Exam #3 Ppt Aortic Abnormalities Flashcards
the most common aortic abnormality is
aortic dilation
multiple measurements should be taken at different areas of aorta if this patient has
dilated aorta
when dilation is severe it is classified as an
aneurysm
how is an aneurysm defined?
an increase of more than 50% above the normal diameter range
causes of aneurysms (7)
Atherosclerosis or degenerative causes (most common), syphilis, trauma, aortic stenosis, genetically triggered ex aortic coarctation, PDA, aortitis
3 types of aneurysms
- dissecting
- saccular
- fusiform
When doing echo, aortic sizes measure from PLAX at (what part of cardiac cycle)
end diastole
TTE and TEE are limited in seeing this part of the aorta
distal ascending aorta (rt parasternal may help)
In echo, measure at these 4 places when measuring aortic sizes
- annulus
- sinuses of vasalva
- supraoptic ridge
- proximal ascending aorta
In echo, with aneurysms you can measure either ___________ or ___________. one is a preferred method.
leading edge to leading edge
OR
inner edge to inner edge (preferred - could underestimate tho)
most common type of aneurysm is
an atherosclerotic aneurysm
what percentage of atherosclerotic aneurysms are thoracic?
25%
75% are abdominal
thoracic aortic aneurysms - most common sites?
aortic arch
descending aorta
atherosclerotic process
weakening of ao wall
medial degeneration
localized vessel dilation
causes disease of the aorta and undermines strength of the ao wall, resulting in expansion to aneurysm
hypertension!
Symptoms of aneurysms
wheezing
coughing
dyspnea
hemoptysis
hoarseness
dysphagia
occurs when aneurysm is large enough to impinge on surrounding structures such as
- lt main bronchus
- recurrent laryngeal nerve
- esophagus
in diagnosing aneurysms, what is the gold standard? what are the runner-ups?
gold standard is angiography!
MRI is excellent
CT w/ contrast is reliable
Chest x-ray can detect mediastinal widening
this aneurysm is a rare anomaly, may present ruptured or unruptured, can be acquired or congenital
sinus of vasalva aneurysm
LSOVA (2)
- may rupture into the LA or RA
- can cause LA compression
NCSOVA (1)
- May rupture into the LA, RA, LV, or ventricular septum
RSOVA (5)
- May rupture into the RA, RV, or adjacent main pulmonary artery
- Can cause RVOT obstruction
- May result in RCA dissection or compression and acute MI
- May compress the conduction system and cause heart block
- may rupture into the pericardium and cause tamponade
aortitis is
inflammation of the aortic wall caused by a broad group of conditions
clinical signs of “this” are nonspecific, including nonspecific pain, fever, malaise, and elevated levels of acute phase reactants
aortitis
acute aortic syndrome is
an overlapping of several life threatening clinical entities that include
- aortic dissection
- intramural hematoma penetrating atherosclerotic ulcer
- traumatic aortic rupture due to blunt deceleration trauma
- aortic aneurysm leak and rupture
least common site for congenital aortic stenosis
congenital narrowing of the ascending ao just distal to insertion of the coronary arteries (very rare)
this type of supravalvular ao stenosis is associated with Williams syndrome
“hour glass” shaped
2 types of subvalvular obstruction
- discrete
- tunnel
3 types of supravalvular obstruction
- hour glass
- fibrous membrane
- hypoplasia of descending ao
aortic dilation associated conditions
HTN
Atherosclerosis
Cystic medial necrosis
Poststenoic dilation
Marfans
Reiters Syndrome
Rheumatoid Arthritus
Systemic Lupus
AO dissection causes (study - compare and contrast)
HTN
Atherosclerosis
Marfans
Aging
Pregnancy
Trauma
Iatrogenic Injury
Inflammatory diseases
Cocaine use
Renal disease
Strenuous physical exercise
patient suffering from atherosclerotic ulcer, aortic dissection, trauma from blunt deceleration force, aortic aneurysm and rupture… what syndrome might this be
ACUTE AORTIC SYNDROME
Type 1 Debakey Ao Dissection
type 1 includes ascending ao, transverse ao (aortic arch), descending ao - 70%
Type 2 Debakey Ao Dissection
type 2 includes ascending ao involved but stops pros to brachiocephalic (5%)
Type 3 Debakey Ao Dissection
type 3 includes descending ao and may extend to abdominal ao (25%)
Type A Stanford Ao Dissection
ascending ao
Type B Standford Ao Dissection
all dissections that do not include ascending ao
Ao Dissection caused by:
HTN
Atherosclerosis
Marfans
Aging
Pregnancy
Trauma
Iatrogenic Injury
Inflammatory diseases
Cocaine use
Renal disease
Strenuous physical exercise
Ao dilation causes (study - compare and contrast)
HTN
Atherosclerosis
Cystic medial necrosis
Poststenoic dilation
Marfans
Reiters Syndrome
Rheumatoid Arthritus
Systemic Lupus
symptoms for dissecting aneurysms
most common are:
excruciating pain, severe at onset, clammy, appear as though they are in shock, hypertensive, hypotensive if tamponade is present
In 2D findings, abnormal linear density within the aorta creates
a true and false lumen
***can be an ARTIFACT tho, so confirm in not one, but TWO different views.
In identifying Ao dissection, distinction from other structures needs to be. clear such as (3)
calcification
arteriosclerotic plaque
intracardiac monitoring lines
True or False! False lumen Is usually larger than true lumen?
