Diseases of Aorta Flashcards
S3Q4
AORTA
systole vs. diastole
laplace law
diameter (3)
aortic wall - main shit, 3 layers (0.1.2)
- LV –> aorta
- systole: distended since receive blood
- diastole: recoil since pump blood to peripheral
- laplace law: wall tension DP pressurexradius
diameter
- ascending: 3cm
- thoracic: 2.5cm
- abdominal: 1.8-2cm
aortic wall
- endothelium
- internal elastic lamina, thick tunica media (smooth muscle cell), adventitia (CT covering vasa & nervi)
AORTA: Aneurysm
what, proximal vs. distal, d/t (2)
extra type - true, pseudo (2), fusiform (1=1), saccular (1=1)
etiology - general (5), mediated by (2.1=2=1)
- pathologic dilation of segment of vessel
- proximal > distal since closer to branches
- d/t Htn & collagen
extra types
- true aneurysm: whole layers
- pseudoaneurysm: adventitia spared; perivascular clot
- fusiform: whole circumference = diffuse dilation
- saccular: part of circumference = outpouching of vessel wall
etiology
- general: degenerative, infectton, vasculitis, inherited, trauma
- mediated by: t & b-cell lymphocyte; macrophage = degrade elastin & collagen = alter tensile strength
AORTA: Aneurysm - Etiology
athero - associated/trend, pathology (1=1)
cystic - pathology (2 + where) & what into what, where, etiology (3), extra type
infection - symphilic where (2) + sex, tuberculus where, mycotic trend + etiology (3) + where + extra type
atherosclerosis
- most associated c degenerative aneurym
- plaques = thinner walls = weaken
cystic medial necrosis
- degeneration of elastin & collagen in tunica media
- medial cells changed into weaker mucoid material
- where: proximal aorta
- eti: Htn, ehler, marfan type 4
- extra type: fusiform
infection
- symphilic: in ascending & arch; M>F
- tuberculus: in thoracic
- mycotic: rare; streph staph salmonella; at arthero plaques; saccular
AORTA: Aneurysm - Etiology
vasculitides - etiology (2), where (2=2)
spondylo - etiology + where (2G)
traumatic - where
vasculitides
- inflammation or autoimmune
- takayasu & giant cell: in descending, arch
spondylo
- MSK stuff = ascending
- behchet syndrome = thoracic & abdominal
traumatic
- after chest trauma
- where: descending near ligamentum arteriosum
AORTA: Thoracic Aneurysm
etiology - (1.2.3)
epidemiology - average growth + 2
clinical - mostly what, compress=(1.3=1), dilation=1=1, compression=(5), pain where (2)
etiology
- cystic medial necrosis: most for ascending
- athero: arch & descending thoracic
- rare: syphilis, ehler, marfan (wider)
epidemiology
- 0.1-0.2cm/y
- < 4cm = 2-3%/y
- < 6cm = 7%/y
clinical presentation
- mostly asymp
- compress SVC = blush, distended veins in neck chest UE = congestion
- dilation of aorta = regurgitation = CHF
- compression of adjacent = SOB, dyspnea, cough, hoarseness, dysphagia
- substernal back or neck pain
AORTA: Thoracic Aneurysm
imaging - radio, xray, CT, MRa, which best
tx - if _ diameter, descending, ascending
imaging
- chest radiograph: calcified dilated aorta
- chest xray: first to suggest thoracic aorta
- CT c contrast: best
- MRA: aneurysm size, differentiate from other lesions
tx
- > 6cm = repair since 5y survival
- descending = endovascular graft, beta blocker
- arch or ascending = open surgery
AORTA: Abdominal Aneurysm
epidemiology - sex, risk (4), risk factor abdominal vs. thoracic, renal elvel
pathology - (2) = what happens = what
signs - pulse boogsh where (4), hypo vs. hypertensive, emergency sx, usually what, exam (4.2)
mx - (2.1), which PT prefer
- epi: M>F
- risk: alcohol, smoking, Htn, athero
- risk factor: 5y for abdominal, 4y for thoracic
- infrarenal > suprarenal
- pathology: mural thrombi/platelets = stick together as thrombi = eventually travel out as emboli
- pulse boogsh in: chest, lower back, scrotum, labia
- hypotensive = already rupture
- hypertensive = rupturing
- hypo + pain = emergency
signs/sx
- asymptomatic
- palpable expandile nontender pulsatile mass
- incidental in x-ray or ultrasound
mx
- standard (open surgery): put graft
- endovascular: no heart access; just femoral artery or faster abdominal aorta
- PT like endo
AORTA: Aortic Dissection
risk (5) + who morbidity (2)
pathology - events (2G), main structure + why, subsitute structure, pressure=1=1=1, dissection usual direction
sx - pain direction + describe + location, hypo vs. hypertensive, other sx (4) + 2 d/t of 1 of those, other sx (3)
other sx: syncope & bowel ischemia
- risk: cystic, htn, 3rd trimester pregnancy, marfan & ehler (inc morbidity)
- d/t circumferential or transverse tear
pathology
- intima or tunica tear first
- at right lateral wall of ascending aorta (first to receive blood = high hydraulic shear stress), or descending aorta near ligamentum arteriosum
- pressure in aorta = blood make false lumen = compress true lumen = compromise up/down circulation
- dissection is usually distally via descending aorta
signs/sx
- if ascending pain = worse since going to brain
- pain is like tearing; local in chest
- Htn = better since not yet lose blood
- neuro = d/t carotid or spine ischemia
- syncope, weakness, dyspnea
- bowel ischemia, bowel attack, renal failure
AORTA: Aortic Dissection
complications - horner sx (2) + d/t, acute aortic regurgitation common for where
debakey (3), stanford (2G), which prefer
tx - main shit, 2 pharma, 2 op
complications
- horner: ptosis & miosis; d/t thoracic aneurysm compressing sympathetic ganglia
- acute aortic regurgitation: common for proximal dissection
debakey
- type I: both
- type II: proximal = emergency
- type III: distal
stanford
- type A: proximal/ascending = surgery
- type B: distal/descending = can wait, elective
tx
- fix BP trigger
- anticholesterol, antihypertensive
- op: percutaneous graft, open heart surgery
AORTA: PAD
pathology (2), etiology (5), risk (5), age (2) + specific etiology
sx - UE vs. LE, main sx what + when, 2nd sx what + when + emergency if, other sx (4.5) + indication, ischemic neuropathy (2)
eti: thrombi, risk: smoking hyper
- patho: stenosis or obstructed artery
- eti: atherosclerosis, thrombi, embolus, spondyloarthropathies, anything inflammatory to artery
- risk: smoking (3x), DM (2x), Htn, hypercholesterol, hyperhomocysteinemia, CRP, fibrinogen
- age: 40 before 30 now, 60-70y for athero PAD
signs/sx
- LE > UE
- intermittent claudication: pain numbness fatigue in muscles when walking & relieved by rest
- critical limb ischemia: numb or cold in foot or toe when horizontal/sleeping & relieved by dependent/dangling; if persistent pain = emergency
- dec pulse & bruit distal to site, atrophy, edema
- shiny skin, pallor, cyanosis, hair loss, thickened/ulcer/gangrene nails
- ischemic neuropathy = numb, hyporeflexive
AORTA: PAD
exam - ABI normal + severe, ultrasonography, pulse volume N, other test
tx - non-op (1), op (2G)
exam
- ABI: < 1= PAD, 0.5 = severe
- arterial ultrasonography: lower = PAD
- pulse volume recording: N=10mmHg
- treadmill stress test
tx
- control cholesterol
- revascularization: if stenosed femoral = put saphenous prox & distal to site to compensate
- percutaneous intervention
AORTA: Thromboangitis Obliterans
other name, epidemiology (age sex risk), etiology
pathology (2) of (2) where (2)
triad, pulse (2), other sx + tx
imaging - arterio (2), confirmatory
tx (1.1)
- buerger’s disease
- epi: M, <40y, smokers
- eti: idiopathic
- pathology: inflammatory occlusive in small & medium arteries & veins in distal UE/LE
- pulse normal in brachial & popliteal
- trophic/ulcer/gangrene in nails = amp
triad
- claudication
- raynauds phenomenon
- migratory superficial vein thrombophlebitis
imaging
- arteriography: smooth gapering distal vessels + angiogenesis (new vessel = collateral formation)
- excisional biopsy
tx
- no specific
- arterial bypass
AORTA: Raynaud’s Phenomenon
pathology (3), trigger, main sx (3)
phase 1 (3), phase 2 (1=2)
RAYNAUDS PHENOMENON
- patho: migraine, prinzmetal, ischemia of digits
- trigger: emotional in women
- triphasic color: pallor/blanch —> cyanosis —> rubor after exposure to cold then rewarm
- ischemic phase: blanching, no sensation, artery vasospasm & capillary dilate
- hyperemic phase: bye vasospam = color & blood
AORTA: Raynaud’s Disease
if, epidemiology (age sex trend), where (2) + rare (3)
tx - if mild, if severe (1.1)
- if can’t find cause
- epi: F, 20-40y, fingers>toes, 50%
- rare: earlobe, nose tip, penis
tx
- mild & infrequent = just no cold exposure
- severe = vasodilators, digital sympathectomy (cut off supply = dilate forever)
AORTA: CRPS
I - other name, etiology, pathology (2), pain type, other sx (3=1), other sx (5), phases (1.3.1) + when PT
II - other name, etiology, sx where
CRPS I / Reflex Dystrophy
- patho: neuro or arterial
- eti: trauma
- allodynia (other mod), hyperpathia (OA)
- other sx: vasoconstrict + edema + sweating = varying temp
- other sx: sensory trophic autonomic motor pain
- phase 1 (3m): inflammatory sx
- phase 2 (3-6m): nutrition, skin, perfusion
- phase 3: flexion contracture = PT
CRPS II / Causalgia
- d/t damaged peripheral nerve
- pain either within distribution or spread
