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Clin Med - Cardio II > DZ of Aorta > Flashcards

DZ of Aorta Flashcards

1
Q

normal diameter of ascending aorta

A

3cm

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2
Q

normal diameter in descending portion

A

2.5cm

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3
Q

measurement of aorta in abdomen

A

1.8-2cm

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4
Q

why is the aorta prone to injury

A

d/t its constant exposure to high pulsatile pressure and shear stress

-more prone than any other vessel

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5
Q

3 layers of the aorta

A
  1. intima - thin inner layer
  2. media - thick middle ayer that give the aorta strength, elasticity, and distensibility
  3. adventitia - thin outer layer
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6
Q

2 anatomically into two components

A
  1. thoracic - within the thorax, above the diaphragm

2. abdominal aorta - section below the diaphragm

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7
Q

three segments of thoracic arota

A
  1. ascending
  2. aortic arch - has great vessels
  3. descedning aorta
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8
Q

2 segments of ascending aorta

A
  1. aortic root: lower segment
    - begins at the level or the aortic valve
    - supports the aortic valve leaflets
    - extends into the sinotubular junction
    - area where right and left main coronaries arise
  2. ascending aorta - upper segment
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9
Q

3 vessles that come off the aortic arch

A
  1. innominate artery/brachiocephalictrunk
  2. left CCA
  3. left subclavian
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10
Q

descending thoracic aorta runs how to the diaphragm

A

distally

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11
Q

what is the aortic isthmus

A

point at which the aortic arch joins the descending aorta

-vulnerable to trauma

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12
Q

abdominal aorta extends from the what

A

from the thoracic aorta at the level of the diaphragm to the bifurcation of the right and left common iliac arteries

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13
Q

2 segments of abdominal aorta

A
  1. suprarenal - segment aboe the renal arteries

2. infrarenal - segment below the reanl arteis

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14
Q

aorta as we age

A
  1. elasticity and distensibility decreases with age
    - these changes occur earlier and more rapidly in men tha women
  2. loss of elasticity is accerelated in pts with HTN, hypercholesterolemia, and CAD
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15
Q

2 dz of the aorta

A
  1. aortic aneurysms
    - thoracic
    - abdominal
  2. aortic dissections
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16
Q

what is an aortic aneurysm

A

pathologic dilation of the aorta that can occur anywhere along the course of the aorta
-involves all layers of the vessel

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17
Q

2 types of aortic aneursysm

A
  1. fusiform - affects the entire cirumference of a segment of a vessel
  2. saccular - involves only a portion of the circumference (outpouching of a vessel)
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18
Q

classification of aortic aneurysms

A

determined by locations

  1. abdominal - below diaphragem
  2. thoracic - above diaphragem
  3. thoracolumbar - involves the descending thoracic aorta and abdominal aorta
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19
Q

complications of aortic aneurysms

A

dissection

acute ruptrue - greatest fear!!

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20
Q

avg growth rate of thoracic aortic aneurysm

A
  1. 1-0.2cm/year

- those with marfacns syndrome may expand ast a greater rate

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21
Q

risk of rupture is related to the

A

size and presence of symptoms

  • -2-3% rupture per year when 6.0cm in diameter
  • fewer than 1/2 of pts with an acute rupture arrive to the hospital alive
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22
Q

etiology of thoracic aortic aneurysms

A
  1. ascending aortic aneurysms - cystic medial necrosis is most common cause
  2. aortic arch and descending thoracic aneurysms - atherosclerosis is the most common cause
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23
Q

risk factors for thoracic aortic aneurysms

A
  1. atherosclerosis
  2. connective tissue disorders - Marfan’s Ehlers-Danlos syndrome
  3. HTN
  4. familial thoracic aortic aneurysm syndromes
  5. infections - syphilis (rare) TB,
  6. vasculitis
  7. traumas
24
Q

s/s of thoracic aortic aneurysms

A

most are asymptomatic and found on routine physical exam or chest x ray
-+/- chest and back pain (steady, deep and at times extremely severe

25
Q

if symptoms are present, they coincide with what?

A

size and location of aneurysm

  1. aortic root: CHF, AR
  2. aortic arch - compress the trachea and/or recurrent laryngeal nerve
  3. descending - compresses esophagus
26
Q

imaging for thoracic aortic aneurysms

A
  1. CXR - widening of mediastinum, displacement or compression of trachea, calcifications of the outline of the aorta, large aortic knob
  2. TEE: can assess the proximal ascending aorta and descending thoracic aorta
  3. CT scan - MODALITY OF CHOICE
  4. MRII AND AORTOGRAPHY - BOTH SENSITIVE AND SPECIFIC TEST
27
Q

TX OF THORACIC AORTIC ANEURYSMS

A
  1. SURGERY -
    - AORTIC ARCH/ASCENDING AORTA:OPEN SURGERY REQUIRED - -DESCENDING - ENDOVASCULAR STENT GRAFTING
  2. MEDICAL MANAGEMENT
28
Q

indications for surgery in a thoracic aortic aneurysm

A
  1. symptomatic pts
  2. ascending aortic aneurysm >5,5-6cm
    descending aortic aneurysm >6.5-7cm
    aneurysms that have increased >1.0 cm/year
    Marfan’s syndrome pts: ascending aortic aneurysm >5cm
29
Q

surgical complications of thoracic aortic aneurysm

A
  1. higher morbidity and mortality than AAA
  2. paraplegia (4-10% rate foloowing endovascular repair)
  3. stroke
30
Q

medical management of thoracic aortic aneurysms

A
  1. indications - asymptomatic pts with aneurysms too small to jusitfy surgery
  2. beta blockers - decreased mortality and slow the rate of dilation
  3. ACE-I/ARBs - sutdies showiing these reduce the rate of expansion in pts with Marfans’ syndomre
31
Q

prognosis of thoracic aortic aneurysms

A
  • survival rate of those not undergoing repair is 20% at 5 eras
  • less than 1/2 of the pts with an acute rupture arrive to the hospital alive
32
Q

what is abdominal aortic aneurysms

A

defined as an aneurysm measuring >=3.0cm
M>F 4:1-90% of AAA are related to atherosclerosis
90% are infrarenal in location
risk of rupture increases as the size increases 5cm: 5 year risk of rupture if 20-40%

