Aortic Dissection and Aneurysm

Question 1

Aortic Dissection

definition

Answer 1

intimal tear with blood flowing into tunica media

Question 2

Aortic dissection can be fatal in at least these three ways

Answer 2

1. hypovolemic shock
2. retrograde bleeding into pericardial sac

–> cardiac tamponade

3. cardiac/end organ ischemia from obstruction

Question 3

Where do aortic dissections occur?

Answer 3

proximal 10 cm of aorta

(high stress region)

Question 4

Predispositions for aortic dissection

Answer 4

connective tissue disorders

HTN

Question 5

Presentation of aortic dissection

Answer 5

sharp, tearing chest pain that radiates to back

Question 6

Which disease can classically cause a thoracic aneurysm?

Answer 6

tertiary syphillis

endarteritis of vasa vasorum -> luminal narrowing, decreased blood flow, and atrophy of blood vessel wall -> dilation

Question 7

Major/common complication of thoracic aneurysm

Answer 7

aortic regurgitation

dilation pulls leaflets of aortic valve apart

Question 8

Strange complications of thoracic aneurysm

Answer 8

compression of mediastinal structures

(airway, esophagus, nerves)

thrombus/embolus

Question 9

Abdominal aortic aneurysm

definition

Answer 9

balloon-like dilation of abdominal aorta

Question 10

Where does a AAA normally occur?

Answer 10

below renal arteries

above illiac bifurcation

Question 11

Underlying pathology of AAA

Answer 11

atherosclerosis

deposits create barrier for diffusion of nutrients from intima to media

wall becomes weak

balloons out

Question 12

When is a AAA really dangerous?

Answer 12

> 5 cm

Question 13

Presentation of ruptured AAA

Answer 13

hypotension, pulsatile abdominal mass, flank pain

Question 14

Unusual complications of AAA

Answer 14

compression of local structures

(ureter)

thrombosis/embolus