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CMT-uno > Arterial Disease > Flashcards

Arterial Disease Flashcards

1
Q

what imaging do we use to check for aortic aneurism?

A

MRI or CT

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2
Q

what are the layers of the aorta?

A

Tunica Intima (innermost)
Tunica media
Tunica adventitia (outermost)

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3
Q

Aneurysm definition

A

Dilatation of the aorta ( > 3cm)

Involves all 3 layers of vessel wall

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4
Q

conditions of heart

Dissection

A

Tear of the tunica intima creates a false lumen

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5
Q

conditions of the heart

Rupture

A

Full-thickness tear of aorta

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6
Q

Abdominal Aortic Aneurysm
Epidemiology

A

2% of men over 55 years old
Male > female (4:1)
90% originate below renal arteries
Involvement of the aortic bifurcation
May involve common iliac arteries

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7
Q

Abdominal Aortic Aneurysm

Risk Factors

A

Advanced age
Male sex
Tobacco use
Alcohol use
White population
Family history
Atherosclerotic risk factors
Hypertension
Hyperlipidemia

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8
Q

who is at the highest risk of abd aortic aneurysm?

A

white elderly men with a history of tobacco use and atherosclerotic risk factors

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9
Q

abd aortic aneurysm

Sx

A

Asymptomatic
Incidental finding on abdominal ultrasound or CT imaging

Symptomatic – Sign of rapid expansion or impending rupture
Mild to severe deep abdominal or flank pain that is constant or intermittent
Exacerbated upon palpation
Pain radiates to back

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10
Q

abd aortic aneurysm

complications

A

rupture - very poor prognosis

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11
Q

abd aortic aneurysm

imaging of choice

A

Abdominal Ultrasound
Diagnostic study of choice for initial screening

Abdominal CT with contrast
Assess diameter
Surgical planning

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12
Q

58 yo male PMHX: HTN, HLP, and tobacco presents for routine OV and has a pulsatile abdominal mass. Which test is indicated at this time?
Abdominal ultrasound
CT angiogram
MRA
TEE

A

Abdominal ultrasound

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13
Q

Abdominal Aortic Aneurysm

Surgical Repair indications

A

Diameter > 5.5 cm
Rapid expansion in diameter (> 0.5 cm in 6 months)

Symptomatic – Pain, tenderness
May indicate impending rupture

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14
Q

what diseases make you more prone?

A

marfans and Ehlers-Danlos syndrome

not testable

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15
Q

abd aortic aneurysm

complications of open repair and endovascular repair

A

Open repair carries more intraoperative risk, while endovascular repair has higher incidence of post-operative complications

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16
Q

A 55 yo patient presents to pcp for routine yearly exam. + tobacco abuse. 148/90. What screening test is NOT indicated?
a.Lipid panel
b.ECG
c.Abdominal aortic ultrasound
d.Coronary artery calcium score
e.cxray

A

D. only need if deciding they need statin, but knowing that they are smoker and over 55 with high BP we know they need a statin

(goal bp is 130/80)

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17
Q

Thoracic Aortic Aneurysm

Etiology and Risk Factors

A

Idiopathic/Degenerative
Atherosclerosis
Hypertension
Smoking
Aortitis
Takayasu arteritis
Giant cell arteritis
Connective tissue disorders
Marfan syndrome
Ehlers-Danlos syndrome
Bicuspid aortic valve
Family history of TAA

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18
Q

Thoracic Aortic Aneurysm

Sx

A

Asymptomatic
Symptoms dependent upon size and position of the aneurysm and rate of growth
Esophagus – dysphagia
Trachea – stridor, dyspnea
Superior vena cava – Upper extremity edema, jugular venous distension
Aortic root – Aortic regurgitation
Substernal chest pain
Pain radiating to the back or neck
Complications
Rupture

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19
Q

Thoracic Aortic Aneurysm

Imaging

A

Chest radiographs
Useful initial evaluation
Not sensitive or specific

CT Angiography
Best initial imaging for patients suspected to have TAA

Transesophageal or transthoracic echocardiogram
Further evaluation

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20
Q

A patient presents with acute tearing scapular pain. They have a history of thoracic aortic aneurysm. BP 70/40 with HR 130. They are becoming confused. Which of the following is indicated?
A- TEE at bedside stat
B- CTA stat
C- MRA stat

A

A- is the answer

If hemodynamically unstable, dont want CT or MRA

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21
Q

Patient presents with acute chest pain, no ECG changes, and mediastinal widening on cxray…..

