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cardiology > Aortic aneurysm, Dissection PVD > Flashcards

Aortic aneurysm, Dissection PVD Flashcards

1
Q

What is an aneurysm

A

bulge in vessel wall caused by weakening of vessel wall followed by dilation due to increased wall stress

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2
Q

Epidemiology of AAA

A
  • AAAs have a reported prevalence of 1.3-12.7% in the UK
  • M>F
  • Most common in the elderly: >60
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3
Q

RFs of AAA

A
  • Age
  • Male
  • Smoking
  • HT
  • Diabetes
  • EDS and Marfans
  • FH
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4
Q

pathogenesis of aortic aneurysm

A
  • Degradation of tunica media + adventitia > vessel dilation
  • In atherosclerosis Chronic inflammation results in release of matrix metalloproteinases enzymes - degrade ECM in tunica media, weakening aortic wall
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5
Q

most common location for aortic aneurysm

A
  • Below level of renal arteries - knows as infra- renal aneurysm
  • Below this level abdominal aorta lacks vasa vasorum - makes tunica media susceptible to ischaemia
  • Thickening of intima makes it harder for O2 to diffuse into tunica media

between renal and inferior mesenteric arteries

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6
Q

What is inflammatory AAA

A

type of AAA that usually affectsyounger patientsand is associated with smoking, atherosclerosis and vasculitis, accounting for 5-10% of aortic aneurysms cases. An inflammatory AAA presents similarly to a normal AAA but may also be associated withfever.

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7
Q

Presentation of aortic aneurysm

A
  • mostly asymptomatic
  • found below renal arteries
  • pulsatile mass on palpitation if it is big
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8
Q

Signs of an AAA

A
  • Pulsatile abdominal mass
  • Tachycardia and hypotension: red flags signifying ruptured AAA
  • Grey-Turner’s sign: flank bruising secondary to retroperitoneal haemorrhage
  • Cullen’s sign: pre-umbilical bruising
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9
Q

Symptoms of AAA

A
  • Flank, back or abdominal pain
  • Pulsating abdominal sensation
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10
Q

How would you diagnose an aortic aneurysm

A

1st line investigation - ultrasonography

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11
Q

major complications of aneurysm

A
  • AAA Rupture
  • thromboembolism
  • fistula
  • ureteric obstruction
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12
Q

Management of an aneurysm

A
  • require urgent repair
  • for asymptomatic AAA surveillence > repair
  • open repair or endovascular anuerysm EVAR
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13
Q

when you would you repair AAA

A

When diameter exceeds 5.5cm in men or 5.0 in women

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14
Q

presentation of ruptured AAA

A
  • Acute onset of severe tearing abdominal pain
  • painful pulsatile mass
  • hypovolemic shock
  • syncope
  • nausea
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15
Q

screening and repeat screening principles for AAA

A
  • men over 65 are screened
  • if small aaa 3.4-4cm then yearly us
  • if medium aaa 4.5-5.5 repeat every 3 months
  • if large aaa 5.5 or more then surgery
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16
Q

what is an aortic dissection

A

a tear in the intimal layer of the aorta which leads to a collection of blood between the intima and medial layers

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17
Q

Aortic dissection epidemiology

A
  • Aortic dissection has a worldwide incidence of 0.5 to 2.95 per 100,000 people annually
  • M>F
  • Most common between the ages of 50-70 and is rare below 40
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18
Q

pathophysiology of aortic dissection

A
  • Tear in tunica intima of aorta - High pressure blood flow through aorta tunnels between intima and media seperating the 2 layers
  • High pressure blood continues to cut more tunica intima off tunica media > blood pools between layers increasing diameter of BV - area where blood collects called false lumen
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19
Q

Where does Aortic dissection typically occur in?

A

Ascending aorta + Aortic Arch

20
Q

what arteries can be the false lumen be in ?

