CARDIOLOGY Flashcards
What is an Aortic Aneurysm?
Localised dilation of the Aorta due to weakness in wall. (1.5x of typical anteroposterior diameter)
Can occur anywhere along Aorta (AAA = Common)
What are some risk factors/cause of an Aortic Aneurysm?
Smoking, Age, Family Hx, Males
Marfans ( inherited connective tissue disorder)
How does an individual with an un-ruptured Aortic Aneurysm present?
Mainly asymptomatic
Sometimes difficulty swallowing (oesophageal compressions) + voice hoarseness (Recurrent laryngeal N compression) + wheeze/stridor (tracheal compression)
How does an individual present with a ruptured Aortic Aneurysm?
Severe stabbing pain in chest
How is an Aortic Aneurysm diagnosed/detected?
Often through accidental screening.
Ultrasound is often first-line detection.
CT + MRI often used for operative planning.
What is the management of an Aortic Aneurysm?
CONSERVATIVE = Surveillance through frequent ultrasounds + management of risk factors
INTERVENTIONAL (for large/rupture) = Endovascular repair *** + Expandable stent graft + Open surgery (most extreme)
What is an Aortic Dissection?
Separation in the aortic wall intima, calling blood flow into a new false channel composed of inner + outer layer of intima –> Progressve haematoma in wall
What are some risk factors for an Aortic Dissection?
Age (60-80), Marfans, Bicuspid Aortic valve, Hypertension
Typically younger ppl = Connective tissue disorder
Typically older ppl = Hypertension/Atherosclerosis
How do someone with Aortic Dissection present?
Abrupt onset of chest, back , abdominal RIPPING pain
Asymmetrical BP depending on which branch or aorta
What may cause an Aortic Dissection
- Hypertension (MOST common)
- Trauma
How to diagnose an Aortic Dissection?
- CT Angiography (GOLD STAND.)
- BP difference between arms (20+mmHg)
- ECG = ST elevation due to coronary artery occlusion
Difference between Type A and Type B Aortic Dissection? (Stanford Classification)
A = Ascending Aorta
B = Not Ascending Aorta
Management of Aortic Dissection?
Stanford Type A = Immediate surgery bc Asc = high rupture risk –> Open/endovascular
Standard Type B = only needs medical therapy = IV Fluids + Vasopressers + B-blockers
What is Peripheral Arterial Disease?
Range of arterial syndromes that are caused by atherosclerotic obstruction of LOWER extremity arteries.
How may someone with PAD present?
Usually Asymptomatic
Intermittent Claudification + Gangrene + ED + Buttock pain while walking (alleviated through rest)
What are the 3 main causes of Aortic Valve Stenosis?
1- Calcific Aortic Stenosis
2- Congenital abnormality (bicuspid)
3- Secondary to Rheumatic Valve disease
What are the 3 main causes of Primary Aortic Regurgitation?
**Due to problems with the valve leaflets themselves
1- Congenital abnormality (Bicuspid)
2- Infective Endocarditis
3- Rheumatic Valve Disease
What are the some causes of Secondary Aortic Regurgitation?
**Due to problems with the aortic root/annulus
- Hypertension cause root dilation (CHRONIC)
- Aortic Dissection (ACUTE)
What are the symptoms of Aortic Stenosis and Regurg?
Mostly Asymptomatic (During compensatory phase)
S.A.D
S = Syncope
A = Angine
D = Dyspnoea (esp Regurg)
What are some compensatory measures for both Aortic Stenosis and Regurg?
STENOSIS = Hypertrophy –> Need more force to push blood through narrow valve
REGURG = Dilated LV –> Allow for more blood to fill up due to leaky valve
What are some sign of Aortic Stenosis?
*Signs of HF = Severe Stenosis
- Low systolic pressure
- Low pulse pressure (Small diff bw syst + diast)
- Systolic murmur -> Heard in carotids
- Hyperdynamic Apex beat (very heavy)
What are some signs of Aortic Regurg?
**Signs of HF = Sever Regurg
- High pulse pressure (High diff between syst + diast)
- Displaced Apex Beat due to LV dilation (form of compensatory measures)
- Diastolic Murmur
What are some investigations for Aortic Stenosis and Regurg?
1- ECG = Look for LV Hypertrophy + Arrhythmias (AFib = more difficult to manage patient)
2- KEY - Transthoracic echocardiography = Look for thickened valve + LV walls
What is the Pharma Management of Aortic + Mitral Stenosis and Regurg, and what is the purpose?
Purpose = Symptoms relief + comorbidity management
- Furosemide (key for excessive fluid - HF)
- AFib medications = Anti-coags
- Meds for causative factors = Hypertension, T2 Diabetes etc