33
Q

overall mortality from rupture is

A

80%

34
Q

approx what % of pts with acute will die b4 receiving med attn
-operative mortality for those reaching hospital is

A

50%

35
Q

risk factors for abdominal aortic aneurysms

A

atherosclerosis - MC

  • HTN
  • smokoking
  • hypercholesterolemia
  • PVD
  • age m>55 W>70
  • male gender
  • genetics
36
Q

s/s of abdominal aortic aneurysms

A

asymptomatic mostly

  • usually found on exam as a palpable, pulsatile nontender mass or seen incidentally on imaging studies ordered for an unrelated issue
  • as the aneurysm expands, pts 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
37
Q

dz/imaging for abdominal aortic aneurysm

A
  • pulsatile mass anywhere from the xiphoid process to the umbilicus (abdominal aorta)
  • abdominal US - Gold STandard
  • xray - calcified outline of aneurysm
  • CT - can diagnose and size aneurysm
  • contract aortography - invasive and require contract
  • MR angiography - extremely accurate, used to plan for surgical repair
38
Q

tx of abdominal aortic aneurysm

A

surgery - definitive

  • indications - any size that is symptomatic
  • any aneurysm that is rapidly expanding
  • diameter >5.5cm
    procedures: insertion of a prosthetic graft (open procedure)
  • endovascular stent graft
39
Q

medical tx of abdominal aortic aneurysm

A

smoking cessation

  • aggressive control of HTN
  • control of hyperlipidemia
  • beta blockers - reduce expansion and rupture
  • serial imaging q6months to monitor size and rae of expansion for aneurysms >4 cm or greater
40
Q

prognosis of AAA

A

if treated surgically - 5 year survival after tx 60%, MI is leading cause of death
-if n surgery 12% annual risk of rupture if>6cm 25% annual risk of rupture if >7cm

41
Q

prevention/screening of AAA

A
  • treat risk factors (HTN, hyperlipidemia)
  • smoking cessation
  • screening indications - all men age 665-75 yo who have ever smoked, siblings or offspring of people with thoracic aortic or peripheral arterial aneurysm
42
Q

what is an aortic dissection

A

tear of the intima that results in the formatio of a false channel with in the media layer

43
Q

how does the dissection usually progress

A

distally down the descending aorta and into ts branches

44
Q

common sites of aortic dissection

A
  1. right lateral wall of the ascending aorta (shear stress is highest)
  2. descending thoracic aorta just below the ligamentum arteriosum
45
Q

epidemiology of aoritc dissection

A

peak incidence in 7th and 8th decades of life

M>W 2:1

46
Q

risk factors of aortic dissection

A
  • HTN
  • age
  • bicuspid aortic valve
  • marfans’ syndrome and Ehlers Danlos syndrome
  • infalmmatory aortitis
  • pregnancy (3rd tri)
  • blunt trauma to aorta
47
Q

two classification of aortic dissectin

A
  1. Debakey classification

2. standored classification

48
Q

debakey classification of aortic dissection

A
  • type I - originates in ascending aorta, continues to the aortic arch and many times beyond the arch distally
  • type III - originates and is confined to the ascending aorta
  • type III - originates in the descending aorta with extension distally
49
Q

stanford classification of aortic dissection

A

type A - all dissection involving the ascending aorta

type B - all dissections not involving he ascending aorta

50
Q

symptoms of aortic dissection

A
  • severe, persistent, sudden onset CP most common initial symptom
  • pain described as tearing, ripping and sharp
  • may localized to the front or back of chest, lower back
  • pain may migrate as it progresses
  • ascending dissection: neck throat, jaw pain
  • descending dissection - chest pain +/- radiation to back, inter scapular or anterior chest
  • less common symptoms: dyspnea, syncope, weakness, CHF, CVA, paraplegia, cardiac arrest
51
Q

signs of aortic dissection

A

HTN, hypotension
aortic regurg
-periph pulses decreased or unequal
-pulm edema
-intestinal ischemia or renal insufficiency
-neuro findings dt carotid artery obstruction (hemiplegia, hemianestheisa)
-paraplegia (spinal cord ischemia)

52
Q

imaging/dx of aortic dissection

A
  1. CXR - may show widened mediastinum and pul edma
    - EKG - may be normal, may show LVH, acute changes may develop if it involves the coronary artery
    - CT IS DIAGNOSTIC test of coice - should include chest and abdomine
    - ECHO and MRI - also diagnositc but not sued first line in an acute setting
53
Q

tx of aortic dissection

A

goal is to stop the progression of dissection

  • medical - BP control is essential
  • beta blocker unless contraindicated to get HR down to 60bpm
  • sodium nitroprusside to lower SBP
54
Q

surgery for aortic dissection

A

superior to medical tx in acute proximal dissections

  • indications
  • acute distal dissections w/ vital organ compromise, rupture or impending rupture
  • dissections in Marfans’ syndrome or
  • continued pain
  • involves incising the intimal flap, obliterating the false lumen and placing a graft in the lumen of the vessel
55
Q

what is the largest blood vessel in the body

A

aorta

Clin Med - Cardio II (12 decks)

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