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Cardiology Exam 4 > ANEURYSM DISEASE > Flashcards

ANEURYSM DISEASE Flashcards

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1
Q

complications of an untreated aneurysm?

A
  • Rupture
  • Dissection
  • Embolism of material distally
  • Thrombosis of the Aneurysm
  • Aorto-enteric Fistula
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2
Q

Etiologies of Aneurysms?

A
  • ATHEROSCLEROSIS • Most occur in the 6th & 7th decade of life
  • Often associated with: – C.A.D. – Hypertension – Cerebral Vascular Disease – Renal Impairment – Diabetes – C.O.P.D.
  • Syphilis – Is a late Complication of – Previously most common cause
  • Cystic Medial Necrosis – Marfan’s Syndrome – Small percentage of aneurysms
  • Ehlers-DanlosSyndrome – Loss of Elastic Fibers
  • Trauma
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3
Q

Risk factors for aneurysms?

A
  • Age (increases with age, 60-80)
  • Gender (incidence greater in males)
  • Family History (15% familial)
  • Atherosclerosis
  • Hypertension
  • Smoking
  • plus: other atherosclerotic associated risk factor
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4
Q

Aneurysm classifications are based on?

A

•Location •Type •Pathology

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5
Q

Locations of aneurysms?

A

Aortic Locations: • Sinus of Valsalva • Ascending Aorta • Transverse Aortic Arch • Descending Thoracic Aorta • Thoraco-Abdominal Aorta • Abdominal Aorta – Infra-renal = 90%

• Iliac Artery • Femoral Artery • Popliteal Artery • Carotid Artery • Mesenteric Arteries – Splenic

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6
Q

What is a fusaform aneurysm?

A

• Ovoid configuration
Involves the Entire Circumference of the artery

TRUE: • Fusiform shape - usually • Has all the elements of the vessel wall • Localized Dilation of the Artery • Weakening of the whole wall of the artery

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7
Q

What is a saccular aneurysm?

A

Aneurysmal Defect is confined to a portion of the circumference of the arterial wall, the remainder is uninvolved

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8
Q

What is a pseudo-aneurysm?

A

FALSE (Pseudo-aneurysm) • Does not include all the layers/elements of the arterial wall • Adventiais Usually Intact • Frequently due to TRAUMA • “Hematoma” • Can be due to instrumentation of an artery – Surgery or Percutaneous

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9
Q

Explain a dissecting aneurysm?

A

DISSECTING: • False Lumen • The histological layers of the arterial wall are separated by blood entering through an intimal tear • There is Progressive Extension of the False Lumen Proximally and/or Distally

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10
Q

What is a mycotic aneurysm?

A

• InfectedAneurysm – Bacterial – Fungal • Tuberculosis – Syphilitic • Infected Pseudo-aneurysm • Dissection • Embolization • Fistula

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11
Q

What is a sinus of valsalva aneurysm?

A

• Uncommon • Male >Female • Average age 31 • Etiology – Usually congenital weakness – Bacterial Endocarditis – Tuberculosis – Syphilis • Rupture – into Right Ventricle or Atrium

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12
Q

What are the symptoms of the sinus of valsalva aneurysm?

A

• Pain –Angina like –Right upper quadrant • Nausea / Vomiting • Dyspnea • Feeling of Constriction

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13
Q

Findings of a sinus of valsalva aneurysm?

A

• Often found incidentally at heart catheterization or on C.T. Scan • Asymptomatic (usually) unless Rupture • Murmur +/– Partial obstruction of Pulmonary outflow tract – If concurrent aortic valve disease • C.H.F. • Wide Pulse Pressure • Death

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14
Q

what is an ascending throacic aneurysm? its etiologies?

A
  • Fusiform • Associated Hypertension 90% • There may be concomitant atherosclerotic occlusive disease in other areas • 50% of thoracic aneurysms
  • 6th and 7th decade of life –can be earlier • Male > Female • Atherosclerosis • Syphilis –Most common cause in the Past –May be saccular
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15
Q

Symptoms of an ascending thoracic aneurysm?

