Dissecting Aortic Aneurysm

Question 1

what are the 3 layers in the Aorta

Answer 1

intima, media, and adventitia

Question 2

What is a spontaneous or traumatic tear in the intimal layer of the aorta causing dissection of the inner and middle walls of the aorta?

Answer 2

Aortic dissection

Question 3

Type a or B dissection
Involves the arch of the aorta proximal to the left
subclavian artery

Answer 3

A

Question 4

Type a or B dissection

dissection occurs in the proximal descending aorta

Answer 4

B

Question 5

True/false
Spontaneous dissections are rarely associated with hypertension, connective tissue disorders (Marfan syndrome), bicuspid aortic valve, pregnancy, and coarctation of the aorta.

Answer 5

False

HIGHLY associated

Question 6

What are the symptoms of Aortic Aneurysm

Answer 6

Sudden severe chest pain radiating to the back, often described as a ripping or tearing pain.

• Hypertension
• Syncope
• paralysis of lower extremities

Question 7

How would a dissecting aortic aneurysm show on a PE exam

Answer 7

• Diminished or unequal peripheral pulses

- Possible diastolic murmur of Aortic Regurgitation

Question 8

CXR of a dissecting aortic aneurysm may show what?

Answer 8

May reveal abnormal aortic contour or WIDENED

MEDIASTIMUM.

Question 9

What is the imaging modality of choice to find an aneurysm?

Answer 9

CT with IV contrast

Question 10

What is the goal when treating a dissecting aortic aneurysm?

Answer 10

lower blood pressure to SBP of 100-120 and lower HR to <80.

Question 11

True/False
Type A aortic dissections do not require emergent surgery unless there is loss of blood flow to extremities or other organs

Answer 11

FALSE

REQUIRES EMERGENT SURGERY

Question 12

Type B aortic dissections do not require emergent surgery unless what?

Answer 12

there is loss of blood flow to extremities or other organs

Question 13

How would you treat an aortic aneurysm?

What is the mainstay of therapy?

Answer 13

ABCs, IV, O2 if saturation < 94%, Monitor

• Beta blockers are mainstay of therapy.
  
  • Metoprolol 5 mg IV, or 50-100 mg orally
  • Labetalol 5-10 mg IV q 30 minutes to goal, or 100 mg q 6 hours orally
• Pain control with Morphine 4-8 mg IV

Question 14

Aneurysm

Long term management can use regular _____ medications in addition to beta blockers such as ACEI, ARB, Diuretics

Answer 14

antihypertensive

Question 15

______ is the definitive therapy for Type A dissections

Answer 15

Surgery

Question 16

Would you promote smoking cessation for a pt with aortic aneurysm?

Answer 16

yes……….

Question 17

Would you Medevac your aneurysm pt?

Answer 17

yes…………