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CVS > Arterial Aneurysms > Flashcards

Arterial Aneurysms Flashcards

1
Q

What is an aneurysm?

A

An artery with a dilation > 50% of its original diameter

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2
Q

What are the different types of aneurysms?

A
  • True aneurysm
  • False aneurysm
  • Dissecting aneurysm
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3
Q

What are true aneurysms?

A
  • Aneurysms that involve all the layers of the vessels wall
    => There are 2 types:
  • Fusiform aneurysms (bulges on both sides)
  • Saccular aneurysms (bulges on one side)
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4
Q

What are false aneurysms?

A
  • When there is a collection of blood in the outer layer only
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5
Q

What is an Aortic Dissecting Aneurysm?

A
  • Vessel dilatation caused by blood splaying apart the media to form a false lumen
  • Occurs when there is a tear in the intima
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6
Q

What are the 2 types of dissecting aneurysms?

A

=> Stanford Classification

  • Type A: Involve the ascending aorta
  • Type B: Do not involve the ascending aorta

Type A is more serious than Type B

=> DeBakey Classification:

  • Type I: Originated in ascending aorta and propagates distally
  • Type II: Originates and stays in ascending aorta
  • Type III: Originates in descending aorta and projects distally
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7
Q

What are the risk factors of dissecting aneurysms?

A
  • Hypertension
  • Abnormal media (Marfans Syndrome, Ehlers-Danlos Syndrome)
  • Pregnancy
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8
Q

What is the clinical presentation of Aortic Dissecting Aneurysms?

A
  • Hypertension and asymmetrical pain

- Tearing pain between shoulder blades

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9
Q

What are the complications of Type A Aneurysms?

A
  • MI
  • Stroke
  • Cardiac Tamponade
  • Aortic Regurgitation
  • Exsanguination
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10
Q

What are the complications of Type B Aneurysms?

A
  • Rupture
  • Renal ischaemia
  • Gut ischaemia
  • Lower limb ischaemia
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11
Q

What is the management of Aortic Dissecting Aneurysms?

A

=> Type A:
- Managed via immediate surgical repair, target systolic BP between 100-120 mmHg whilst waiting for intervention

=> Type B:

  • Conservative management
  • Bed rest
  • Reduce BP using IV Labetelol
  • Surgery reserved for complications
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12
Q

What is an Abdominal Aortic Aneurysm?

A
  • An aneurysm below the level of the renal artery
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13
Q

What is the diameter of the aorta past the age of 50?

A

Males => 1.7cm
Females => 1.5cm

A diameter > 3cm is AAA
A large AAA > 5.5cm

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14
Q

What are the risk factors of an AAA?

A
  • Smoking
  • Hypertension
  • Atherosclerosis
  • Age (elderly)
  • Gender (Male)
  • Family History
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15
Q

What are the causes of AAA?

A
  • Atheroma
  • Trauma
  • Connective tissue disorders
  • Infection (Syphillis)
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16
Q

What are the 2 main connective tissue disorders?

A
  • Marfans syndrome

- Ehlers Danlos syndrome

17
Q

What is the clinical presentation of AAA?

A
  • Intermittent or continuous abdominal pain
  • Collapse
  • Expansile abdominal mass
  • Sweating

=> only presents clinically when ruptured

18
Q

What are the investigations in suspected AAA?

A
  • Ultrasound

- CT

19
Q

What is the emergency management of a ruptured AAA?

A
  1. Summon vascular surgeon and anaesthetist
  2. Do ECG, take blood for amylase, Hb and crossmatch. Catheterise bladder.
  3. Gain IV access and transfuse O Rh -ve blood for shock
  4. Take straight to theatre. NO TIME WASTING WITH INVESTIGATIONS
  5. Give prophylactic antibiotics
  6. Surgery: clamp aorta above leak
20
Q

What is the management of an unruptured AAA?

A

Insert endovascular stent via femoral artery

21
Q

What is the management of an unruptured AAA based on size?

A

< 3 cm - Discharge from screening
3 - 4.4 cm - Annual surveillance
4.5 - 5.4 cm - 3 monthly surveillance
> 5.5 cm - Consider surgery

CVS (12 decks)

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