Cardiovascular

Question 1

What is the cause of thoracic aortic aneurysm?

Answer 1

Vast majority result from atherosclerosis, connective tissue disease

Question 2

What is the major DDx of thoracic aortic aneurysm?

Answer 2

Aortic dissection

Question 3

S/sx of thoracic aortic aneurysm?

Answer 3

Most are asymptomatic
CP
Stridor
Hemoptysis
Recurrent laryngeal nerve compression

Question 4

How is a thoracic aortic aneurysm most commonly discovered?

Answer 4

Routine CXR

Question 5

Which diagnostic tests should be performed for a thoracic aortic aneurysm?

Answer 5

CXR
CT scan
MRI
Aortography

Question 6

What are the indications for tx of thoracic aortic aneurysm?

Answer 6

> 6 cm in diameter
Sx
Rapid increase in diameter
Rupture

Question 7

What is the tx for thoracic aortic aneurysm?

Answer 7

Replace with graft, open or endovascular stent

Question 8

What are the dreaded complications after tx of a thoracic aortic aneurysm?

Answer 8

Paraplegia

Anterior spinal syndrome

Question 9

What is anterior spinal syndrome?

Answer 9

Syndrome characterized by:
Paraplegia
Incontinence
Pain and temperature sensation loss

Question 10

What is aortic dissection?

Answer 10

Separation of the walls of the aorta from an intimal tear and disease of the tunica media
A false lumen is formed and a reentry tear may occur, resulting in double-barrel aorta

Question 11

What are the aortic dissection classifications?

Answer 11

DeBakey classification

Stanford classification

Question 12

Stanford classification type A

Answer 12

Ascending aorta (requires surgery)
\+/- descending aorta (includes DeBakey types I and II)

Question 13

Stanford classification type B

Answer 13

Descending aorta only (nonop, except for complications)

Same as DeBakey type III

Question 14

What is the etiology of aortic dissection?

Answer 14

HTN
Marfan's syndrome
Bicuspid aortic valve
Coarctation of the aorta
Cystic medial necrosis
Proximal aortic aneurysm

Question 15

S/sx of aortic dissection

Answer 15

Abrupt onset of severe chest pain, most often radiating/tearing to the back
Onset is typically more abrupt than that of MI
The pain can migrate as the dissection progresses
Pt describes a tearing pain

Question 16

What are three other sequelae of aortic dissection?

Answer 16

Cardiac tamponade
Aortic insufficiency
Aortic arterial branch occlusion/shearing

Question 17

Which diagnostic tests are indicated in aortic dissection?

Answer 17

CXR
-Widened mediastinum
-Pleural effusion
TEE
CTA

Question 18

What is the tx of Stanford type A aortic dissection?

Answer 18

Surgical

Question 19

What is the tx of Stanford type B aortic dissection?

Answer 19

Medical (control BP), unless complicated by rupture or significant occlusions

Question 20

Preop tx for aortic dissection

Answer 20

Control BP with sodium nitroprusside and beta blockers

Question 21

What is the postop tx for aortic dissection?

Answer 21

Lifetime control of BP and monitoring of aortic size

Question 22

What is the possible cause of MI in a pt with aortic dissection?

Answer 22

Dissection involves the coronary arteries or underlying LAD