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Cardiovascular > Aortic Disease > Flashcards

Aortic Disease Flashcards

1
Q

What is an aortic aneurysm?

A

Dilation/localised enlargement of all layers of the aorta, leading to an increase in diameter of >50%, caused by weakening of the vessel wall

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2
Q

How quickly to aortic aneurysms grow?

A

Aneurysms grow approx 2mm a year and as it gets bigger, the walls get thinner

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3
Q

Name the 3 layers of the aorta

A

Tunica externa

Tunica media

Tunica intima

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4
Q

What is a ‘true’ AAA?

A

Weakness and dilation of wall that involves all 3 layers

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5
Q

What is a ‘false’ AAA?

A

Not all layers are dilated, rupture contained by adventitial layer

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6
Q

What term is used to describe a AAA on one side?

A

Saccular

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7
Q

What term is used to describe a AAA on both sides?

A

Fusiform

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8
Q

What are the causes of AAA?

A

Degenerative disease/atherosclerosis

Connective tissue disease/hyper-elasticity conditions

  • Ehlers Danlos
  • Marfan’s syndrome

Syphilis

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9
Q

Name some risk factors for AAA

A

M>F

>Age

Smoking

HTN

FH

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10
Q

How does an AAA present?

A

Back/abdomen pain

Painful pulsatile abdominal mass

Sharp angina

  • Radiating to the back between shoulder blades

Dyspnoea

Hoarseness

Haemodynamic instability/shock

  • Tachycardia
  • Hypotension
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11
Q

Name some complications of an AAA

A

Distal embolisation

Hypoperfusion/inadequate perfusion to tissues

Aortocaval or Aortoenteric fistula

Ureteric occlusion

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12
Q

What investigations are used in AAA diagnosis?

A

US

CT

  • Ruptured AAA are diagnosed clinically as patients do not have time for a CT to confirm diagnosis
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13
Q

Describe the AAA screening programme

A

Single abdominal US for males 65

If aorta is less than 3cm/normal, no further action is taken

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14
Q

How many cm is a normal aorta?

A

<3cm

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15
Q

How many cm is a small AAA?

A

3-4.4cm

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16
Q

How many cm is a medium AAA?

A

4.5-5.5cm

17
Q

How many cm is a large AAA?

A

>5.5cm

18
Q

How often do patients with a small AAA go for US?

A

Rescan annually

19
Q

How often do patients with a medium AAA go for a US?

A

Rescan every 3 months

20
Q

What size does an AAA have to be to be considered for surgery?

A

>5.5cm

21
Q

What is a low rupture risk AAA?

A

Asymptomatic

Aortic diameter < 5.5cm (i.e. small and medium aneurysms)

22
Q

What is a high rupture risk AAA?

A

Symptomatic

Aortic diameter >=5.5cm or rapidly enlarging (>1cm/year)

23
Q

What is the management of a low rupture risk AAA?

A

Abdominal US surveillance

Optimise cardiovascular risk factors

24
Q

What is the management of a high rupture risk AAA?

A

Refer within 2 weeks to vascular surgery

Elective endovascular repair (EVAR), in which stent is placed into the abdominal aorta via the femoral artery

Open repair if unsuitable for EVAR

25
Q

Give a complication of EVAR

A

Endo-leak, where the stent fails to exclude blood from the aneurysm, presenting without symptoms on routine follow up

26
Q

What is the management of a ruptured AAA?

A

Immediate vascular review and emergency surgical repair

27
Q

What is an aortic dissection?

A

Tear in the inner wall of the aorta (tunica intima) resulting in the redirection of blood flow

28
Q

What are the causes of an aortic dissection?

A

HTN

Trauma/Surgery

Atherosclerosis

Marfan’s/connective tissue disorders

Pregnancy

Turners and Noonans

Syphillis

Aneurysms

Bicuspid aortic valve

29
Q

How does an aortic dissection present?

A

Tearing chest pain

  • Anterior if ascending aorta
  • Back pain if descending
  • Very similar to MI

Collapse

Radial-radial delay

Abscent femoral pulse

Auscultation

  • Soft early diastolic murmur, aortic regurgitation

Neurological symptoms

30
Q

What investigations are used in the diagnosis of an aortic dissection?

A

CXR

  • Widened mediastinum

CT of chest, abdomen and pelvis

  • Tennis ball sign
  • Contrast shows true lumen as white while false lumen is grey due to fibrosis

Transoesophageal echocardiography (TOE)

  • More suitable for unstable patients who are too risky to take to CT scanner
31
Q

What classification is used in aortic dissections?

A

Sandford

32
Q

What are the two classifications of aortic dissections?

A

A

  • Involves the ascending aorta

B

  • Descending aorta, distal to left subclavian origin
33
Q

What is the management of an aortic dissection?

A

Type A

  • Aortic root replacement and IV labetolol

Type B

  • HTN control/IV Labetalol
34
Q

Give complications of aortic dissections

A

Backward tear

  • Aortic regurgitation
  • MI

Forward tear

  • Stroke
  • Renal failure

Cardiovascular (12 decks)

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