Diseases of the Aorta Flashcards
diameter of ascending, descending, and abdominal aorta
- ascending = 3cm
- descending = 2.5cm
- abdominal = 1.8-2.0cm
Why is the aorta prone to injury and dz?
constant exposure to high pulsatile pressures and shear stress
define aortic isthmus
- point where aortic arch joins descending aorta
Why is the aortic isthmus vulnerable to trauma?
- ductus arteriosus
How does the aorta change when we age?
- elasticity and distensibility decrease
- changes occur earlier and more rapidly in females
- decr elasticity is accelerated in pts w/ HTN, hypercholesterolemia, and CAD
define aortic aneurysms
- dilation of aorta anywhere
- all layers of vessel
- fusiform or saccular
difference b/t fusiform and saccular aneurysms
- fusiform = entire circumference
- saccular = outpouch
classifications of aortic aneurysms
- abdominal
- thoracic
- thoracolumbar
complications of aortic aneurysms
- dissections
- rupture
epidemiology of thoracic aneurysms
- avg growth = 0.1 - 0.2cm/yr, Marfan’s grow faster
- rupture is related to size and presence of sx
- fewer than 1/2 of patients with an acute rupture arrive to the H alive
etiology of thoracic aneurysms
- ascending = MC is cystic medical necrosis
- aortic arch and descending = MC is atherosclerosis
risk factors of thoracic aneurysms
- atherosclerosis
- connective tissue d/o
- HTN
- familial thoracic aortic aneurysms
- infx: syphillis, TB
- vasculitis
- trauma
S+S of thoracic aneurysms
- asx
- if present, coinsicde w/ size + location
- +/- chest pain (usually when at risk of rupture)
What are specific S+S of aortic root, aortic arch, and descending thoracic aneurysms?
- aortic root = CHF, aortic regurg
- aortic arch = compress trachea and/or recurrent laryngeal n.
- desc = compress esophagus
diagnostics of thoracic aneurysms
- CXR
- TEE
- CT
- MRI
- aortography
treatment of thoracic aneurysms
- surgery (open v. endovascular stent)
- medical management: BB, ACE/ARB
define abdominal aortic aneurysms (AAA)
- greater than or equal to 3cm
epidemiology of AAA
- males more than females
- 90% = infrarenal
risk factors of AAA
- MC = atherosclerosis
- HTN
- smoking
- hypercholesterolemia
- PVD
- age
- male
- genetics
S+S of AAA
- mostly asx
- palpable, pulsatile, non-tender mass
- referred pain to abdominals or lower back
diagnostics of AAA
- US
- CT
- MRA
treatment of AAA
- surgery (indicated when symptomatic, greater than or equal to 0.5cm/yr, greater than or equal to 5.5cm diameter): prosthetic graft or endovascular stent
- decr smoking
- HTN + hypercholesterolemia control
- BB (decr. expansion + rupture)
- serioal imaging q6mo (vs. qyr for thoracic)
prevention/screening of AAA
- tx risk factors + decr smoking
- screen males 65-75 y/o who have ever smoked
- screen siblings + offspring
define aortic dissection
tear in intima leads to false channel in medial layer
How does an aortic dissection progress?
distally
What are the common sites of aortic dissection?
- right lateral wall of ascending aorta d/t shear stress
- descending, distal to ligamentum arteriosum
What is a result of aortic dissection?
- branching a. loose blood flow which leads to organ ischemia
epidemiology of aortic dissection
- 7th-8th decades
- males more than females
classification systems for aortic dissection
- DeBakey
- Stanford
risk factors for aortic dissection
- HTN
- age
- biscuspid aortic valve
- connective tissue d/o
- inflammatory aortitis
- pregnancy
- blunt trauma
symptoms of aortic dissection
- MC initially = severe, presisten, sudden onset chest pain
- tearing, ripping, sharp pain
- localized pain
- may migrate
Where will symptoms of an ascending aortic dissection migrate?
- neck
- throat
- jaw
Where will symptoms of a descending aortic dissection migrate?
- chest pain +/- radiating to back, interscapular, or anterior chest
signs of aortic dissection
- hyper or hypotension
- AR murmur when ascending (diastolic decrescendo)
- decr or unequal peripheral pulses
- pulm edema
- intestinal ischemia/renal insufficiency
- neuro sx
- paraplegia
diagnostics of aortic dissection
- CXR = widened mediastinum + pulm edema
- EKG = LVH
- CT of chest + abdomen
- echo
- MRI
treatment goals for aortic dissection
stop progression
treatment options for aortic dissection
- control BP (BB, CCP, Na nitruprusside)
- pain management (morphine)
- surgery (better than drugs in acute proximal aortic dissection
When is surgery indicated for aortic dissection?
- vital organ compromise
- rupture or impending rupture
- marfans
- continued pain
When is BP control and pain managment indicated for aortic dissection?
only for uncomplicated + stable distal w/ f/u imaging 1 6-12mo