TRUE
In Ao dissection, the “flap” moves toward _______ lumen in what diastole?
true
true lumen expands during _______ and shrinks during _______.
expands during SYSTOLE
shrinks during DIASTOLE
______ flow in false lumen. _______ flow in true lumen.
SLOW FLOW in FALSE lumen
RAPID FLOW in TRUE lumen
Complications associated with false lumen in Ao dissection (3)
- compression of true aortic lumen
- extends into other branch vessels
- THROMBOSIS
An aortic wall thickness of > 15mm suggests
THROMBOSIS of the FALSE lumen!
Most common cause of death in Type A dissections is
tamponade
this type of supravalvular ao stenosis is associated with Williams syndrome
“hour glass” shaped
what t type of supravalvular ao stenosis can be seen in a normal sized heart?
discrete fibrous membrane
this type of supravalvular ao stenosis involves the origins of the brachiocephalic arteries and is also called “strand” stenosis
hypoplasia of ascending aorta
what are 4 characteristics of hypoplastic left heart syndrome?
- very small aorta
- vessel connecting aorta and pulmonary artery
- opening between atria
- underdeveloped left ventricle
this is more common in kids, coarctation of aorta… TRUE OR FALSE
TRUE
how many types of supravalvular ao stenosis and how many types of subvalvular obstructions
3 supravalvular ao stenosis types
2 subvalvular obstruction types
M-mode appearance of membranous sub aortic obstruction
coarse systolic flutter of AoV leaflets from turbulent prevalvular flow
Midsystolic partial closure of valve from LVOT obstruction
Aortic dilation associated with what conditions
HTN
Atherosclerosis
Cystic medial necrosis
Post stenotic dilation
Marfans
Reiters
Lupus
Rheumatoid arthritis
“-ectasia” means
expansion (dilation)
shapes of aneurysms where these numbers correlate to part of aorta
(1) annulus
(2) sinus of vasalva
(3) sinotubular junction
3 types
A) 1 and 2 (called annuloaortic ectasia)
B) 1, 2, and 3 (tubular part of asc ao)
C) 3 (begins at sinotubuluar)
most common echo finding is Ao Dissection in this syndrome
Marfans syndrome
When you think of Marfan’s conditions, think of a house caving in on itself.
Prox ao dilation
Multivalvular prolapse
LA compression
AI, MR
Ao dissection (most common)
LVVO pattern - LV dilation with hyperkinesis
most common type of aneurysm
atherosclerotic aneurysm
25% are thoracic (most common sites are aortic arch and descending ao)
the rest are abdominal
describe the atherosclerotic process
- weakening of the Ao wall
- medial degneration
- localized vessel dilation
what things contribute to the weakening of the aortic wall?
atherosclerotic process
hypertension
strength of the Ao wall is important. why?
weak or weakening walls can llead to dilation (expansion) of the walls which can expand into eventual aneurysm
angiography is the standard for diagnosing aneurysms. when are aneurysms missed - even at this level of diagnosis?
when aneurysm is layered with thrombus
compression of surrounding structures is indicative of what
aneurysm
a patient with an aneurysm greater than _______ cm is at risk for rupture and symptoms of aneurysm
7 cm
congenital causes of aneurysm (4)
- bicuspid aortic valve
- connective tissue disease
- Ehler Danlos syndrome
- Marfans syndrome
Acquired causes of aneurysm (3)
- atherosclerotic degeneration
- iatrogenic post aortic valve surgery / cath lab
- endocarditis
Which Sinus of Vasalva aneurysm can cause the most complications based on location? (5)
RSOVA
1. may rupture into the RA, LA< or adjacent main pulmonary artery
2. can cause RVOT obstruction
3. may result in RCA dissection or compression and acute MI
4. May compress conduction system and cause heart block
5. may rupture into the pericardium and cause tamponade
clinical presentation of SOV aneurysm varies depending on (4)
site, size, compression, and rupture
Physical exam and auscultation of SOV aneurysm
(auscultation)
wide pulse pressure from AI
long diastolic murmur
(other exams)
LVH on EKG
CXR : cardiomegaly, signs of CHF, Unfolding of AO
Transcatheter repair is being used with increasing success to repair
aneurysm (SOV)
Aortitis can have many underlying general causes (4)
- infection
- noninfectious
- radiation induced
- idiopathic
4 main categories of this powerpoint
- obstructions
- aneurysms
- dissection
- trauma
traumatic aortic rupture due to blunt declaration trauma… one symptom of many… what syndrome am I
acute aortic syndrome
this syndrome encompasses several life threatening clinical entities with overlapping features:
-aortic dissection
- intramural hematoma atherosclerotic ulcer
- traumatic aortic rupture due to blunt declaration trauma
- aortic aneurysm leak and rupture
complications associated with false lumen of ao dissection
- compresses true aortic lumen
- extends into other branch vessels
- thrombosis (ao wall thickness >15mm suggests thrombosis of false lumen)
- malperfusion - coronary/cerebral/spinal/limb/abdominal ischemia
- rupture - pericardial/pleural/peritoneal space
- tamponade (common cause of death in TYPE A dissections - asc aorta)
