degradation of aortic medial connective tissue due to increased MMP activity causes
Aortic Aneurysms
Ischemic injury of the media from atherosclerosis or damage to vasa vasorum can cause
Aortic aneurysms
Under the age of 65, the major reason for aortic aneurysms is
Syndromic CT disorders
The result of a disorder with fibrillin
Marian Syndrome
Aneurysmal degeneration that occurs in the thoracic aorta is termed
Thoracic Aortic Aneurysm (TAA)
A consistently high proportion of patients w/ TAA have family history. What are 3 inherited disease associated w/ TAA
Marian syndrome, Ehlers-Danlos, and Turner syndrome
Infection that causes small vessel arteritis which can lead to TAA
Syphilis
An inflammatory condition that can result in TAA
Takayasu Arteritis
Environmental risk is MORE important as this disease is more likely degenerative
Abdominal Aortic Aneurysm
Smoking, COPD, prior aneurysm, CAD, and hypertension are all risk factors for
Abdominal Aortic Aneurysm
Are usually asymptomatic until they rupture
Abdominal Aortic Aneurysms (AAA)
The typical finding of AAA on physical exam is a
Pulsations Abdominal Mass
When we see abdominal AND/OR back pain PLUS low BP, we think
Ruptured AAA
Screening is effective for an
AAA
What can we use to manage AAA’s of 5.5 cm or greater?
Endovascular Stenting
The presence of. Flow-limiting lesion in an artery that provides blood supply to the limbs
Peripheral Arterial Occlusive Disease
At rest, normal blood flow to the extremity muscle groups averages
300-400 mm/min
Each stenosis segment of an atherosclerotic limb acts to reduce the pressure experienced by
Distal muscle groups
With exertion, the reduction in pressure produced by the atherosclerotic lesion becomes more significant and the distal pressure is greatly
Diminished
The most common clinical manifestation of peripheral arterial disease
Pain w/ exertion, (claudication)
Reproducible ischemic muscle pain that occurs during physical activity and is relieved after a short rest
Intermittent claudication
Same symptoms as with claudication or tingling, weakness, or clumsiness.
-Relief with sitting or otherwise changing position
Spinal Stenosis
Pain, weakness, numbness in the legs when walking due to increased metabolic demands of compressed nerve roots
Neurogenic claudication
W/ neurogenic claudication, the pain is relived when the patient
Flexes spine by sitting
The most common form of ischemic limb is in the
Distal superficial femoral artery
This disease in the distal superficial femoral artery causes claudication in the
Calf muscle
Atherosclerotic disease in the aortoiliac areas can result in
Thigh and buttock claudication and male erectile dysfunction
Associated w/ increased risk of CAD in younger males
ED
Pathology of atherosclerotic PAD is identical to
CAD
40% of patients with PAD have clinically significant
CAD
Complete cardiovascular exam for PAD will focus on the
Lower extremity and pulse evaluation
What are two major physical findings consistent w/ chronic arterial insufficiency
Thickened toe nails and Dependent rubor
Dermal arterioles and capillaries no longer constrict in the presence of increased hydrostatic pressure
-suggestive of severe PAD
Dependent Rubor
At baseline, a healthy person may have a higher measured ankle pressure than arm pressure. A normal ankle-brachial index is
1.0 to 1.4
What is a medication that can be used to treat intermittent claudication?
Cilostazol
An inhibitor of phosphodiesterase 3 used to treat intermittent claudication
Cilostazol
Critical narrowing or thrombosis will cause
Rest pain
In the aorta, medial elastin layers decline from
Proximal to distal
Layer of aorta comprised of endothelial cells overlying the IEL
Intima
Layer of aorta composed of SMCs and an ECM of collagen and elastic fibers
Media
Layer of aorta composed of collagen, perivascular nerves, and vasa vasorum
Adventitious
The presence of elastic lamellae allows the aorta to withstand
High pressures
A glycoproteins that helps to maintain the structural integrity of the aortic wall and valve leaflets by tethering VSMCs to a matrix of elastin and collagen
Fibrillin-1
Leads to VSMC detachment from elastin and collagen inducing apoptosis and loss of ECM structural integrity
Deficiency of fibrillin-1 (i.e. Marian syndrome and Bicuspid Aortic Valve)
As we age, which component of the aorta begins to degrade?
-Leads to stiff aorta
Elastic component
Usually manifests as a discrete constriction of the aortic isthmus
Coarctation of the aorta
Associated with other congenital heart defects such as bicuspid aortic valve and Turner syndrome
Coarctation of the Aorta
Does not cause a hemodynamics problem in utero, as two-thirds of the combined CO flows through the PDA into the descending thoracic aorta
Coarctation of the aorta
Causes increased afterload and the development of aortic collaterals and hypertension
Pathophysiology
Development of aortic collaterals can lead to
Nothing of the ribs
A classic finding of coarctation of the aorta is
Radial artery to femoral pulse delay
The majority of adult patients w/ coarctation are detected via
Incidental hypertension
Gives a systolic/holosytolic murmur w/ left paravertebral interscapular area
Coarctation of the aorta
