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1ST YEAR SYSTEMS: Cardiovascular > Aneurysms and carotid artery disease > Flashcards

Aneurysms and carotid artery disease Flashcards

1
Q

what is aneurysm disease of the aorta

A

dilatation of ALL layers of the aorta, leading to an increase in diameter of >50%
due to weakening of the vessel wall

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2
Q

artery wall is made up of what 3 layers of tunica

A

tunica externa
tunica media
tunica intima

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3
Q

causes of aneurysm disease? (3)

A

Degenerative disease

Connective tissue disease (e.g. Marfan’s disease)

Infection (mycotic aneurysm)

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4
Q

risk factors for abdominal aortic aneurysm disease?

A 
male sex 
age 
smoking 
hypertension
syphilis 
salmonella
family history (30% prevalence in 1st degree male relatives)
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5
Q

prevalence of AAA disease in the UK?

A

3%

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6
Q

who is abdominal aortic aneurysm screening available for on the NHS

A

ultrasound for men during the year they turn 65

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7
Q

if a patient has a large AAA of >5.5cm on screening what happens?

A

urgent referral to vascular surgeon

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8
Q

what qualities must a screening test have?

A

high sensitivity (ability to designate an individual with disease as positive) and specificity (to see if it’s false)

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9
Q

criteria for screening for AAA?

A 
Definable disease
Prevalence
Severity of disease
Natural history – normal aorta which gets larger and larger and then bursts 
Reliable detection
Early detection confers advantage
Treatment options available
Cost
Feasibility
Acceptability
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10
Q

symptoms that may present on impending rupture

A

increasing back pain

tender AAA

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11
Q

symptoms that may present on rupture

A

abdominal/ back/ flank
(between ribs and hip on side of body) pain

painful pulsatile mass

haemodynamic instability

hypoperfusion - cold feet, confused/unconscious

may cause sudden death

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12
Q

rare presentations of AAA

A

distal embolisation - trash foot
Aortocaval fistula - aneurysm erodes into inferior vena cava
blocking of one of the ureter tubes or small bowel

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13
Q

What is the management of AAA if patient is asymptomatic?

A

is the aneurysm a size to consider repair?
is the patient a candidate for repair?
is the aneurysm suitable for endovascular or open repair

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14
Q

How to assess patient fitness

A 
Full history and examination 
bloods
ECG
ECHO 
PFTs - Pulmonary function tests
End of bed test
CPEX - Cardiopulmonary Exercise Test
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15
Q

What imaging can be done to assess AAA

A

ultrasound - inadequate for surgical planning

CT abdomen or MRA- magnetic resonance angiogram - blood vessels

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16
Q

what is the best imaging technique to choose

A

CT however radiation could cause problems with younger patients that may get lots of scans over the course of their life

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17
Q

treatment for AAA

A

conservative - patient or aneurysm may not be fit for repair. Consider event of rupture
endovascular repair
open repair

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18
Q

what is endoleak

A

persistent blood flow outside the lumen of an endoluminal graft but within the aneurysm sac

caused by incomplete sealing or exclusion of the aneurysm sac.

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19
Q

which type of aortic dissection is most common

A

type A- on the ascending aorta

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20
Q

open repair vs endovascular aortic repair

A

EVAR good in short term - less invasive
open is durable

however if you are not fit for it you don’t do anything

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21
Q

Management of symptomatic AAA

A

ABCDE - airways etc
history, check records
CTA maybe - computed tomography angiography

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22
Q

how do patients get diagnosed with AAA

A

usually incidental finding through screening or symptomatic

23
Q

process of management/ treatment once anuerysm reaches 5.5cm or if it is expanding at >1cm a year or if symptomatic?

A

then assess patient’s fitness and assess aneurysm to see whether to do EVAR or open repair

24
Q

who is involved in management of carotid disease to prevent further events

A

vascular surgeons

25
Q

Transient Ischaemic Attack (TIA)

A

Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia.

Symptoms last less than 24 hours and there are no permanent neurological conditions as a consequence of this.

26
Q

What is a stroke

A

rapidly developing

clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.

27
Q

what is carotid disease

A

disease of the carotid arteries - narrowing or blockage of them perhaps by atherosclerosis

28
Q

what are the 2 different types of stroke

A

haemorrhage

ischaemic

29
Q

Causes of stroke (/TIA)

A

AF
Carotid atherosclerotic plaque rupture/thrombus (15%)
Endocarditis
MI
Carotid artery trauma/dissection
Drug abuse
Haematological disorder e.g. sickle cell disease

30
Q

risk factors for carotid artery atherosclerosis

A 
Smoking
Diabetes
Family history
Male sex
Hypertension
Hyperlipidaemia/hypercholesterolaemia
Obesity
Age
31
Q

How would you diagnose carotid disease?

