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Clin Med II MHM - Cardio 2 > Aorta + PAD Lectures > Flashcards

Aorta + PAD Lectures Flashcards

1
Q

How does aortic diameter normally vary between ascending, descending thoracic, and abdominal?

A
  • Ascending 3 cm
  • Descending thoracic 2.5 cm
  • Abdominal 1.8 to 2.0 cm
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2
Q

Why is the aorta prone to injury and disease?

A

Constant exposure to high pulsatile pressure and shear stress

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3
Q

Which vessel is more prone to rupture than any other?

A

Aorta

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4
Q

How is the wall of the aorta divided?

A
  1. Intima (thin inner layer)
  2. Media (thick middle; gives aorta strength, elasticity and distensibility)
  3. Adventitia (thin outer)
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5
Q

What is the aortic root and its purpose?

A
  • Lower segment of ascending aorta
  • Supports valve leaflets
  • Extends into sinotubular junction (area where R/L coronaries arise)
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6
Q

What is the sinotubular junction?

A

Area where right and left main coronaries arise

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7
Q

What is the aortic isthmus?

A
  • Point where aortic arch joins descending aorta

- Vulnerable to trauma

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8
Q

Which features of the aorta decrease with age?

A
  • Elasticity

- Distensibility

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9
Q

Loss of aortic elasticity is accelerated in patients with:

A
  • HTN
  • Hypercholesterolemia
  • CAD
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10
Q

Diseases of the aorta are:

A
  1. Aneurysms

2. Dissections

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11
Q

Define aortic aneurysm

A
  • Pathologic dilation anywhere along the course of the aorta

- Involves ALL layers

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12
Q

2 types of aortic aneurysm

A
  1. Fusiform (entire circumference of a segment affected)

2. Saccular (outpouching, only involves a portion of circumference)

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13
Q

What are the complications of aortic aneurysms?

A
  • Dissection

- Acute rupture (greatest fear)

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14
Q

What is the MC common etiology of ascending aortic aneurysms?

A

Cystic medial necrosis

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15
Q

What is the MC common etiology of aortic arch and descending thoracic aneurysms?

A

Athero

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16
Q

Risk factors for thoracic aortic aneurysms

A
  • Athero
  • CT disorders like Marfan’s
  • HTN
  • Familial
  • Infections (syphilis, TB)
  • Vasculitis
  • Trauma
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17
Q

What is the diagnostic test of choice for thoracic aortic aneurysms?

A

CT

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18
Q

What is the treatment for thoracic aortic aneurysms (ascending, descending)?

A
  • Arch/ascending = open surgery

- Descending = endovascular stent grafting

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19
Q

What are the indications for surgical repair of thoracic aortic aneurysms?

A
  • Symptomatic
  • Ascending 5.5-6.0+ cm
  • Descending 6.5-7.0+ cm
  • Grown 1.0+ cm in a year
  • Marfan’s ascending 5.0+ cm
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20
Q

What are the surgical complications of thoracic aortic aneurysms?

A
  • Higher morbidity and mortality than AAA
  • Paraplegia
  • Stroke
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21
Q

How do beta blockers help with thoracic aortic aneurysms?

A

Decrease mortality and slow the rate of dilation

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22
Q

What is the role of medical management in thoracic aortic aneurysms?

A

Used in asymp pts with aneurysms too small to justify surgery

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23
Q

How are ACE-I/ARBs used in thoracic aortic aneurysms?

A

May reduce rate of expansion in Marfan’s patients

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24
Q

Describe abdominal aortic aneurysm (AAA)

A
  • 3.0+ cm
  • Males 4:1
  • 90% related to athero
  • 90% are infrarenal
  • Risk of rupture increases as size increases
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25
Q

What is the biggest risk factor for AAA?

A

Athero

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26
Q

What is the gold standard for diagnosing AAA?

A

Abdominal U/S

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27
Q

What is the definitive treatment of AAA?

A

Surgery

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28
Q

What are the indications for surgery in AAA?

A
  • Any size that is symptomatic
  • Rapidly expanding aneurysm (0.5+ cm/year)
  • Diameter 5.5+ cm
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29
Q

What is the medical management of AAA?

A
  • BBs reduce expansion and rupture
  • Serial imaging q6 months
  • Smoking cessation
  • Aggressive control of HTN and HLD
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30
Q

When is screening for AAA recommended?

A
  • All men 65-75 yo who have ever smoked

- Siblings or offspring of people with aortic aneurysms

31
Q

Define aortic dissection

A

Tear of the intima that results in formation of a false channel within the media layer

32
Q

What are the MC sites for aortic dissection?

A
  • R lateral wall of ascending aorta (shear stress is highest)
  • Descending thoracic just below ligamentum arteriosum
33
Q

What populations are affected by aortic dissection?

A
  • 70s-80s

- Males 2:1

34
Q

What are the greatest risk factors for aortic dissection?

A

HTN (70% of pts)
Pregnancy (3rd trimester)
BLUNT trauma to aorta

35
Q

How are aortic dissections classified?

A

DeBakey

Stanford

36
Q

Explain DeBakey classifications

A
  • For aortic dissections
  • Type I: ascending, continues to aortic arch and many times beyond arch
  • Type II: confined to ascending
  • Type III: originates in descending aorta
37
Q

Explain Stanford classifications

A
  • For aortic dissections
  • Type A: ascending aorta involved
  • Type B: ascending aorta NOT involved
38
Q

How are aortic dissections classified when they originate from ascending aorta?

