Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio Part 2= Clin Med > Diseases of the Aorta > Flashcards

Diseases of the Aorta Flashcards

1
Q

Aorta (5)

A

The largest blood vessel in the body
Delivers blood that is ejected from the heart to the rest of the body
Measures 3cm in diameter at the origin of the ascending aorta
Measures 2.5cm in the descending portion in the thorax
Measures 1.8-2.0cm in the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The wall of the aorta is divided into 3 layers

A
  1. Intima- the thin inner layer
    1. Media- the thick middle layer that gives the aorta strength, elasticity and distensibility
    2. Adventitia- the thin outer layer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is the aorta Prone to injury/ disease (2)

A

Prone to injury and disease due to it’s constant exposure to high pulsatile pressure and shear stress
More prone to rupture than any other vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The aorta is divided anatomically into two components:

A
  1. The thoracic aorta- within the thoracic cavity.

2. The Abdominal aorta- the section below the diaphragm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The aorta is divided into 3 distinct segments

A
  1. The ascending aorta
    1. The aortic arch
    2. The descending aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The ascending aorta is divided into 2 distinct segments

A
  1. Aortic Root: the lower segment
    - Begins at the level of the aortic valve
    - Supports the aortic valve leaflets
    - Extends into the sinotubular junction
    - Area where right and left main coronaries arise
    1. Ascending aorta: Upper segment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aortic Arch gives rise to? (3)

A

Gives rise to the “Great vessels”

  1. Innominate Artery
  2. Left Common Carotid Artery
  3. Left Subclavian Artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Descending Thoracic Aorta (3)

A

Runs distally to the diaphragm
The point at which the aortic arch joins the descending aorta is called the aortic isthmus
This is the point at which the aorta is vulnerable to trauma due to its fixation to other structures within the chest cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Abdominal Aorta (3)

A

Extends from the thoracic aorta at the level of the diaphragm to the bifurcation of the right and left common iliac arteries
Consists of two segments:
Suprarenal- the segment above the renal arteries
Infrarenal- the segment below the renal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The aorta as we age (4)

A

Elasticity and distensibility decreases with age
These changes occur earlier and more rapidly in men than in women
Loss of elasticity is accelerated in patients with HTN, Hypercholesterolemia and coronary artery disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diseases of the Aorta (2)

A
  1. Aortic Aneurysms
    - Thoracic
    - Abdominal
    1. Aortic Dissections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aortic Aneurysm (2)

A

Pathologic dilation of the aorta that can occur anywhere along the course of the aorta
Involves all layers of the vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

2 Types of Aortic Aneurysm

A

Fusiform- affects the entire circumference of a segment of a vessel
Saccular- involves only a portion of the circumference (outpouching of a vessel)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Classification of Aortic Aneurysms (3)

A

determined by location
Abdominal- below diaphragm
Thoracic- above diaphragm
Thoracolumbar- involves the descending thoracic aorta and abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications of Aortic Aneurysms (2)

A

Dissection

Acute Rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risk of rupture of Thoracic Aortic Aneurysms (3)

A

is related to the size and presence of symptoms
2-3% per year 6.0cm in diameter
Fewer than ½ of patient’s with an acute rupture arrive to the hospital alive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Natural History of Thoracic Aortic Aneurysms (2)

A

Average growth rate: 0.1-0.2cm/year

Those w/ Marfans syndrome may expand at a greater rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Etiology of Thoracic Aortic Aneurysms (4)

A

Ascending aortic aneurysms
Cystic medial necrosis is most common cause
Aortic arch and descending thoracic aneurysms
Atherosclerosis is the most common cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk Factors of Thoracic Aortic Aneurysms (6)

A

Atherosclerosis
Connective tissue disorders such as Marfan’s and Ehlers-Danlos syndrome
Hypertension
Familial thoracic aortic aneurysm syndromes
Infections: Syphilis (rare), tuberculosis
Vasculitis (ex. Takayasu’s arteritis, giant cell arteritis)
Trauma (penetrating or non-penetrating)

20
Q

Signs and Symptoms of Thoracic Aortic Aneurysms (6)