A
  • coronary
  • brachiocephalic
  • intercostal
  • visceral
  • renal
  • iliac
21
Q

risk factors for aortic dissection

A
  • hypertension
  • trauma
  • smoking
  • FH
  • vasculitis
  • cocaine use
  • connective tissue disorder
22
Q

Signs of AD

A
  • Weak downstream pulses: radio-radial and/or radio-femoral delay
  • A difference in blood pressure between two arms: >10 mmHg
  • Hypertension
  • Tachycardia and hypotension: as condition progresses
  • Diastolic murmur: due to aortic regurgitation
23
Q

clinical features of aortic dissection

A
  • sudden and severe tearing pain in chest radiating to back
  • hypotension
  • asymmetrical blood pressure
  • syncope - red flag symptom
24
Q

Stanford Classication of AD

A
  • Type A: Dissection involves ascending aorta +- involvement of arch and descending aorta - proximal to left subclavian artery
  • Tybe B: No ascending aorta - only descending thoracic or abdominal aorta - distal to left subclavian artery
25
Q

Debakey classification of Aortic Dissection

A
  • Type I: originates in the ascending aorta and involves at least the aortic arch, but can extend distally
  • Type II: originates and confined to the ascending aorta
  • Type III: originates in the descending aorta and extends distally, but can extend proximally
26
Q

diagnostic tools for AD

A
  • ECG - T wave inversion or ST segment depression
  • CHEST X RAY
  • Contrast enhanced CT - GS
27
Q

Type A management of Aortic Dissection

A
  • Blood transfusion
  • Beta blocker e.g. IV labetalol: aim for a systolic blood pressure of 100-120 mmHg; high pressures are associated with extension of the dissection
  • Urgent surgical repair/ stenting: open surgery with replacement of the ascending aorta should be performed immediately upon diagnosis
28
Q

Type B management for Aortic Dissection

A
  • Conservative management: bed rest and analgesia
  • Beta blocker e.g. IV labetalol: aim for a systolic blood pressure of 100-120 mmHg; patients are usually monitored closely on the high dependency or intensive care unit
  • Thoracic endovascular aortic repair (TEVAR):
29
Q

Complications of Aortic Dissection

A
  • Aortic regurgitation
  • MI
  • Stroke
  • Renal failure
30
Q

What is peripheral vascular disease

A

major circulatory disorder characterised by arterial obstruction, leading to reduced blood supply and ischaemia in the lower limbs

31
Q

pathophysiology of PVD

A
  • commonly atherosclerosis leading to claudication of vessels
32
Q

rx for PVD

A

SMOKING
DIABETES
HTN
SEDENTARY LIFESTYLE
HYPERLIPIDAEMIA

33
Q

Presentation of PVD

A

pulse less
pallor
pain
pressingly cold
paralysis
parasthesia

34
Q

investigation for PVD

A

Ankle brachial pressure

35
Q

Treatment for PVD

A

Smoking cessation
regular exercise
weight reduction
BP CONTROL, DM CONTROL
STATIN

36
Q

complication of PVD

A

acute limb ischemia

37
Q

Most common location of an aneurysm

A

Infra renal aorta

38
Q

what happens to the plaque when we get an acute clinical complication

A

rupture with thrombus formation

39
Q

what is the most potent risk factor for PAD

A

SMOKING

40
Q

6ps in ishaemia

A

pain
pallor
parasthesia
paralysis

41
Q

most common location of aneurysm

A

infra renal aorta

42
Q

define aneurysm

A

dilatation of artery to 2x normal normal involving all 3 layers

43
Q

Stanford classification of aortic dissection

A

Type a - involves ascending aorta , arch of aorta
Type b - involves the descending aorta

44
Q

Clinical signs of aortic dissection

A

Radio radial delay
Radio femoral delay
Blood pressure differential between arms

45
Q

Definitive diagnosis for aortic dissection

A

CT ANGIOGRAM

46
Q

Definitive management for aortic dissection

A

Type a - usually requires surgical management
Type b - managed with observation and blood pressure control

47
Q

What is commonly seen on CXR for patients with aortic dissection

A

Widened mediastinum

cardiology (16 decks)

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