Aortic Aneurysm - PVD Flashcards
What does high content elastin in the media allow?
significant destinsibility
- expands during systole and recoils during diastole
How does advancing age change for the aorta?
elastin degenerates and the aorta becomes stiffer which increases in systolic BP
What are the three most common clinical conditions for the aorta?
aneurysm
dissection
obstruction
How do you classify localized dilatation?
when increased by 50% compared to normal
What is a true aneurysm?
dilatation of all 3 layers of the aorta
- creating a large bulge in the vessel wall
What is pseudoaneurysm?
contained rupture of the vessel lumen that develops when blood leaks out the hole in the intima and media layer
- contained by the adventitia
- very unstable and prone to rupture
What is the cause of pseudoaneurysm?
infection, trauma, puncture (cardiac cath)
What are some conditions associated with?
- medial degeneration (Marfan’s, Elher-Danlos, Loeys-Dietz, Aortic valve problems, genetic)
- Atherosclerosis
- Infections
- Vasculitis
- Trauma/aortic dissection
What are the causes of descending aortic and abdominal?
- atherosclerosis (smoking, HTN, male, dyslipidemia, older, caucasian)
- genetic predisposition
- vessel inflammation
- weak media due to infections (salmonella, staph, strep, TB, syphilis)
What are the clinical presentation?
mostly asx but can:
- feel a pulsating mass or sensation in abdomen (detect imaging)
- feeling organs being constricted or pressed
- non-specific back pain
- nausea
- abdominal pain
- pain in flanks radiating to legs
- general malaise due to infection
- weight loss if due to inflammation
What are the sx of thoracic aneurysm?
compression of neighboring stractures: trachea, mainstem bronchus, esophagus
- cough
- dysphagia
- hoarseness (due to recurrent laryngeal nerve)
When the aortic ring dilates, what are the sx?
aortic regurgitation and sx of CHF
What is the most devastating consequence of an aortic aneurysm?
a rupture
- often fatal
What are the sx of slow leaks of aortic aneurysm?
- diffuse
- deep belly pain
- GI sx
- bloating
- cramping
What are the sx of a rupture?
- hypovelima and hypotension
- deep pain in the back or abs
- vomitting
- diaphoresis
- loss of consciousness
What are the risk factors of a rupture?
- increased size
- rapid expansion
- tobacco use
- increasing or uncontrolled HTN
- cardiac or renal transplants - from steroids for immunosuppression
- COPD
- Female
- Recent surgery
Why is gender a strong predictor for aortic aneurysm?
More prevalen possibly due to decreased tensile strength and increased wall stress in women
How is it diagnosed?
Imaging on screening
US (americaaaaaa) screeening
Abdominal palpation (more reliable in larger AA)
How is an unrupture treated?
- manage the underlying disease process and its risk factors
- repair surgically or endovascularly
How is a ruptured treated?
emergent surgical repair
What is the survival rate of an aortic aneurysm?
less than 50% do not survive to reach the ED
- even if they do reach, rate decreased by 1% every minute that passes
What is aortic dissection?
tear in the intima into the media which spreads along the artery
- blood then flows in between the layers of the blood vessels
Aortic Dissection
What can it lead to?
can lead to an aortic rupture
- life threatening
Aortic Dissection
Where does it usually occur?
in the thoracic aorta
Aortic Dissection
What are the risk factors?
- artherosclerosis
- blunt trauma to chest
- HTN
Aortic Dissection
What is the sudden onset that hints at a dissection?
onset of chest or back pain with a tearing or ripping sensation
- can radiate to shoulder, jaw, arm, neck
Aortic Dissection
What are the other sx?
- signs of hypoperfusion: dizziness or syncope
- nausea and vomiting
- rapid, weak pulse
