Cardiology- Aneurysms

Question 1

What is the most common aortic aneurysm?

Answer 1

abdominal aortic aneurysm

Question 2

What defines abdominal aortic aneurysm

Answer 2

aortic diameter > 3.0 cm

Question 3

Where are most AAA located

Answer 3

40% AAA are associated with iliac artery aneruysm

Question 4

What % of pts with thoracic aortic aneurysm will have AAA

Answer 4

20% - decreasing in incidence due to screening

Question 5

Who gets screened for AA

Answer 5

1. Men 65-75 who Smoke 2. Men 65-75 not smoker but 1st degree relative who required AAA repair of died of ruptured AAA

Question 6

Who is at risk

Answer 6

1. Men 2. > 65 yo 3. CAD/CVD/PAD 4. Fam Hx 5. Smoke 6. HTN 7. elevated cholesterol or anything that causes damage to blood vessel wall 8. Congenital: Marfan’s; Ehler’s Danlos Type IV

Question 7

Primary cause of abdominal aortic aneurysm

Answer 7

Atherosclerosis

Question 8

Signs of AAA

Answer 8

1. Often Asymptomatic 2. Substernal abdominal pain radiating to back 3. Flank pain 4. Diminished Pulses 5. PAD 6. ** Hoarse voice 2/2 damage of laryngeal nerve 7. Dyspnea- SOB 8. Dysphagia- difficulty swallowing

Question 9

Signs of possible worsening AAA/ Rupture

Answer 9

1. SEVERE abd pain (tearing) radiating to back 2. HYPOtension 3. Palpable pusaltile mass 4. Shock 5. Pale

Question 10

DDX AAA

Answer 10

1. Renal Colic 2. Perforated Bowel 3. Diverticulitis 4. GI Bleed 5. Ischemic bowel

Question 11

Workup AAA

Answer 11

1. CBC 2. Type and CROSS (NOT type and screen) 3. ** Abd US if ASX 4. Symptomatic AAA- Abd CT/ MRI 5. Aortography

Question 12

Edovascular surgical repair - when to treat AAA

Answer 12

> 5.5 cm. If you are in poor health and going to die in a couple years- no surgery risk outweigh benefits

Question 13

What is considered rapid expansion in AAA

Answer 13

> 0.5 cm change in 6 mo

Question 14

Other things to assess in AAA for pt health

Answer 14

1. Blood pressure control 2. Smoking cessation 3. Risk of rupture of AAA is 5-10% if size is 5.0 cm to 5.9 cm

Question 15

PE for AAA

Answer 15

1. Assess abdominal pulsatile mass 2. Peripheral vascular exam 3. Peripheral neurological exam

Question 16

When is surgery indicated for an aortic aneurysm

Answer 16

1. Descending => 6.0 cm 2. Ascending => 5.5 cm \ 3. Connective tissue disease or a bicuspid aorta cutoff is 5.0 cm

Question 17

Define an aneurysm

Answer 17

An abnormal bulge in the wall of the aorta. Characterized by greater than 1.5 times the size of the normal aorta. It may occur because of a localized weakness of the artery wall (saccular). Or football like swelling around the aortic wall (fusiform). Enlargement of the aorta may be only mild in degree (ectasia- less than 1.5 times the size of normal aorta).

Question 18

Where are most thoracic aorta aneurysms located?

Answer 18

90% below the diaphragm; other 10 % in the chest

Question 19

Causes of thoracic aortic aneurysms

Answer 19

1. HTN 2. Cholesterol

Question 20

Classifications of aortic aneurysm versus dissection

Answer 20