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Adult II Complex > Aortic Aneurysm & Aortic Dissection > Flashcards

Aortic Aneurysm & Aortic Dissection Flashcards

1
Q

Aortic aneurysm

A

Outpouching or dilatation of the aorta

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2
Q

Causes of Aortic Aneursym

A
  1. Degenerative
  2. Congenitial problems (Marfan’s)
  3. Mechanical (penetrating or blunt trauma)
  4. Inflammatory (aortitis)
  5. Infectious (HIV)
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3
Q

Risk factors

A

Age, male gender, hypertension, CAD, family history, tobacco use, hyperlipidemia, PAD lower extremities, carotid artery disease, previous stroke, obesity

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4
Q

Locations

A
  1. Ascending aorta
  2. Aortic arch
  3. Thoracic aorta (TAA)
  4. Abdominal aorta (AAA)
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5
Q

True – wall of artery forms aneurysm

A

a. Fusiform
b. Saccular

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6
Q

False

A

a. Pseudoaneurysm
b. Disruption of all arterial wall layers with bleeding into surrounding anatomic structures

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7
Q

Thoracic aneurysm (TAA) Clinical Manifestations

A

chest pain (deep, diffuse extending into interscapular area

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8
Q

Ascending aorta and aortic arch Clinical manifestations

A

a. angina
b. transient ischemic attacks (TIAs)
c. coughing, shortness of breath
d. hoarseness and/or difficulty swallowing – from pressure on laryngeal nerve
e. if presses on superior vena cava, decreased venous return leading to JVD, edema of face and arms

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9
Q

Abdominal aortic aneurysm (AAA) clinical manifestations

A

a. palpable pulsatile mass
b. bruit over aneurysm
c. abd or back pain, epigastric discomfort
d. altered bowel elimination
e. intermittent claudication
f. “blue toe syndrome”
-patchy, mottling of feet and toes with pulses present

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10
Q

Complications- Aneurysm rupture

A

a. Diaphoresis
b. Pallor/ clammy skin
c. Weakness
d. Tachycardia
e. Hypotension
f. Abdominal, back, groin or periumbilical pain
g. Changes in LOC
h. Pulsating abdominal mass
f. decreased uop

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11
Q

Complications - Rupture into retroperitoneal space

A

severe back pain or flank ecchymosis (grey turners sign)

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12
Q

Complication- Rupture into thoracic or abdominal cavity

A

pt can die from Massive hemorrhage

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13
Q

Diagnostic studies

A

a. Chest x-ray – to reveal abnormal widening of the thoracic aorta.
b. Abdominal x-ray – shows calcification within aortic wall
c. 12-lead ECG – to rule out an MI
d. Echocardiography – assess the function of valve
e. Ultrasound – monitor aneurysm size
f. CT or MRI- diagnose and assess location and severity of aneurysm
g. Angiography- can map the entire aortic system

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14
Q

Medical management aneurysm < 5.4 cm

A

a. Early detection and prompt treatment
b. Monitor growth aneurysm over time
c. Risk factor modification
d. Manage hypertension
e. AAA – if < 5.4 cm and asymptomatic
f. Ultrasound or CT every 6-12 months if 4-5.4 cm (<4 cm -ultrasound every 3 years)

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15
Q

Surgical intervention

A

a. Utilized for AAA 5.5 cm or >, if symptomatic, high risk rupture
b. If aneurysm ruptures, requires emergency surgical intervention
c. Open aneurysm repair (OAR)
d. Endovascular graft (EVAR) minimally invasive repair

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16
Q

Endovascular graft (EVAR) minimally invasive repair

A

(1) post procedure angiography to check for leaks and confirm Patency
(3) Potential complications: endoleak, aneurysm growth, Aneurysm rupture, aortic dissection, bleeding, renal artery Occlusion

17
Q

Potentially lethal complication in emergency repair

A

-Intraabdominal hypertension (IAH)
*Associated with abdominal compartment syndrome

18
Q

Preop management

A

(a) mark peripheral pulse sites
(b) Medications – IV antibiotic, betablocker if h/o CVD

