Aortic Aneurysm

Question 1

Define and classify aortic aneurysm

Answer 1

An enlargement of the aorta due to a weakness in the arterial wall. The shape of the aorta is distorted, often bulged, and can therefore impede blood flow. Can be located in the thoracic or abdominal region of the aorta.

Classifications:
Fusiform - involve all 3 layers of the vessel wall, bulbous in shape. ‘true aneurysms’
Sacculated - out pouching, only involves one side of the vessel
Pseudoaneurysm - involve no more than 2 layers of the arterial wall

Locations:

• Ascending Thoracic Aortic Aneurysm
• Descending Thoracic Aortic Aneurysm
• Abdominal Aortic Aneurysm

Question 2

Define and classify aortic dissection

Answer 2

Seperation of the layers of the aortic wall due to a tear in the intima layer causing blood to flow into the intima-media space
*90% occur within 10cm of aortic valve (highest stress with each pump of the heart, also curve of aorta)
*mortality high

Type A:
Involves the ascending aorta, descending aorta may also be involved, intimal tear may be present
*usually treated surgically*

Type B:
Involves descending aorta only
*usually treated medically*

Question 3

Describe the assessment/investigations for a ruptured aortic aneurysm

Answer 3

DRSABCD
-Usually pain in chest/epigastric region ‘sharp, tearing, ripping’
Tachycardia
May be hypertensive - usually in discending aorta
May be hyotensive - ruptured aorta/cardiac tamponade
Difference in bilateral BP
Pathology
ECG
cxr
CT with contrast
Echocardiogram​

Question 4

Describe the emergency management of a ruptured aortic aneurysm

Answer 4

Focus is:
Resus and stablisition
Prevention of ongoing dissection
- Control BP
- Control HR
- Control pain
Surgical repair

Pharmacological:

• Beta blockers - first line (esmolol - if not available, metoprolol)
• Art line - for BP titration
• Vasdilator - sodium nitroprusside or GTN
• Surgical repair​

Question 5

Identify preoperative investigations which may be undertaken prior to aneurysm repair

Answer 5

?

Question 6

Define and describe the clinical manifestations of a hypertensive crisis

Answer 6

Systolic BP >180mmHg
Diastolic BP > 120mmHg

The rapid rise in BP can cause end-organ dysfunction in the cardiovascular, renal and neurological systems

Clinical manifestations:
Chest pain
SOB
numbness/weakness
Severe headache
SOB
Nose bleed
Anxiety

Question 7

Describe the possible cause of hypertensive crisis

Answer 7

HTN with stroke
Hypertensive encephalopathy
APO
AMI
Acute aortic dissection
Illegal drugs
AKI
Pre-eclampsia/eclampsia

Question 8

Discuss the management of a hypertensive crisis

Answer 8

Dependent on clinical cause. Aim is to stop organ dysfunction, must ensure hypo-perfusion doesn’t occur secondary to reduction on blood flow

• aim to decrease BP/MAP by no more than 25% within 1-2 hours
• In a ?aortic disection - aim to achieve BP control within 5-10 minutes
• In an ischemic stroke - important to maintain cerebral perfusion. If pt to recieve thrombolysis BP reduction is required to mitigate risks with the treatment.
• Meds = nitrates and sodium nitroprusside
  Maybe beta blockers and ACE inhibitors too

Question 9

Differentiate between and aortic aneurysm and aortic dissection in relation to clinical manifestations and treatment

Answer 9

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