Cardio Flashcards
what is an Aortic dissection?
Tear in the intima (innermost layer of the abdominal aorta); causing blood to bulge and continuously fill between the intima and media layers, creating a false lumen & reduction of blood supply to rest of body
name of Aortic dissection classification
stanford type A & B
Type A aortic dissection location
& management
ascending aorta/arise anywhere before the origin of the left subclavian artery
surgery
Type B aortic dissection location
& management
distal to the origin of the left subclavian
BP control
3 possible pathophysiology of blood entering media
1) Atherosclerotic ulcer leading to intimal tear
2) Disruption of vasa vasorum causing intramural haemorrhage
3) de novo intimal tear
Symptomatic presentation of aortic dissection
Sudden onset tearing chest pain, radiating to back.
sweating, nausea, SoB, weakness, syncope
symptoms other than chest pain
- syncope
- seizure
- limb paraesthesia
- pain/weakness
- SoB
- haemoptysis
3 inherited risk factors for aortic dissection
- Marfans syndrome
- ehlers-danlos syndrome type IV
- turner syndome
risk factors for aortic wall stress
- HTN
- Previous cardiovascular surgery
- infection
- cocaine
- smoking
- high cholesterol
investigations for aortic dissection
- ECG
- Bloods: troponin, FBC, CRP, U&E, cross match/group&save, WCC
imaging for investigating aortic dissection, and findings
CXR: widening mediastinum, abnormal aortic contour
ECHO: either transthoracic or transoesophageal
CT/MRI
Emergency A-E management of aortic dissection
- High flow 15Loxygen via non-rebreath mask
- insert 2 large bore cannula into each ACF
- Invasive monitoring
- Group & save/crpss match blood, warn blood bank
IV Beta blocker: propranolol/labetalol & Vasodilator: GTN/labetalol
Call senior & cardiothoracic surgeon
(beta blockers avoids reflex tachycardia which would increase aortic wall stress)
indications for surgery for an aortic dissection (4)
- Type A
- Persistent pain
- Branch occlusion
- Leaking
- Continued extension despite optimal med management
name 5 congenital heart defects
- Atrial septal defects
- Bicuspid aortic valve
- Ventricular septal defects
- Coarctation of the aorta
- Pulmonary stenosis
symptoms of ASD
- pulmonary HTN
- cyanosis
- haemoptysis
- chest pain
- arrhythmia
complication of Atrial septal defect
the initial left to right shunt causes pulmonary hypertension that then causes reversal to a right to left shunt causing cyanosis, HF & chest infections
presentation of VSD in infants
severe heart failure
classical auscultation in VSD
harsh pan systolic murmur in left sternal edge w/ systolic thrill
2 associations with coarctation of aorta
- turner syndrome
- bicuspid aortic valve
signs of coarctation of aorta
- radiofemoral delay
- weak femoral pulses
- raised BP
4 features of Fallot’s tetralogy
1) Ventricular septal defect
2) Pulmonary stenosis
3) Right ventricular hypertrophy
4) Aorta overriding the VSD
most common cyanotic congenital heart defect?
Fallots tetrology
name 3 cyanotic heart diseases
- Fallots tetrology
- Tricuspid atresia
- Transposition of great arteries
name 3 acyanotic heart diseases
- ASD
- VSD
- PDA
