aortic heart disease

Question 1

What happens when you dilate the venous system? (effect on preload)

Answer 1

decrease the preload

Question 2

aorta anatomy draw it out

Answer 2

Question 3

Which area is the aortic isthmus?

Answer 3

L Subclavian and Ligamentum Arteriosum

Question 4

Traumatic aortic rupture (car accident) , coarctation- affects which what

Answer 4

aortic isthmus

Question 5

what are the layers of the vessel wall?

Answer 5

intima,
media
and adventita

Question 6

What is an aortic dissection

Answer 6

tear through the intima and media., and propagates through the media (second lumen forms)

Question 7

What are the causes of aortic dissection?

Answer 7

hypertension (MCC), aortic vasculitis,

connective tissue: marfan, Ehlers danlos.

Structural: coarctation, biscupid aortic valve

Question 8

presentation of the aortic dissection

Answer 8

severe, tearing retrosternal chest +/0 eadiatic back pain. assemtric blood pressure and pulse discrepancies.

Question 9

ECG findings of aortic dissection

Answer 9

Left ventricular hypertrophy

Question 10

location for aortic dissection for ascending aorta is known as what and what is the management?

Answer 10

stanford A, surgical management

Question 11

descending aorta, what type of aortic dissection is it and what is the management?

Answer 11

stanford b. medical mangement.

Question 12

What are the complications of aortic dissection

Answer 12

aortic rupture, aortic regurgitation, cardiac tamponade, ischemia

Question 13

If you cardiac tamponade and aortic dissection- you’ll usually affect which part of the heart first?

Answer 13

right side of the heart, JVD, Muffled heart sounds, and hypotension.

Question 14

How do you tell the difference between cardiac tamponade and cardiogenic shock?

Answer 14

cardiogenic shock- pulmonary edema
tamponade- should not see pulmonary edema (affects right heart first)

Question 15

DDx for widened mediastinum

Answer 15

Aortic Dissection
Aortic aneursym
anthrax

Question 16

What is the test to order for aortic dissection

Answer 16

CT angio. see the flap here

Question 17

What is the treatment for stanford b aortic dissection

Answer 17

beta blocker (esmolol) then vasodilator; decrease contractility and decrease HR
you dont want to give vasodilator first because that would cause reflex tachycardia

Question 18

pathophysiology of aortic aneursym

Answer 18

transmural inflammation: dilation of intima, media and adventita.

Question 19

risk factors for aneurysm

Answer 19

smoking, arterosclerosis, old age, connective tissue disease, tertiary syphilis (sphirocete infection obliterates part of the aorta–>necrosis)

Question 20

presentation for aortic aneurysm

Answer 20

asymptomatic until rupture- rupture: hypotensive, acute onset severe tearing ripping abdominal and pack pain.

Question 21

What is the difference between thoracic and abdominal aneurysms?

Answer 21

risk factors

thoracic: hypertension, tertiary syphlis, biscupid aortic valve, connective tissue disease. deals with ascending aorta (therefore chest pain +/- dysphagia, hoarseness of voice- l recurrent nerve wraps around aorta)

abdominal: smoking, artherosclerosis. symptoms include: abdominal bruit, pulsatile mass; location= below renal artery

Question 22

what is the recommendation for all men who have ever smoked?

Answer 22

abdominal ultrasound screening in men 65-75

Question 23

marfan syndrome pathology is a defect in which protien

Answer 23

fibrillin-1
autosomal dominant

Question 24

cystic medial degeneration of aorta, aortic root dilatation (thoracic)- associated with which disease

Answer 24

marfan syndrome

Question 25

ddx of mitral valve prolapse

Answer 25

mid systolic click at apex
connective tissue disease marfan, EDS,
acute rheumatic, infective endocarditis

Question 26

aortic coarctation definition

Answer 26

narrowing of the aortic isthmus (between l subclavian and ductus arteriosis)

Question 27

associations with aortic coarctation

Answer 27

turner syndrome, bicuspid aortic valve, williams syndrome, berry aneursym. harsh systolic murmur (because the blood is going through a small hole). rib notching chest xray (if there are collateral circulation)

Question 28

Differential cyanosis happens when?

Answer 28

aortic coarctation without PDA
brachial femoral delay
lower extremity claudication

Question 29

What are the origins of stanford A? (aortic dissection)

Answer 29

sinotubular junction

Question 30

What are the origin location of aortic dissection for stanford b

Answer 30

descending aorta