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CVS pathophysiology > Aortic aneurysms and carotid artery disease > Flashcards

Aortic aneurysms and carotid artery disease Flashcards

1
Q

What is an aneurysm?

A
  • localised swelling in the wall of an artery

- can rupture

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2
Q

What is an aneurysm?

A
  • localised enlargement of an artery caused by weakening of the vessel wal
  • can rupture
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3
Q

State risk factors for degenerative AAA disease

A
  • male
  • age (>65)
  • smoking
  • hypertension
  • FMX
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4
Q

Causes of aneurysm disease

A

Anything that causes weakness of BV wall

  • degenerative disease
  • connective tissue disease ( Marfan’s)
  • Infection
  • atherosclerosis
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5
Q

What is abdominal aortic aneurysm screening

A
  • detects dangerous swelling of aorta. Mainly in men the year they turn 65
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6
Q

Criteria for screening

A

REMOVE

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7
Q

State possible outcome of screening

A

Normal aorta : discharged

Small AAA(3-4.4cm) : annual USS scans

Medium AAA(4.5-5.5cm): 3 monthly USS scans 
Large AAA : (>5.5cm)
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8
Q

Presentation: symptomatic + unusual symptoms of an aneurysm

A

Asymptomatic

Symptomatic

  • dyspnoea/stridor
  • HF ( due to dilation of cardiac skeleton
  • hoarseness ( compressing on laryngeal nerve; ascending aorta)
  • abdominal/back/flank pain
  • painful pulsatile mass
  • haemodynamic instability( single episode/progressive)
  • hypopoperfusion

Unusual presentations

  • distal embolisation
  • aortocaval fistula
  • aortoenetric fistula
  • ureteric occlusion
  • duodenal obstruction
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9
Q

Aneurysm size and risk of rupture

A

e

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10
Q

Investigation of aneurysm

A

USS(ultrasound)

  • no radiation/contrast
  • but operatory dependent
  • not used in surgical planning

CTA/MRA

  • quick + not operatory dependent
  • surgical planning (detailed anatomy)
  • but uses contrast/radiation
-Bloods
ECG
ECHO
PFTs
MPS
CPEX
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11
Q

Types of aneurysm

A

True and false aneurysms

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12
Q

True vs false aneurysms

A

True aneurysms

  • walls of artery (t.intima) form walls of aneurysm
  • can be fusiform(equal dilation) + saccular(unequal dilation)

False aneurysms

  • hole in wall causes blood to pool(haemorrhage) but contained within T.advettia/surrounding tissue
  • haematoma can go on to form a clot
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13
Q

What is a dissecting aneurysm !

A
  • tear in t.intima causing bleeding in t.media. It seperates the 3 layers and doesn’t forma balloon unlike a pseudoaneurysm
  • Type A = ascending aorta
  • Type B = dissection that occurs anywhere but the ascending aorta
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14
Q

Causes of true aneurysms

A
  • atherosclerosis
  • hypertension
  • smoking
  • collagen abnormalities ( marfan’s syndrome)
  • trauma
  • infection( mycotic; detaches and embolises and causes weakness to vessel eall)
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15
Q

Causes of false aneurysms

A
  • inflammation(endocarditis
  • trauma
  • iatrogenic(catheters)
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16
Q

Symptoms of an aneurysm

A

remove

17
Q

Clinical presentation of aneurysm

A
  • if rupture, tachycardia/hypotension

- pulsatile mass in abdomen

18
Q

Investigations of aneuryssm

A
  • ultrasound screening for men >60yrs

- MRI/CT scan

19
Q

Treatment of aneurysms

A

Surgery>5.5cm(if less does not benefit)

-Surgery= open repair/EVAR (Endovascular aneurysm repair)

20
Q

Sizes of aneurysm classification ( small, medium, large)

A

REMOVE

21
Q

Describe Open +endovascular repair (fixx)

A

Open
-invasive, surgically open abdomen to gain access to AA
and a stent is placed.

EVAR

  • Cut into femoral artery in groin and a guided wire introduced in AA via femoral artery then a sheathed stent graft ( with use of flurosopy which is a movie X-Ray).
  • upper portion of device immediately below renal arteries
  • 2nd guide wire contralateral iliac artery placed into open lumen of stent
  • sheath is withdrawn leaving the stent in place.
  • This will expand to fit against the wall of the artery
22
Q

Endovascular repair complications

A
  • infection, bleeding/haematoma
  • scarring
  • contrast reaction
  • kidney injury, radiation

Technical

  • endoleak
  • femoral artery dissection/pseudoaneurysm(false)
  • rupture
  • distal emboli/ischaemia/colonic isachemia
  • damage to femoral vein/nerve
23
Q

What is an endoleak?

A

An endoleak is defined as persistent blood flow in the aneurysm sac external to the endograft

24
Q

Open vs EVAR

A
  • Open AAA repair better than stenting as it can deal with short necks/poor iliac anatomy
  • Wheras EVAR need to have good neck/illiac anatomy so that stent can be placed well
25
Q

Describe what happens in an emergency open repair

A
  • theatre
  • transfusion protocol. Prep abdomen, rapid anaesthetic
  • laprotomy xiphersternum to pubic symphysis
  • 30-50% morbiditity
26
Q

What can atherosclerosis of carotid ateries lead to?

A
  • transient isachemic attacks

- isachaemic stroke

27
Q

What is a transient ischaemic attack?

A
  • focal CNS disturbance caused by microemboli + occlusion > cerebral ischaemia
  • symptoms last LESS than 24 hours + no permanent neurological damage
28
Q

What is a stroke?

A
  • syndrome consisting of signs of focal/global disturvance of cerebral function
  • lasts LONGER than 24 hours/can cause death
29
Q

Causes of stroke/TIA

A
  • cerebral infarction(mainly)
  • AF, carotid atherosclerotic plaque rupture/thrombus
  • endocarditis
  • MI
  • carotid artery trauma/dissection
  • drug abuse
  • haemotological disorder ( sickle cell disease)
  • primary intracerebral haemorrhage
  • subarachnoid haemorrhage
30
Q

What does virchow’s triad state?

A

3 categories that contribute to thrombosis: BF, coagulability, vessel wall

31
Q

State the symptoms of TIA/troke

A

-paralysis/paresis/visuospatial neglect, dysphasia, ipsilateral amaurosis fagux symptoms

32
Q

Investigation of TIA/stroke

A
  • cardiac
  • ascultation of carotids
  • CT
  • carotid USS
  • doppler
33
Q

What does poisuille’s law state?

A
  • as radius of vessel decreases, velocity increases

- used to measure severity of stenosis

34
Q

Velocity and its stenosis

A

Velocity <125cm/s = <50% stenosis
Velocity >125cm/s = 50-69% stenosis
Velocity >270cm/s = 70-79% stenosis

35
Q

What is the end diastolic velocity?

A

> 140cm/s = 80-99% stenosis

36
Q

Treatment of TIA/stroke

A
  • smoking cessation
  • control of hypertension
  • antiplatelet
  • statin
  • diabetic control
  • carotid endarectomy ( if high stenosis)
  • stenting ( if atherosclerosis/plaque)
37
Q

Describe carotid endartectomy

A
  • incision on neck to open the carotid artery + plaque is removed
  • closed
38
Q

complications of carotid enarectomy

A
  • wound infection, bleeding scar, anaesthetic risks
  • vagus/hypoglossal nerve damage
  • perioperative stroke due to plaqe rupture/hypoperfusion/virchow’s traid ( raw intimal surface + thrombosis)

CVS pathophysiology (23 decks)

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