A

• Pain +/• Usually secondary to Compression, Distortion or Erosion of surrounding structures • Rupture • May become quite large without symptoms • Dyspnea – Compression of trachea or bronchus

Pain: • May be Acute if Sudden Rupture or Dissection • Mild if Gradual expansion • Radiate – Neck, back, shoulder or abdomen • If pain is increasing it is an Ominous sign

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16
Q

Findings of an ascending thoracic aneurysm?

A
  • Palpable only if extends above the supra-sternal notch - rare
  • Tracheal Deviation
  • Murmur – Aortic Valve Insufficiency (AVI) – Aortic Valve Stenosis (AVS)
  • Heart Failure – AVI
  • Hoarseness – Stretch on Vagus or Recurrent Laryngeal Nerve • Left vocal cord paralysis
  • Dysphagia - Compression of Esophagus
  • Embolic findings/symptoms
  • Sudden Death – Shock – Cardiac Tamponade
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17
Q

Evaluation of ascending thoracic aneurysm?

A
  • CXR – Widened Mediastinum – Calcification
  • C.T. scan
  • MRA
  • Echocardiography
  • Arteriography – Lumen may appear normal if laminated thrombus
18
Q

Acute treatment of Ascending thoracic aneurysm?

A

Medically Stabilize: • Control Blood Pressure – Beta Blocker - control cardiac contractility • Propranolol - Inderal® (historical) • Esmolol - Brevibloc® • Labetalol - Normadyne® – After-load Reduction - reduce hypertension • Sodium Nitroprusside - Nipride® • Labetalol - Normadyne®

19
Q

Surgery for Ascending thoracic aneurysm?

A 
Surgery: 
• Mediansternotomy 
• Extracorporal Bypass
• Interposition Graft 
• Patch Graft 
• Valve conduit if aortic valve involved
20
Q

A descending thoracic aneurysm can be which types? most commonly?

A
  • Fusiform –Most
  • Saccular –Rare
  • Mycotic –Bacterial –Syphilis
21
Q

what is a descending thoracic aneurysm?

A
  • 40% of Thoracic aneurysms
  • Expand slowly - rarely rupture
  • 6th thru 8th decade
  • Majority begin just distal to the Left Subclavian artery • Length –Localized to… –Full length of the Aorta
22
Q

Etiologies of descending thoracic aneurysm?

A
  • Atherosclerosis
  • May be associated with Trauma – at left subclavian artery (ductus arteriosum)
  • Hypertension
  • Cystic Medial Necrosis
  • Syphilis - rare
23
Q

Symptoms of a descending thoracic aneurysm?

A
  • Usually Asymptomatic
  • Pain can be the first symptom
  • Compression symptoms – Stridor – Cough – Dyspnea – Hoarseness – Erosion
  • Hemoptysis
24
Q

Findings of a descending thoracic aneurysm?

A
  • Often diagnosed on Routine CXR – Calcification
  • Usually no specific physical findings
  • Bruit ?
  • Reduced Left Arm BP if Subclavian artery is involved
  • Evidence of Dissection – Asymmetric pulses
25
Q

Evaluation of a descending thoracic aneurysm?

A
  • Chest x-ray
  • T.E.E.
  • C.T. Scan / C.T.A.
  • MRA
  • Arteriography
26
Q

Treatment of descending thoracic aneurysm?

A
  • Medical - acute –Control of Blood pressure –Negative Inotropy
  • Surgery –Bypass –Shunt –Clamp, Cut, Sew
27
Q

What is a thoraco abdominal aneurysm ?

A
  • Less common
  • Etiology – Atherosclerosis (most)
  • Symptoms – Vague
  • Often Diagnosed Incidental to other evaluation
  • Treatment (Complex) –Surgery - Often Staged –Endovascular
28
Q

what is a infra-renal abdominal aortic aneuryms?