A

Most are asymptomatic and found on routine physical exam or Chest X-ray
If symptoms are present, they coincide with the size and location of the aneurysm
Aortic root: CHF, aortic regurgitation (dilation of aortic valve)
Aortic arch: may compress the trachea (deviation, cough) and/or recurrent laryngeal nerve(hoarseness)
Descending: dysphagia (compresses esophagus)
Chest and back pain which is described as steady, deep and at times extremely severe may occur

21
Q

Imaging/ Diagnosis of Thoracic Aortic Aneurysms (2)

A 
CXR:  
Widening of mediastinum, displacement or compression of the trachea, calcifications of the outline of the aorta, large aortic knob
Transesophageal echocardiogram (TEE):  
can assess the proximal ascending aorta and descending thoracic aorta
CT scan:
Modality of choice  
MRI and Aortography
Both sensitive and specific test
22
Q

Treatment of Thoracic Aortic Aneurysms (4)

A

Surgery
Aortic arch/ascending aorta: open surgery required
Descending: endovascular stent grafting
Medical Management

23
Q

Surgery Indications for Thoracic Aortic Aneurysms (5)

A

Symptomatic patients
Ascending aortic aneurysms >5.5-6.0cm
Descending aortic aneurysms >6.5-7.0cm
Aneurysms that have increased >1.0cm/year
Marfan’s syndrome patients and patients with bicuspid aortic valve: ascending aortic aneurysm >5.0cm

24
Q

Surgical Complications for Thoracic Aortic Aneurysms (3)

A

Higher morbidity and mortality than AAA
Paraplegia (4-10% rate following endovascular repair)
Stroke

25
Q

Medical Management for Thoracic Aortic Aneurysms (3)

A

Indications:
Asymptomatic patients with aneurysms too small to justify surgery

Beta Blockers:
decrease mortality and slow the rate of dilation

ACE-I/ARB’s:
Studies are showing these reduce the rate of expansion in patients with Marfan’s syndrome

**Should have follow up for CT about every 6 months

26
Q

Prognosis for Thoracic Aortic Aneurysms (2)

A

Survival rate of those not undergoing repair is 20% at 5 years
Less than ½ of the patients with an acute rupture arrive to the hospital alive

27
Q

Abdominal Aortic Aneurysms (5)

A

Defined as an aneurysm measuring ≥3.0cm
Male to female ratio is 4:1
90% of AAA >4.0cm are related to atherosclerosis
90% are infrarenal in location
Risk of rupture increases as the size increases
5.0cm: 5 year risk if 20-40%

28
Q

Natural History of Abdominal Aortic Aneurysms (3)

A

Overall Mortality from rupture is 80%
Approximately 60% of patients with acute rupture die before receiving medical attention
Operative mortality for those reaching hospital is 50%

29
Q

Risk Factors for Abdominal Aortic Aneurysms (7)

A 
Atherosclerosis- most common
HTN
Smoking
Hypercholesterolemia
Peripheral vascular disease
Age (incidence increases rapidly at 55 yr in men and 70 yr in women
Male gender
Genetics (1st degree relatives)
30
Q

Signs and Symptoms for Abdominal Aortic Aneurysms (5)

A

Mostly asymptomatic
Usually detected on exam as a palpable, pulsatile, non-tender mass or seen incidentally on imaging studies ordered for an unrelated symptoms
As the aneurysm expands, patients may feel abdominal or lower back pain
Pain may be constant or intermittent and may be brought on by gentle pressure on the aneurysm
Pain is usually a sign of impending rupture and is a medical emergency

31
Q

Imaging/ Diagnosis of Abdominal Aortic Aneurysms (4)

A

Pulsatile mass noted from the xiphoid process to the umbilicus
Abdominal Ultrasound- gold standard (inexpensive, noninvasive, almost 100% sensitive and does not use contrast)
X-ray- may show the calcified outline of the aneurysm (25% are not calcified)
Computed Tomography-Can diagnose and size aneurysm, though w/ contrast it is more expensive and a risk of allergic reaction
Contrast Aortography- Invasive and requires contrast
MR angiography-uses contrast, extremely accurate, used to plan for surgical repair (may underestimate the size)

32
Q

Surgery Treatment for Abdominal Aortic Aneurysms

A 
Surgery
The definitive treatment!
Indications
Any size that is symptomatic
Any aneurysm that is rapidly expanding (≥ 0.5cm/yr)
Diameter >5.5cm
Procedures 
Insertion of a prosthetic graft (open procedure)
Mortality rate 1-5%
Endovascular stent graft
Mortality rate 0.5-2%
33
Q