A

History

Examination - neurological - checking both sides of body for symptoms.
Cardiac and auscultate carotids

CT

Carotid Ultrasound scan

32
Q

what would happen to someones eyesight with TIA

A

rapid deterioration

33
Q

What does carotid artery imaging/ doppler test help to evaluate

A

blood flow — images of arteries and info about blood flow re both its speed and direction

34
Q

what happens to velocity as radius of a vessel decreases due to stenosis in carotid disease?

A

the velocity increases
there is a larger pressure drop than usual and blood is pushed faster through as heart pumping faster to make sure blood reaches tissues

35
Q

Best treatment options to prevent carotid disease? (5)

A 
smoking cessation
control of hypertension
antiplatelet medication
statins - lower cholesterol
diabetic control
36
Q

what is the circle of willis

A

circulatory connection between cerebral arteries that keeps the brain and surrounding structures perfused

37
Q

what is a carotid doppler test?

A

imaging test that uses ultrasound study to evaluate blood flow through a blood vessel

38
Q

Carotid endarterectomy

A

surgical procedure to remove plaque from carotid artery if artery has 50-60% stenosis.

39
Q

what can a carotid endarterectomy maybe prevent if carotid artery is severely narrowed?

A

a stroke

40
Q

general and nerve complications with Carotid endarterectomy

A

General:-
Wound infection, bleeding, scar, anaesthetic risks

Nerve damage:-
vagus
hypoglossal

41
Q

how can you tell if someone has hypoglossal nerve damage?

A

Usually, one side of the tongue is affected, and when the person sticks out his or her tongue, it deviates or points toward the side that is damaged.

42
Q

Causes for perioperative stroke complication in endarterectomy

A

plaque rupture
hypoperfusion
virchow’s triad - raw intimal surface and thrombosis

43
Q

TRUE or FALSE

there is no carotid stenting in Scotland

A

true

44
Q

what do current guidelines suggest for treatment of asymptomatic patients with stenosis of 60-99% stenosis if under 75 years old?

A

Carotid endarterectomy (CEA) doesn’t normally fix it - more prophylactic

45
Q

when is the most risky period for further event?

A

2 weeks after TIA or stroke

46
Q

what do you offer for all symptomatic patients with >70% stenosis (except occluded)

A

carotid surgery

47
Q

why is surgery not offered if carotid artery is 100% occluded?

A

because the risk of stroke and significant brain damage from the procedure is too great

48
Q

where would you find a popliteal aneurysm

A

behind knee

49
Q

where would you find a femoral aneurysm

A

near groin at front

50
Q

aortic dissection-

RFs, signs, symptoms, diagnosis/investigation, management

A

RFs:
Hypertension, atherosclerosis, trauma, Marfan’s, Cystic medial necrosis

Signs:
Back pain 
Reduced/absent peripheral pulses
Acute - hypotension chronic - hypertension
AR murmur
pulmonary oedema

Symptoms:
Acute - sharp chest pain - radiating to the back
collapse (tamponade, acute A, external rupture)
Chronic - asymptomatic

Diagnosis/investigation:
CXR - widened mediastinum
CT/MRI
TOE - transoesophageal echocardiogram - ultrasound of your heart using a special probe that scans the heart from inside oesophagus

Management - Type A - surgery - arch replacement
Type B (not the ascending aorta) - meticulous antihypertensive treatment, Na nitroprusside + beta blocker
stenting
Long term follow up - CT/MRI

51
Q

which is more commonly ruptured? aortic dissection or abdominal aorta aneurysm?

A

aortic dissection

52
Q

symptoms/ signs of thoracic aortic aneurysm

A

signs:
hypotension
tachycardia
pulsatile mass

symptoms:
Most asymptomatic 
rapid expansion/rupture:
Severe pain, sudden death
Stridor 
SOB
hoarseness 
haemoptysis
53
Q

what is coarctation of the aorta?

A

narrowing of the aorta at the distal to the insertion of the ductus arteriosus

54
Q

coarctation of the aorta:

RFs, signs, symptoms, diagnosis/investigation, management

A

RFs:
Male
Turner syndrome
Bicuspid aortic valve

Signs:
Upper limb hypertension
weak, delayed pulses in legs
Poor peripheral pulses in severe cases
Mid-late systolic murmur - aortic stenosis
Vascular bruits may be heard
Symptoms:
Asymptomatic 
headaches 
nosebleeds 
claudication

diagnosis/investigations:
CXR - dilated aorta - indent at coarctation
ECG - LV hypertrophy
Echo - coarctation
CT/CMR - accurately demonstrate coarcation and quantify flow

Management:
neonates - surgical repair
older children/adults - balloon dilatation and stenting - angioplasty is an option but surgery still used often
if it is a second time having coarctation - angiplasty better option

1ST YEAR SYSTEMS: Cardiovascular (39 decks)

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