A
  • 90% - 95% aneurysms are below the Renal Arteries
  • Aorta is normally < 3 cm (non-pathologic)
  • 60 - 70 years old
  • Male > Female (5:1)
  • May involve one or both Iliac Arteries
  • Dubois – 1951, repaired with Homograft
29
Q

Etiologies of infra-renal abdominal aortic aneuryms

A

• Atherosclerosis • Associated –HTN –Diabetes • Infectious –Rare –Gram positive (more common) • Ehlers Danlos syndrome

30
Q

Symptoms of infra-renal abdominal aortic aneuryms?

A
  • Typically Asymptomatic till Rupture
  • Pain –Pain of Rupture may be the First Symptom
  • May begin weeks or months before rupture –Abdominal Pain –Back Pain –Radiated Pain – Flank / Groin / Chest
  • Pulsating sensation
  • Sense of Fullness
  • Compression symptoms –Intestine –Ureter –Bladder
  • GI Bleeding- fistula
  • Inferior Vena Cava – Erosion, Rare <1%
31
Q

findings of a infra-renal abdominal aortic aneurysm?

A
  • Palpable Aneurysm –Pulsatile –“Expansatile”
  • Findings of Thrombosis
  • Thrill / Bruit
  • Pulses Distally - normal (+/- if PAD)
  • Shock
32
Q

Rupture of an infra-renal abdominal aortic aneurysm?

A
  • History of AAA
  • 75% Retroperitoneal
  • 25% Intraperitoneal –Rapid Exsanguination
  • Pain
  • Pulsatile Mass
  • Hypotension
33
Q

Evaluation of infra-renal abdominal aortic aneurysm?

A
  • CT scan: • Excellent study • Shows Rupture • Now more convenient to obtain than in the past
  • Back X-ray
  • Ultrasound of Abdominal –Gallbladder evaluation
  • Screening tests
  • Etc.

Arteriogram: • Not for Diagnosis of aneurysm • May (+/-) help to evaluates Anatomy in preparation for repair • Risks

Ultrasound: • Bedside • Sensitive • Specific • Excellent to follow the Status of the Aneurysm • Bowel gas may interfere with evaluation

34
Q

treatment upon observation of an infra-renal abdominal aortic aneurysm?

A

Observation: • Conservative Management • Must weight risk of Rupture vs. Repair – May be a difficult call • Frequent Surveillance – Ultrasound – CT Scan (if U/S is not suitable) – Every 4 – 12 months

35
Q

Elective repair of an infra-renal abdominal aortic aneurysm?

A
  • 3 cm?, 4 cm?, 5 cm? or 6 cm?
  • Double the size of the Native Aorta – Usually compared to the supra-renal dimension
  • When patients health may afford the best opportunity • Surgery – open abdominal repair
  • Endovascular approach – percutaneous
  • Elective repair - 1% - 5% mortality
36
Q

Emergency repair of an infra-renal abdominal aortic aneurysm?

A

• Differential Diagnosis – Need to consider what else it could be

  • Resuscitate – Fluids – Blood products (transfusion)
  • Surgery / (EVAR) – Emergency: 50% mortality (vs. <5% for elective)
37
Q

Femoral aneurysms?

A

• FEMORAL –Frequently Pseudoaneurysms –Associated with instrumentation of the vessel

38
Q

Popliteal aneurysms?

A

POPLITEAL –May be associated with A.A.A. –Initial presentation may be Embolic –May present with pain

39
Q

Mesenteric aneurysms?

A

MESENTERIC –Splenic most common

40
Q

Symptoms of an aortic dissection? Diagnostic test? Mortality?

A
  • Symptoms – Pain • Sharp tearing pain (50%) • Migratory pain (15%) – Neuro-symptoms – can be transitory – Beware of Chest Pain, Neurologic Symptoms and Limb changes!
  • CXR – is suspicious 65% of the time
  • Mortality is 1-2% per hour • 75% dead in 2 weeks

Cardiology Exam 4 (21 decks)

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