19
Q

Postop management

A

(a) mark peripheral pulse sites
(b) Medications – IV antibiotic, betablocker if h/o CVD
(2) Postop management
(a) Airway management
(b) Arterial line, RAP, ECG monitoring, O2 sat
(c) May have chest tubes
(d) Pain control
(e) Maintain graft patency -normal BP, IV fluid and blood products, RAP or PAP monitoring, UOP hourly, avoid (hypertension) (meds)
(f) Manage cardiovascular status -ECG monitoring, electrolyte monitoring, ABGs, O2, Meds, pain control
(g) Prevent infection
(h) Manage GI status -monitor for paralytic ileus and assess for bowel ischemia (absent bowel sounds, fever, abd distention, diarrhea, bloody stools)
(i) Monitor neurologic status
(j) Monitor peripheral perfusion -Doppler as needed , Absence in lower extremity pulses (temp) -absent pulses + cool/pale/mottled or painful extremity means embolization or graft occlusion -> report immediately
(k) Monitor renal function-hourly UOP, I&O, daily weight, RAP, BUN & Creatinine

20
Q

Teaching

A

(a) Gradually increase activities as prescribed to
moderate physical activity
(b) No heavy lifting for 6 weeks
(c) Teach signs symptoms of infection & neurovascular
Changes -Report redness, swelling, increased pain, drainage from incision, temperature > 100F
-Report changes color, warmth of extremities
(d) Teach to check peripheral pulses
(e) Sexual dysfunction common after aortic surgery

21
Q

Aortic dissection

A
  1. Sudden tear in intimal layer of aorta that creates a false lumen
  2. May occlude major branches of aorta causing decreased blood supply to Brain, abdominal organs, kidneys, spinal cord, and/or extremities
  3. Hypertension most important risk factor
  4. Dissection at risk for rupture
22
Q

Type A

A

ascending aorta and arch – requires emergency surgery

23
Q

Type B

A

dissection begins descending aorta – may use conservative Management

24
Q

Type A– ascending aorta and arch CM

A

abrupt onset of severe anterior chest pain or back pain

25
Q

Type B– dissection begins descending aorta

A

back, abdomen or leg pain

26
Q

Aortic Dissection CM

A
  1. Pain described as sharp, worst ever, tearing, ripping or stabbing
  2. May be painless for some
  3. Neurologic deficits (aortic arch)- altered LOC, weak or absent carotid or temporal pulses, dizziness, syncope
  4. BP and arterial pulse differ between arms (Subclavian artery)
27
Q

Complications

A

a. Cardiac tamponade- hypotension, narrowed pulse pressure, JVD, muffled heart sounds, pulsus paradoxus
b. Aortic rupture
c. Hemorrhage (hypovolemic shock)
d. Spinal cord ischemia (weakness, decreased sensation)
e. Renal ischemia (renal failure)
f. Mesenteric ischemia (decreased bowel sounds, altered bowel function, bowel necrosis)

28
Q

Diagnostic studies for aortic dissection

A

a. 12-lead ECG – helps rule out cardiac ischemia
b. chest x-ray – may show widening of mediastinal or pleural effusion
c. CT scan or MRI
d. Transesophageal echocardiography (TEE) – used to diagnosis of AA

29
Q

Initial management for aortic dissection

A

a. HR and BP control
(1) decreased BP and myocardial contractility
(2) IV beta blocker to keep HR <60 or SBP 100-110

30
Q

Conservative therapy (for Type B without complications)

A

a. Pain control
b. HR and BP control
c. Modify CVD risk factors
d. Followup closely with CT or MRI

31
Q

Endovascular dissection repair (Standard for Type B aortic dissections with complications (hemodynamic instability)

A

-Thoracic endovascular aortic repair (TEVAR)
-Similar to EVAR but fewer complications
-May have lumbar drain- to help decrease or prevent neurologic

32
Q

Surgical Therapy for aortic dissection

A

a. Emergency surgery for acute Type A dissection
b. Consider when drug therapy ineffective or when complications
c. Delay surgery to allow edema to decrease and permit clotting blood

33
Q

Preoperative for aortic dissection

A

(1) Position bedrest and semifowler’s in quiet environment
(2) Pain and anxiety management and monitor for increasing pain, restlessness, anxiety
(3) Continuous ECG and BP monitoring, IV antihypertensives, - May have intra-arterial line
(4) Assess for changes in peripheral pulses

34
Q

Postoperative aortic dissection surgery

A

See aneurysm postop care

35
Q

Teaching for aortic dissection

A

(1) Long term HR and BP control – teach meds
(2) Regular followup with CT or MRI
(3) If note pain and other symptoms return, call EMS
(pain, parasthesias, paralysis, pulselessness, pallor)

Adult II Complex (15 decks)

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