A

Stanford A (Debakey I and II)

39
Q

How does AAA present vs. aortic dissection?

A
  • AAA is usually asymptomatic and a pulsatile mass may be felt
  • Dissection is severe sudden onset of chest pain that radiates
40
Q

What is the diagnostic test of choice for aortic dissections?

A

CT chest AND abdomen

41
Q

What is the medical management of aortic dissections?

A
  • BB for BP control

- Pain management (morphine)

42
Q

When is surgery the better treatment of aortic dissections?

A

In acute proximal dissections

43
Q

What is the MC cause of PAD?

A

Athero

44
Q

What is the most modifiable risk factor of PAD?

A

Smoking

45
Q

What are the MC sites of involvement of PAD?

A

Femoral and popliteal

46
Q

What is the MC symptom of PAD?

A

Claudication

*However, less than 50% are symptomatic

47
Q

Site of claudication is always:

A

Distal to the site of occlusion

48
Q

What is a major risk factor for lower leg/foot PAD?

A

DM

49
Q

What is the diagnostic test of PAD?

A

ABI

50
Q

What is the treatment of PAD?

A
  • Conservative
  • Smoking cessation
  • Risk factor reduction
  • Platelet inhibitors
  • Avoid compression stockings! Reduces blood flow to skin
51
Q

What are examples of non-athero vascular disease?

A
  • Fibromuscular dysplasia
  • Thromboangiitis obliterans
  • Vasculitis (Takayasu’s arteritis)
52
Q

Describe fibromuscular dysplasia

A
  • Hyperplastic disorder
  • Stenosis and aneurysms of medium and small sized vessels
  • MC involves renal and carotid arteries
  • Females 30s-40s
53
Q

How is fibromuscular dysplasia diagnosed?

A

“String of beads” appearance on renal angiography

54
Q

Describe thromboangiitis obliterans

A
  • Aka Buerger’s disease
  • Inflamm occlusive disease involving small and medium vessels
  • Distal upper and lower extremities only
  • Asian/E. European men 40+ yo
55
Q

What is the triad of S/S in thromboangiitis obliterans?

A
  • Claudication of affected extremity
  • Raynaud’s phenom
  • Migratory superficial vein thrombophlebitis
56
Q

What is the treatment of thromboangiitis obliterans?

A

No specific tx except smoking cessation

57
Q

Describe Takayasu’s arteritis

A
  • Inflamm and stenotic disease of medium and large sized arteries
  • MC aortic arch and subclavian
  • RARE
  • Women less than 40 yo
  • MC in Asia
58
Q

How is Takayasu’s arteritis diagnosed?

A

Arteriography

59
Q

What is the treatment of Takayasu’s arteritis?

A

Glucocorticoids may relieve general symptoms

60
Q

Describe acute arterial occlusion of a limb

A
  • Sudden loss of BF to an extremity

- Caused by embolism or thrombosis of an athero segment

61
Q

What are the S/S of acute arterial occlusion of a limb?

A

6 P’s

  • Pain
  • Pallor
  • Pulselessness
  • Paresthesias
  • Poikilothermia (coolness)
  • Paralysis
62
Q

Describe thoracic outlet syndrome

A

Compression of the neurovasc bundle (artery, vein or nerves) at thoracic outlet

63
Q

What is Wright’s Maneuver?

A
  • Hyperabduction test
  • To diagnose thoracic outlet syndrome
  • Radial pulse weakens or disappears when arm is abducted and ER on affected side
64
Q

What is Adson’s test?

A
  • To diagnose thoracic outlet syndrome
  • Radial pulse weakens or disappears when pt rotates their head to affected side with extended neck following deep inspiration
65
Q

What is the treatment of thoracic outlet syndrome?

A
  • Conservative

- PT and avoid aggravating positions and activities

66
Q

What is the MC type of peripheral artery aneurysm?

A

Popliteal (50% are bilateral)

67
Q

What is the gold standard for diagnosing peripheral artery aneurysm?

A

U/S

68
Q

Describe Raynaud’s phenomenon

A
  • Paroxysmal digital ischemia
  • Initial (excessive vasoconstriction) and recovery (vasodilation) phases
  • Primarily fingers but can affect toes
69
Q

What is the MC cause of Raynaud’s phenomenon?

A

Exaggerated vasoconstriction of distal arteries in response to cold or emotional stress

70
Q

Types of Raynaud’s phenom and how they present?

A
  • Primary (idiopathic): MC young women, symmetric involvement
  • Secondary (a/w rheumatic dz): rare, digital pitting, ulceration, gangrene
71
Q

Treatment of Raynaud’s phenom?

A
  • Avoid cold weather
  • Smoking cessation! (primary)
  • CCB for severe cases of primary
72
Q

Describe acrocyanosis

A

Arterial vasoconstriction and secondary dilation of capillaries and venules resulting in persistent (not episodic) cyanosis of the hands (and occasionally feet)

73
Q

How does acrocyanosis present?

A
  • Women, 30 yo or less
  • Asymp
  • Pain, ulcers, gangrene do NOT occur
74
Q

Describe pernio (Chilbains)

A
  • Vasculitis a/w exposure to cold
  • MC in young women
  • Raised erythematous lesions on distal lower extremities in cold weather
  • Usually self limiting

Clin Med II MHM - Cardio 2 (12 decks)

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