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CVPR 312 Cardiac Pathophysiology > Diseases Of The Aorta / Cardiac Patho Test 2/2 > Flashcards

Diseases Of The Aorta / Cardiac Patho Test 2/2 Flashcards

0
Q

The descending aorta becomes fixed to the thorax by the intercostal arteries, LSCA, and _____?

A

Ligamentum arteriosum

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1
Q

The ascending aorta and arch are:

A

Mobile

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2
Q

At what point does the descending aorta become fixed to the thorax?

A

Aortic Isthmus

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3
Q

Recite the regions of the aorta starting from the valve?

A

Ascending Aorta
Transverse Arch
Descending Aorta
Abdominal Aorta

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4
Q

Weakening of an artery involving all three layers of the vessel is called what?

A

Localized Dilation

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5
Q

Aortic aneurysm that represents 3/4 of atherosclerotic aneurysms?

Where or what level do they occur?

A

Abdominal

Between the renal arteries and the bifurcation.

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6
Q

Thoracic dilation can occur anywhere along the thoracic aorta, what is the most common site ?

A

Arch and descending aorta

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7
Q

Perianeurysmal fibrosis (10%) May cause what?

A

Urethral obstruction

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8
Q

90% of abdominal aortic aneurysms are ?

A

Infrarenal

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9
Q

Abdominal aortic aneurysm statistics?

A

Focal widening >3 cm
> 60 yrs
M:F = 5:1

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10
Q

What is one major Abdominal aortic aneurysm complication?

A

25% rupture into the left retroperitoneum, GI tract, IVC.

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11
Q

What are 3 other Abdominal aortic aneurysm complications?

A

Peripheral embolization
Infection
Spontaneous occlusion of the Aorta

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12
Q

What is the normal size of a thoracic aortic aneurysm and wt what point does it tend to rupture?

A

Normal size = 4-5 cm

Rupture at = 10 cm

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13
Q

Statistics of thoracic aortic aneurysms?

A

Mean age = 65 yrs

M:F = 3:1

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14
Q

thoracic aortic aneurysm are associated with ?

A

HTN
CAD
AAA

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15
Q

Symptoms of a thoracic aortic aneurysm ?

A 
Subsepternal, back, and shoulder pain experienced by 25%. 
SVC syndrome 
Dysphagia 
Stridor 
Dyspnea 
Hoarseness
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16
Q

What is the gold standard for evaluation of aneurysm?

A

Angiography

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17
Q

Etiology of descending aortic aneurysms?

A

80% atherosclerotic

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18
Q

Percentage of descending aortic aneurysms do to post traumatic circumstances ?

A

15%

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19
Q

CHDs that can lead to descending aortic aneurysms?

A

2% post coarctation, & ductus diverticulum

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20
Q

Syphilis can lead to what type of aneurysms?

A

Ascending aortic aneurysms
And
Arch aneurysms

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21
Q

3 conditions that can lead to arteritis?

A

Takayasu
Giant cell
Relapsing polychondritis

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22
Q

3 conditions that can lead to cystic medial necrosis ?

A

Marfan
Ehlers-Dantos
Annuloaortic ectasia

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23
Q

Aneurysms arise in areas of dense ?

A

Atherosclerosis

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24
Q

Atherosclerosis erodes into the aortic wall and destroys ?

A

Medial elements

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25
Q

During atherosclerotic aortic aneurysms the aorta widens and then what happens?

A

Tension increases, which accelerates the process.

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26
Q

Blunt trauma to the chest AKA

A

De-acceleration injury

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27
Q

Rupture of the Aorta occurs in ____ of all fatal auto accidents?

A

1/6

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28
Q

What is the most common site of aortic rupture during fatal car accidents ?

A

Ligamentum Arteriosum

29
Q

What does syphilitic heart disease primarily effect?

A

Media of the Thoracic Aorta.

AI is common

30
Q

Etiology of Mycotic Aneurysm of the Aorta?

A

IV drug use
Bacterial endocarditis 12%
Immunocompromise
S/P AV surgery, CABG

31
Q

Organisms that cause Mycotic Aneurysm of the Aorta?

A

S. Aureus (53%)
Salmonella (33-50%)
Streptococcus

32
Q

Sites of Mycotic Aneurysm of the Aorta?

A

Ascending aorta >
Visceral artery >
intracranial Artery >
upper/lower extremity arteries

33
Q

Inflation of the aorta ?

