aortic heart disease Flashcards
What happens when you dilate the venous system? (effect on preload)
decrease the preload
aorta anatomy draw it out
Which area is the aortic isthmus?
L Subclavian and Ligamentum Arteriosum
Traumatic aortic rupture (car accident) , coarctation- affects which what
aortic isthmus
what are the layers of the vessel wall?
intima,
media
and adventita
What is an aortic dissection
tear through the intima and media., and propagates through the media (second lumen forms)
What are the causes of aortic dissection?
hypertension (MCC), aortic vasculitis,
connective tissue: marfan, Ehlers danlos.
Structural: coarctation, biscupid aortic valve
presentation of the aortic dissection
severe, tearing retrosternal chest +/0 eadiatic back pain. assemtric blood pressure and pulse discrepancies.
ECG findings of aortic dissection
Left ventricular hypertrophy
location for aortic dissection for ascending aorta is known as what and what is the management?
stanford A, surgical management
descending aorta, what type of aortic dissection is it and what is the management?
stanford b. medical mangement.
What are the complications of aortic dissection
aortic rupture, aortic regurgitation, cardiac tamponade, ischemia
If you cardiac tamponade and aortic dissection- you’ll usually affect which part of the heart first?
right side of the heart, JVD, Muffled heart sounds, and hypotension.
How do you tell the difference between cardiac tamponade and cardiogenic shock?
cardiogenic shock- pulmonary edema
tamponade- should not see pulmonary edema (affects right heart first)
DDx for widened mediastinum
Aortic Dissection
Aortic aneursym
anthrax
What is the test to order for aortic dissection
CT angio. see the flap here
What is the treatment for stanford b aortic dissection
beta blocker (esmolol) then vasodilator; decrease contractility and decrease HR
you dont want to give vasodilator first because that would cause reflex tachycardia
pathophysiology of aortic aneursym
transmural inflammation: dilation of intima, media and adventita.
risk factors for aneurysm
smoking, arterosclerosis, old age, connective tissue disease, tertiary syphilis (sphirocete infection obliterates part of the aorta–>necrosis)
presentation for aortic aneurysm
asymptomatic until rupture- rupture: hypotensive, acute onset severe tearing ripping abdominal and pack pain.
What is the difference between thoracic and abdominal aneurysms?
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
what is the recommendation for all men who have ever smoked?
abdominal ultrasound screening in men 65-75
marfan syndrome pathology is a defect in which protien
fibrillin-1
autosomal dominant
cystic medial degeneration of aorta, aortic root dilatation (thoracic)- associated with which disease
marfan syndrome
ddx of mitral valve prolapse
mid systolic click at apex
connective tissue disease marfan, EDS,
acute rheumatic, infective endocarditis
aortic coarctation definition
narrowing of the aortic isthmus (between l subclavian and ductus arteriosis)
associations with aortic coarctation
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)
Differential cyanosis happens when?
aortic coarctation without PDA
brachial femoral delay
lower extremity claudication
What are the origins of stanford A? (aortic dissection)
sinotubular junction
What are the origin location of aortic dissection for stanford b
descending aorta
