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Clin Med - Cardio Exam #2 > Diseases of the Aorta > Flashcards

Diseases of the Aorta Flashcards

1
Q

diameter of ascending, descending, and abdominal aorta

A
  • ascending = 3cm
  • descending = 2.5cm
  • abdominal = 1.8-2.0cm
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2
Q

Why is the aorta prone to injury and dz?

A

constant exposure to high pulsatile pressures and shear stress

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3
Q

define aortic isthmus

A
  • point where aortic arch joins descending aorta
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4
Q

Why is the aortic isthmus vulnerable to trauma?

A
  • ductus arteriosus
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5
Q

How does the aorta change when we age?

A
  • elasticity and distensibility decrease
  • changes occur earlier and more rapidly in females
  • decr elasticity is accelerated in pts w/ HTN, hypercholesterolemia, and CAD
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6
Q

define aortic aneurysms

A
  • dilation of aorta anywhere
  • all layers of vessel
  • fusiform or saccular
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7
Q

difference b/t fusiform and saccular aneurysms

A
  • fusiform = entire circumference

- saccular = outpouch

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8
Q

classifications of aortic aneurysms

A
  • abdominal
  • thoracic
  • thoracolumbar
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9
Q

complications of aortic aneurysms

A
  • dissections

- rupture

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10
Q

epidemiology of thoracic aneurysms

A
  • 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
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11
Q

etiology of thoracic aneurysms

A
  • ascending = MC is cystic medical necrosis

- aortic arch and descending = MC is atherosclerosis

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12
Q

risk factors of thoracic aneurysms

A
  • atherosclerosis
  • connective tissue d/o
  • HTN
  • familial thoracic aortic aneurysms
  • infx: syphillis, TB
  • vasculitis
  • trauma
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13
Q

S+S of thoracic aneurysms

A
  • asx
  • if present, coinsicde w/ size + location
  • +/- chest pain (usually when at risk of rupture)
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14
Q

What are specific S+S of aortic root, aortic arch, and descending thoracic aneurysms?

A
  • aortic root = CHF, aortic regurg
  • aortic arch = compress trachea and/or recurrent laryngeal n.
  • desc = compress esophagus
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15
Q

diagnostics of thoracic aneurysms

A
  • CXR
  • TEE
  • CT
  • MRI
  • aortography
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16
Q

treatment of thoracic aneurysms

A
  • surgery (open v. endovascular stent)

- medical management: BB, ACE/ARB

17
Q

define abdominal aortic aneurysms (AAA)

A
  • greater than or equal to 3cm
18
Q

epidemiology of AAA

A
  • males more than females

- 90% = infrarenal

19
Q

risk factors of AAA

A
  • MC = atherosclerosis
  • HTN
  • smoking
  • hypercholesterolemia
  • PVD
  • age
  • male
  • genetics
20
Q

S+S of AAA

A
  • mostly asx
  • palpable, pulsatile, non-tender mass
  • referred pain to abdominals or lower back
21
Q

diagnostics of AAA

A
  • US
  • CT
  • MRA
22
Q

treatment of AAA

A
  • 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)
23
Q

prevention/screening of AAA

A
  • tx risk factors + decr smoking
  • screen males 65-75 y/o who have ever smoked
  • screen siblings + offspring
24
Q

define aortic dissection

A

tear in intima leads to false channel in medial layer

25
Q

How does an aortic dissection progress?

A

distally

26
Q

What are the common sites of aortic dissection?

A
  • right lateral wall of ascending aorta d/t shear stress

- descending, distal to ligamentum arteriosum

27
Q

What is a result of aortic dissection?

A
  • branching a. loose blood flow which leads to organ ischemia
28
Q

epidemiology of aortic dissection

A
  • 7th-8th decades

- males more than females

29
Q

classification systems for aortic dissection

A
  • DeBakey

- Stanford

30
Q

risk factors for aortic dissection

A
  • HTN
  • age
  • biscuspid aortic valve
  • connective tissue d/o
  • inflammatory aortitis
  • pregnancy
  • blunt trauma
31
Q

symptoms of aortic dissection

A
  • MC initially = severe, presisten, sudden onset chest pain
  • tearing, ripping, sharp pain
  • localized pain
  • may migrate
32
Q

Where will symptoms of an ascending aortic dissection migrate?

A
  • neck
  • throat
  • jaw
33
Q

Where will symptoms of a descending aortic dissection migrate?

A
  • chest pain +/- radiating to back, interscapular, or anterior chest
34
Q

signs of aortic dissection

A
  • hyper or hypotension
  • AR murmur when ascending (diastolic decrescendo)
  • decr or unequal peripheral pulses
  • pulm edema
  • intestinal ischemia/renal insufficiency
  • neuro sx
  • paraplegia
35
Q

diagnostics of aortic dissection

A
  • CXR = widened mediastinum + pulm edema
  • EKG = LVH
  • CT of chest + abdomen
  • echo
  • MRI
36
Q

treatment goals for aortic dissection

A

stop progression

37
Q

treatment options for aortic dissection

A
  • control BP (BB, CCP, Na nitruprusside)
  • pain management (morphine)
  • surgery (better than drugs in acute proximal aortic dissection
38
Q

When is surgery indicated for aortic dissection?

A
  • vital organ compromise
  • rupture or impending rupture
  • marfans
  • continued pain
39
Q

When is BP control and pain managment indicated for aortic dissection?

A

only for uncomplicated + stable distal w/ f/u imaging 1 6-12mo

Clin Med - Cardio Exam #2 (12 decks)

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