A

Takayasu Arteritis AKA

Giant cell Arteritis
Aortic arch syndrome
Pulseless disease

34
Q

thickening of wall of aortic arch + thoracic aorta.

chronic obliterative arteritis of + carotid arteries subclavian.

diminished pulses in upper extremities
may ==>

A

rib notching

35
Q

Cystic Medial Necrosis of the Aorta Seen in

A

elastic arteries

36
Q

Cystic Medial Necrosis of the Aorta Characterized histologically by

A

deposits of amorphous basophilic accumulations “Microcysts”

within the media

37
Q

“Microcysts” can coalesce and interrupt the elastic fibers causing

A

weakening.

38
Q

Marfan’s Syndrome

A

Connective-tissue disorder: autosomal dominant,

15% sporadic

39
Q

Marfan’s Syndrome

A
  • aortic aneurysm (mostly ascending)
  • dilatation of aortic sinuses
  • aortic dissection
  • coarctation
  • tall stature, long limbs
  • arachnodactyly
  • lax joints
  • scoliosis (60%) / kyphosis / pectus
  • dural ectasia
  • lens subluxation
40
Q

Aortic dissection Caused by

A

sudden tear in intima allowing for a column of blood to enter the Ao wall

41
Q

What is a prerequisite for Aortic dissection?

A

Degeneration of media

42
Q

Aortic dissection can be described as ?

A

Cystic medial necrosis-deterioration of collagen and elastic tissues

43
Q

Aortic dissection is common in what medical syndrome?

A

Marfan’s syndrome

44
Q

DeBakey Type I Aortic dissection

A

ascending Ao and beyond

45
Q

DeBakey Type II Aortic dissection

A

confined to ascending Ao

46
Q

DeBakey Type IIIa Aortic dissection

A

descending, confined to thorax

47
Q

DeBakey Type IIIb Aortic dissection

A

descending, extends beyond diaphram

48
Q

Shumway/Stanford Type A

A

origin in ascending

49
Q

Shumway/Stanford Type B

A

origin in descending

50
Q

what are the three main surgical options for descending aortic lesions?

A

Clamp & run
Shunt
Left heart bypass

51
Q

Explain the shunt surgical option for descending aortic lesions?

A

a Gott Shunt is placed from above the aneursym and connected beyond the distal clamp. Simple but one can not easily control flow through shunt

52
Q

Type III Descending Aortic Lesion requires Clamping the aorta to correct the lesion, which then results in hypoxia and ischemia to the lower body. What are three complication s that we can face?

A

Paraplegia
Renal failure
Ischemia-reperfusion injury

53
Q

What is Left Heart Bypass?

A

Taking blood from the LA and returning it through the femoral artery. Bypasses the LV.

54
Q

Is an oxygenator required for Left Heart Bypass ?

A

No, blood in LA is fully oxygenated

55
Q

When would we need to use left heart bypass?

A

Type III Aortic Aneurysms

To assist/support a failing ventricle LVAD, RVAD, BiVAD

56
Q

Perfusion Parameters for left heart bypass?

A

Pump Flows can be 1/2 what you would flow with full CPB.

Be careful to balance the upper body and lower body perfusion! Don’t sacrifice good cerebral perfusion!

57
Q

Cardiac index for lowerbody perfusion?

A

1.0

58
Q

Treatment for an Aortic disses ton Type A ?

A

Ascending dissection requires surgery

59
Q

Treatment for an Aortic disses ton Type B ?

A

Descending dissection can be medically managed by controlling BP and preventing extension.

60
Q

What are the 2 components of the surgical adhesive?

A

Bovine Serum Albumin

Glutaraldehyde

61
Q

Bioglue curing time?

A

Starts 20-30seconds

Finished in 3 minutes

62
Q

Aortic dissection outcomes with medical treatment ?

A

80% 1 year survival

50% 3-5 year survival

63
Q

Operational mortality for ascending ?

A

5 -10%

64
Q

Operational mortality for descending ?

A

10%

65
Q

Operational mortality for arch ?

A

10 -25%

66
Q

Operational 10yr survival for aortic dissection?

A

46%

67
Q

Percentage risk for a

re-dissection?

A

10%

68
Q

Remember: you are dealing with 2 circuits that share 1 source:

A

The upper body is perfused by the LV ejections.

The lower body is being perfused by the pump.

69
Q

If you are measuring arterial pressures in the upper body then you have

A

a inverse relationship between pressure and pump flow

CVPR 312 Cardiac Pathophysiology (15 decks)

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