A

TAA

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22
Q

Thoracic Aortic Aneurysm

Surgical repair indications

A

Indications
Diameter > 5.5 cm
All symptomatic TAAs require surgical repair
Patients with genetic conditions have a lower threshold for surgical repair due to increased risk of rupture
Repair of asymptomatic TAAs is not recommended until risk of rupture exceeds risks of repair

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23
Q

TAA 5-year Risk of Rupture/Death

A
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24
Q

thoracic aortic aneurysm

What is the risk with surgically repairing a TAA

A

the more extensive the aneurysm, the greater is the risk of paraplegia with repair.

slide 25

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25
Q

Aortic Rupture

Etiology

A

Blunt force trauma
High-speed MVC
Rapid deceleration
No use of seatbelt
Sequela of aortic aneurysm

26
Q

aortic rupture

Triad

A

Triad:
Severe pain
Hypotension
Pulsatile abdominal mass

27
Q

aortic rupture

mortality

A

Extremely high mortality
50% patients exsanguinate before reaching a hospital
Contained rupture in retroperitoneum
Only 50% of patients survive post-surgery
Complications
Abdominal compartment syndrome

28
Q

Aortic rupture

imaging

A

Thoracic:
**Chest CT scan
Transesophageal Echocardiogram

Abdominal
Abdominal CT scan
Hemodynamically unstable: Get to the OR without delay.
Intraoperative imaging vs. open exploration

29
Q

Aortic Rupture

Management

A

-Endovascular
Specialized surgeons and facilities
Hemodynamically stable patients who have undergone CT imaging
Lower perioperative mortality

-Open
50% survive repair

30
Q

Aortic Dissection definition

A

-Spontaneous tear of tunica intima
-Blood dissects into the tunica media
-Repetitive torque during cardiac cycle
-Hypertension

31
Q

Aortic Dissection

RF
(Abnormalities)

A

Hypertension
Abnormalities of smooth muscle, elastic tissue, or collagen
Marfan syndrome
Ehlers-Danlos syndrome

Pregnancy

Anatomic abnormalities
Bicuspid aortic valve
Coarctation of the aorta

32
Q

Aortic dissection

Debakey and Stanford Classification

A

dont need this

33
Q

Aortic Dissection

Triad

A

Triad
1) Abrupt onset thoracic or abdominal pain with sharp, tearing, ripping character
2) Pulse and/or blood pressure variations between extremities
3) Mediastinal and aortic widening on CXR

34
Q

Aortic Dissection

clinical man

A

Sudden onset severe, persistent chest pain described as ripping, sharp, tearing
Pain radiates in respect to location and extension of dissection
Down the back
Anterior chest
Neck
Hypertension
Syncopal episodes
Diminished peripheral pulses
Variations in pulses and blood pressure when comparing extremities
Other clinical findings respective to location and extension of dissection
Hemiplegia
Mesenteric ischemia
Acute kidney injury
Myocardial infarction

35
Q

Aortic root dissections may present with:

2 sounds, 2 diseases

A

Diastolic murmur
Aortic regurgitation

Acute heart failure
Cardiac tamponade

36
Q

when should you consider an aortic dissection?

A

Consider aortic dissection in hypertensive patients with chest pain and equivocal findings on ECG

37
Q

Aortic Dissection

imaging

A

Electrocardiogram (ECG)
Initial evaluation of patients with chest pain
Absence of ECG changes (no ischemia)
Chest Radiograph (x-ray)
Differentiates various causes of chest pain
Widening of mediastinum/aortic silhouette
CT of chest and abdomen
Immediate diagnostic imaging of choice
MRI of chest and abdomen
Not readily available in emergent situations
Transesophageal Echocardiogram

38
Q

aortic dissection

Management and Disposition

A

Labetalol (only one with meds)

39
Q
A
40
Q

Peripheral Artery Disease

A

Systemic atherosclerosis
30% of patients over 70-years-old with no other risk factors
30% of patients over 50-years-old with risk factors

Typically in legs, muscles feel tired and heavy with activity and it improves with rest, tends to be unilateral.

41
Q

PAD

RF

A

Coronary artery disease
Increased age
Hypertension
Dyslipidemia
Tobacco use
Male sex
Diabetes
Metabolic syndrome
Erectile dysfunction
Family history of cardiovascular disease

42
Q

PAD

Clin man

A

Intermittent claudication
Cramping pain in the lower extremities
Induced by activity
Relieved with rest
Cool skin temperature
Pale skin color
Scant hair distribution
Weak distal pulses
Nonhealing wounds

43
Q

PAD

Complications

A

Complication: Chronic limb threatening ischemia -> nonhealing wounds -> gangrene

44
Q

PAD

Dx

A

CT gold standard

45
Q

PAD

Management

Pharm(3) and non pharm(3)

A

Antiplatelet Therapy -Clopidogrel, Aspirin
High-intensity Statin Therapy

Risk factor modification- Smoking cessation, Tight glucose control, Blood pressure control

46
Q

PAD

Surgical intervention

A

Endovascular Revascularization
Indications:
Significant pain, disability, inadequate response to treatment
Critical limb ischemia

Balloon angioplasty with or without stent placement
Arthrectomy
Bypass

47
Q

Chronic Limb Threatening Ischemia

Clincal findings

A

Foot ischemic wounds
Ulceration and gangrene
Severe vascular insufficiency
Ischemic rest pain

ischemic foot wounds that dont heal, or pain in th extremity with rest, limb without pulse

48
Q

Chronic Limb Threatening Ischemia

management

A
49
Q

Acute Arterial Occlusion
Causes

A

from thrombus or embolus

Thrombus- A blood clot that develops as a result of a ruptured atherosclerotic plaque or stagnant blood flow from cardiac arrhythmia
Occlusion of small, distal arteries
History of peripheral artery disease

Embolus- A blood clot arising from the vascular system that travels to a distal area, causing occlusion
Occlusion of larger arteries
History of cardiac event

50
Q

Acute Limb Ischemia

Causes

A

Arterial Embolism
Atrial Fibrillation- most common
Valvular disease
Left ventricular clot formation from myocardial infarction

Acute Thrombus
Pre-existing peripheral artery disease

51
Q

Acute Limb Ischemia

clinical findings

5 p’s

A

Abrupt onset pain in extremity
The 5 P’s
Pain
Pulselessness
Pallor
Paralysis
Paresthesia
Limb is cool to touch
Degree of ischemia is related to collateral blood flow

52
Q

Acute Limb Ischemia

Dx

A

Vascular Sonography
Arterial Doppler Ultrasound
CT Angiography
Delayed intervention
Reserved for viable ischemia

53
Q

Acute Limb Ischemia

Tx

A
  • Anticoagulation
    Unfractionated Heparin IV
    Clot propagation prevention
    Does not resolve the occlusion
  • Endovascular Revascularization
    Catheter-directed thrombolysis
    tPA (Tissue plasminogen activator)
    Clot lysis
    Patients with intact neurologic examination (viable limbs)
  • Thromboembolectomy
54
Q
A

treatments for acute limb ischemia

55
Q

A 65-year-old white man with hypertension and a 10-pack-year history of cigarette smoking should be screened for_____________. What imaging modality is used for surveillance? ___________.

A

abd aortic aneurysm
ultrasound

56
Q

A 76-year-old man comes to the ED with abdominal pain radiating to the back. What imaging study is indicated? ____________ (This question is tricky. Let’s talk about it).

A

if he’s hemodynamically stable you would get a CT.

57
Q

On physical examination, you palpate the abdominal aorta measuring 6.5 cm. The patient has no symptoms. What is your next step? ____________. Do
es this patient need surgery? _________.

A

ultrasound

yes

58
Q

A patient is brought to the ED with ripping, stabbing chest pain. BP is 178/85 mmHg. What is your first step in diagnosis? ___________

A

EKG

to make sure we dont have aortic aneurysm we do esophageal echo

59
Q

On ECG, there is no ST elevation. Cardiac troponin is negative. What is ruled out? ___________

A

Non STEMI/STEMI

60
Q

A 40 yo patient is brought in via EMS from MVA with airbag deployment. The patient reports chest pain and soon loses consciousness. Vs: 80/40, 130, 22. physical exam: chest has diffuse bruising and crepitus
a. TEE with IVF and blood products
b. TTE with IVF and blood products
c. CTA with IVF and blood products
d. CT with IVF and blood products
e. Immediate surgical cx with IVF and blood products

A

E and A …
If patient were more stable would obtain CTA prior to taking to OR

61
Q

ABI

A

Ankle brachial index
Normal:1.0-1.4
PAD: less tan or equal to 0.9
Severe disease: less than 0.5

CMT-uno (54 decks)

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