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Cardiology > Aortic aneurysms and Carotid Artery Disease > Flashcards

Aortic aneurysms and Carotid Artery Disease Flashcards

1
Q

4 possible causes of aneurysm disease

A

Degenerative
Connective Tissue Disease
Inflammatory Disease
Infection - mycotic aneurysm

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2
Q

What connective tissue disease is associated with aneurysm disease?

A

Marfan’s
Ehler Danlos
Loey Dietz

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3
Q

Risk factors for degenerative aneurysm disease

A 
Male
Age
Smoking
Hypertension
Family History
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4
Q

Presentation of aneurysm disease

A

ASYMPTOMATIC

Symptomatic - impending rupture: increasing back pain, tender AAA
Rupture: 
- abdo/back/flank pain
- painful pulsatile mass
-haemodynamic instability
- hypoperfusion
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5
Q

Unusual presentation of aneurysm

A 
Distal embolisation
Aortocaval fistula
Aortoenteric fistula
Ureteric occlusion
Duodenal obstruction
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6
Q

Criteria for screening

A 
Definable disease
Prevalence
Severity
Natural history
Reliable detection
Early detection confers advantage
Treatment options available
Cost effective
Feasability
Acceptability
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7
Q

Screening for AAA

A

Single Ultrasound at age 65

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8
Q

Outcomes of screening for AAA

A

Normal - discharged
Small AAA - 3-4.4cm : annual US
Medium- 4.5-5.5cm - 3 monthly US
Large - >5.5 cm - Urgent referral within 2 weeks

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9
Q

Management for AAA

A

Assess patient fitness

Consider Endovascular or Open Repair

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10
Q

What investigations are required to assess patient fitness?

A 
Full history and exam
Bloods
ECG
ECHO
PFTs
Myocardial Perfusion Scan
CPEX
End of Bed
Patient Preference
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11
Q

Imaging investigations required for AAA

A

Ultrasound

CTA/MRA

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12
Q

Complications of endovascular repair

A

Endoleak
Femoral artery dissection
Contrast reaction

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13
Q

Complications of open repair

A 
Wound infection/dehiscence
Bleeding
Pain
Scarring
Damage to bowel/ureters/veins/nerves
Incisional hernia
Graft infection
Distal emboli
Renal failure
Colonic ischaemia

DVT/PE
MI
Stroke
Death

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14
Q

Types of endoleak

A

I - proximal or distal leak in graft opening
II - retrograde flow into aneurysmal sac; inferior mesenteric or lumbar arteries
III - Issue in graft eg- fabric tear
IV- Porous graft
V- Tension

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15
Q

Management of symptomatic AAA

A

Emergency Open Repair
ABCDE, History, Examination, CTA

Massive transfusion protocol
Laparotomy xiphisternum to pubic symphysis
Occlude aorta proximally

Notify DVLA in any case of AAA greater than 6.5 cm

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16
Q

What is the mortality rate from Emergency Open Repair following symptomatic AAA?

A

30-50%

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17
Q

What is Carotid disease?

A

Atherosclerosis of carotid arteries

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18
Q

What consequential conditions are associated with Carotid Disease?

A

Transient ischaemic attack

Ischaemic stroke

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19
Q

What is a transient ischaemic attack?

A

Focal CNS disturbances due to vascular events eg microemboli and occlusion leading to cerebral ischaemia
Symptoms lasting less than 24 hours
No permanent neurological sequelae

20
Q

At which point in carotid disease is surgery considered?

A

Greater than 70% stenosis

21
Q

Causes of stroke

A

Cerebral infarction
Primary intracerebral haemorrhage
Subarachnoid haemorrhage

22
Q

Instances of cerebral infarction

A 
AF
Carotid atherosclerotic plaque rupture/thrombosis
Endocarditis
MI
Carotid artery trauma/dissection
Drug abuse
Haematological disorder
23
Q

Virchow’s triad

A

Vessel Injury
Hypercoagulability
Flow

24
Q

Branches of external carotid

A 
Posterior auricular
Occipital
Facial
Lingual
Ascending Pharyngeal
Superior Thyroid
25
Q

Complications of carotid endarterectomy

A 
Wound infection
Bleeding
Scar
Anaesthetic risks
Perioperative stroke
26
Q

When might stenting be used instead of a carotid endarterectomy?

A

Inaccessible disease

  • too high up for open surgery
  • previous surgery and scarring
27
Q

Which inflammatory disease is associated with AAA?

A

Takayasu’s aortitis

28
Q

Differential diagnosis to AAA

A 
Renal colic
Diverticulitis
IBD
IBS
GI haemorrhage
Appendicitis
Ovarian torsion
Ovarian rupture
Splenic infarction
29
Q

Prevalence of AAA

A

1 in 70 Males over 65 y/o

3000 deaths per year

30
Q

As well as duplex monitoring for asymptomatic management of AAA, what other factors must be addressed

A 
Weight
Exercise
Smoking cessation
Hypertension control
Statin and aspirin therapy to be started
31
Q

Management of ruptured AAA

A

High flow O2
IV Access
Urgent bloods - FBC, U& Es, clotting
Cross match for minimum 6U units
Aim to keep BP <100mmHg : Permissive hypotension
Transfer to vascular unit - vascular reg, consultant, anaesthetist, theatre and blood transfusion informed
If unstable - immediate transfer for open repair
If stable - CTA to determine EVAR or open

32
Q

What is permissive hypotension?

A

In ruptured AAA blood pressure is kept below 100 mmHg to prevent excessive blood loss

33
Q

Risk factors for carotid artery disease

A 
Age
Obesity
Hypercholesterolaemia
Hypertension
Diabetes
Smoking
Family history
Cardiovascular history
34
Q

Examination findings of carotid artery disease

A

Symptoms of stroke

Carotid bruit

35
Q

Why is carotid disease likely to be asymptomatic?

A

If unilateral - collateral circulation of ICA and vertebral arteries on opposite side due to circle of willis

36
Q

What is amaurosis fugax?

A

Transient visual loss

Can occur in TIA

37
Q

What are differentials for carotid artery disease?

A

Carotid dissection
Thrombotic occlusion of carotid artery
Fibromuscular dysplasia
Vasculitis

38
Q

How is Vasculitis differentiated from carotid artery disease?

A

GCA or Takayasu’s would typically have other systemic symptoms

39
Q

What is fibromuscular dysplasia?

A

Non-atheromatous stenotic angiopathy

Causes hypertrophy of the vessel wall

40
Q

What other non cerebrovascular conditions must be considered when patient presents with symptoms of carotid artery disease?

A 
hypoglycaemia
Todd’s paresis*
subdural haematoma
space-occupying lesion
venous sinus thrombosis
post-ictal state
multiple sclerosis
41
Q

What is Todd’s paresis?

A

Unilateral motor paralysis following seizure

42
Q

Investigations for carotid artery disease

A

CT head
Bloods - FBC, clotting, lipid profile, glucose, U&EsECG
For thrombectomy - CT head contrast angiiography

43
Q

Follow-up investigations for carotid artery disease

A

Duplex USS

44
Q

Complications of stroke

A

dysphagia, seizures, ongoing spasticity, bladder or bowel incontinence, and depression, anxiety, or cognitive decline.

45
Q

First line investigation of Carotid Artery disease

A

Carotid US Doppler

Cardiology (7 decks)

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