Medical Management for Abdominal Aortic Aneurysms (4)

A

Smoking Cessation
Aggressive control of HTN and hyperlipidemia
Beta blockers: reduce expansion and rupture
Serial imaging q6months to monitor size and rate of expansion for aneurysms >4.0cm or greater

34
Q

Prognosis of Abdominal Aortic Aneurysms (5)

A 
If treated surgically
5 year survival after tx:  60%
MI is leading cause of death
If no surgery
12% annual risk of rupture if >6.0cm
25% annual risk of rupture if >7.0cm
35
Q

Prevention/ Screening of Abdominal Aortic Aneurysms (5)

A

Prevention/Screening:
Treat risk factors (HTN, hyperlipidemia)
Smoking Cessation
Screening indications:
All men age 65-75 years who have ever smoked
Siblings or offspring of people w/ thoracic aortic or peripheral arterial aneurysms

36
Q

Aortic Dissection

A

Tear of the intima that results in the formation of a false channel w/in the media layer

37
Q

Common sites for Aortic Dissection (2)

A

The dissection will usually progress distally down the descending aorta and into its branches

Common sites:
Right lateral wall of the ascending aorta (shear stress is highest)
Descending thoracic aorta just below the ligamentum arteriosum

38
Q

Epidemiology of Aortic Dissection

A

Peak incidence in the 6th and 7th decades of life

Men are at twice the risk as women

39
Q

Risk Factors for Aortic Dissection (7)

A

HTN (present in 70% of pts w/ dissection)
Age (50-60’s)
Bicuspid aortic valve
Marfan’s syndrome and Ehlers Danlos syndrome
Inflammatory aortitis (Takayasu’s arteritis, giant cell arteritis)
Pregnancy (normal women in 3rd trimester
1/2 of all aortic dissections in females occur in women <40 years of age)
Blunt trauma to aorta

40
Q

2 Main Classifications of Aortic Dissection

A

The DeBakey Classification

The Stanford Classification

41
Q

The DeBakey Classification for Aortic Dissection (3)

A

Type I- Originates in ascending aorta, continues to the aortic arch and many times beyond the arch distally
Type II- Originates and is confined to the ascending aorta
Type III- Originates in the descending aorta with extension distally

42
Q

The Stanford Classification for Aortic Dissection (2)

A

Type A- all dissections involving the ascending aorta

Type B- all dissections not involving the ascending aorta

43
Q

Symptoms of an Aortic Dissection (8)

A

Severe pain most common initial symptom
Pain described as “tearing”, “ripping” and “sharp”
May be localized to the front or back of chest, lower back
Migrates as it progresses
Ascending dissection: neck, throat, jaw pain
Descending dissection: interscapular pain
Less common symptoms: Dyspnea, syncope, weakness, CHF, CVA, paraplegia, cardiac arrest

44
Q

Signs of an Aortic Dissection (6)

A 
Hypertension or Hypotension
Aortic regurgitation murmur
Asymmetric or loss of pulses
Pulmonary edema
Neuro findings d/t carotid artery obstruction (hemiplegia, hemianesthesia)
Paraplegia (spinal cord ischemia)
45
Q

Imaging/ Diagnosis of Aortic Dissection (3)

A

CXR: may show widened mediastinum and pulmonary edema
EKG: will be normal
CT, echocardiogram and MRI are diagnostic

46
Q

Medical Management for Aortic Dissection (5)

A

Treatment (goal is to stop the progression of the dissection)

Medical therapy:
Blood pressure control is essential
Beta blocker unless contraindicated to get HR down to 60bpm
Sodium nitruprusside to lower SBP <120 mmHg
CCC if BB and nitroprusside is contraindicated
Pain management (morphine)
Used alone for uncomplicated and stable distal dissections w/ follow up imaging q 6-12 months

47
Q

Surgery for Aortic Dissection Treatment (4)

A

Superior to medical tx in acute proximal dissections
Indications:
Acute distal dissections w/ vital organ compromise, rupture or impending rupture
Dissections in Marfan’s syndrome or
Continued pain
Involves incising the intimal flap, obliterating the false lumen and placing a graft

Cardio Part 2= Clin Med (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions