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CM I - Exam 1 (Cardio) > Diseases of the Aorta > Flashcards

Diseases of the Aorta Flashcards

1
Q

Aortic anatomy:
3 layers of the aorta

A
  1. inner intima
  2. middle media
  3. outer adventitia

-structures degenerate w/ age d/t collagen degradation (also degenerate w/ smoking or long-standing HTN)
-thoracic aorta (ascending aorta, aortic arch, descending thoracic aorta)
-abdominal aorta (begins once the descending aorta passes through the diaphragm, separated into suprarenal and infrarenal)

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2
Q

Aortic aneurysms

A

-segmental (only 1 segment not entire aorta), full-thickness (all 3 layers distended) dilation of the aorta (greater than 50% of the normal diameter)

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3
Q

Abdominal aortic aneurysm (AAA)

A

-any dilation >3cm
-MC arterial aneurysm (4x higher risk in males 50yo+)

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4
Q

RF of AAA

A

HTN
smoking
elevated cholesterol
age
male
atherosclerosis
FH (genetic predisposition)

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5
Q

Sx of AAA

A

likely none if unruptured

ruptured AAA: pain, pulsatile mass, hypotension

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6
Q

Screening for AAA

A

US
-screen 65-75yo w/ FH (1st degree relative) of AAA repair or death by a ruptured AAA
-screen MEN 65-75yo who have EVER SMOKED

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7
Q

Dx studies for AAA

A

-US to screen and if symptomatic + hemodynamically unstable (emergent)
-CT for hemodynamically stable pts; also used for surgical planning

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8
Q

AAA: management

A

-ruptured aneurysms require emergency surgery (very high mortality, ~80%)
-symptomatic, unruptured aneurysms require urgent surgery
-asymptomatic unruptured aneurysms: watchful waiting, if <5cm (r/o rupture > r/o surgery once 5.5cm+)

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9
Q

thoracic aortic aneurysms of the ascending aorta are associated with what conditions?

A

Marfan syndrome
Ehlers-Danlos syndrome
(both collagen disorders)

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10
Q

thoracic aortic aneurysms of the descending aorta are associated with what conditions?

A

HTN
Atherosclerosis

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11
Q

Clinical presentation of pt w/ thoracic aortic aneurysm

A

-~1/2 are symptomatic
-may apply pressure to adjacent structures (trachea, esophagus, recurrent laryngeal n. (SOB, loss of vocal pitch, hoarseness, choking/coughing while swallowing))
-chest pain

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12
Q

Thoracic aortic aneurysm: PE

A

may feel aortic impulse in R upper sternal border

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13
Q

Thoracic aortic aneurysm: Dx test

A

-CXR: widening of the mediastinal silhouette
-MRI & spiral CT are most commonly used for dx

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14
Q

Thoracic aortic aneurysm: Tx

A

-control BP (B-blockers)
-if <5cm unlikely to rupture (monitor); >7cm are high risk (consider TEVAR - thoracic endovascular aortic repair)
-aneurysms that are invading local structures should be resected

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15
Q

aortic dissection

A

tear in intima w/ development of a hematoma btwn the intima and adventitia

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16
Q

Stanford classification system of aortic dissection (& what each is associated with)

A

A: involves ASCENDING aorta; high mortality if untreated; associated with connective tissue disorders

B: DESCENDING aorta only; associated with long-standing HTN; age

17
Q

DeBakey classification system of aortic dissection

A

Type I: involves entire aorta

Type II: involves only ascending aorta

Type III: spares the ascending aorta and arch

18
Q

Aortic dissection: RF

A

-HTN
-old age
-male
-preexisting aortic aneurysm
-atherosclerosis

Less common:
-connective tissue d/o
-vascular inflammation
-deceleration trauma (injury d/t sudden halt)

19
Q

aortic dissection: clinical presentation

A

ABRUPT PAIN IN BACK/CHEST “tearing pain”

Type A: may have syncope or hypotension; stroke (lack of BF to brain & UE)

Type B: pain in back w/ radiation down legs

*both may present w/ pulse deficits
**high mortality!

20
Q

aortic dissection: Dx tests

A

-CXR: widened mediastinum
-CT: method of choice for dx

21
Q

aortic aneurysm vs dissection on CT scan

A

Aortic aneurysm: wide aorta w/ a WIDE lumen

Aortic dissection: wide aorta w/ a NARROW lumen

22
Q

Aortic dissection: Tx

A

Surgical repair
-Type A: urgent surgical repair
-Type B: surgery w/ life-threatening complications (ischemia of kidneys, bowel, extremities; progression of aneurysm, impending rupture, extension of dissection)

Medical therapy:
-aggressively control BP (B-blockers)

23
Q

Takayasu arteritis & epidemiology

A

inflammatory dz of aorta and major branches
-80-90% of cases involve WOMEN btwn 10-40yo
-highest prevalence in ASIA
-Probably autoimmune

24
Q

clinical presentation of Takayasu arteritis

A

Early sx: fever, loss of appetite, wt loss, night sweats, arthralgias (constitutional sx = all over body)

-Claudication
-cyanosis
-lightheadedness (lack of BF to brain via carotids)
-tenderness over carotids
-diminished radial pulses & HTN in 50% pts, may be different btwn arms (d/t lack of BF to one or both arms w/ compensation (HTN) in opposite arm)

25
Q

Takayasu arteritis: Dx tests

A

-ESR, CRP (nonspecific inflammatory markers)
-Normocytic normochromic anemia (body stores iron for later use so it’s unavailable –> anemia)
-MRA or CTA are best imaging modalities

26
Q

Takayasu arteritis: Tx

A

Systemic glucocorticoids (steroids)

27
Q

Giant cell arteritis (temporal arteritis) & epidemiology

A

-inflammation of temporal artery and adjacent vessels

-Old white pt (almost never occurs <50yo; Scandinavian descent)
-closely associated w/ polymyalgia rheumatica

28
Q

clinical presentation of giant cell arteritis (temporal arteritis)

A

HA
fever
jaw claudication
***fear is PERMANENT VISION LOSS (1/5)

29
Q

Giant cell arteritis (temporal arteritis): Dx tests

A

-ESR, CRP
-Arterial bx is essential for dx

30
Q

Giant cell arteritis (temporal arteritis): Tx

A

-start steroids IMMEDIATELY, even before bx, to prevent potential permanent vision loss

31
Q

coarctation of the aorta & epidemiology

A

-localized narrowing of the aorta
-most commonly just distal to the origin of the L subclavian a.
-affects 4/10,000 (typically congenital)
-cause of secondary HTN

32
Q

classic PE finding of coarctation of the aorta

A

decreased pulse/BP in legs compared to the arms

33
Q

Coarctation of the aorta: Sx

A

-CHF in neonates
-HTN is typical presentation in adults

34
Q

Coarctation of aorta: Dx tests

A

echo

35
Q

Coarctation of aorta: Tx

A

surgical stent placement

36
Q

What dz is the “3 sign” associated w/?

A

coarctation of aorta
-seen on x-ray (notch of “3” in the aorta is location of coarctation/narrowing)

37
Q

Rib notching: what is it and what dz may it be associated w/?

A

-rib abnormalities on x-ray (notching)
-w/ coarctation of the aorta there is so much blood going into the subclavian and intercostal arteries that it is causing damage to the ribs

CM I - Exam 1 (Cardio) (11 decks)

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