Lecture 8: Aortic Disease

Question 1

RF for patient populations for anyeursm

Answer 1

1. Marfans
2. Erlos-Danlos
3. BAV
4. turner’s
5. coarctation of the aorta

Question 2

which lab test rules out dissection

Answer 2

d-dimer < 500

Question 3

imaging for dissection

Answer 3

CT/MRI if stable

unstable - CT or TTE/TEE

Question 4

medical tx dissection

Answer 4

Type A- root - surgery
Type B - medical therapy
- IV BB (keep BP < 120), + IV nitroprusside to keep HR < 60-70

Question 5

referral to thoracic/ abdominal surgery anyeursm

Answer 5

1. > 5.5 cm
2. > 0.5 cm every 6 months
3. symptoms of compression

Question 6

murmur for dissection

Answer 6

1. low pitch diastolic murmur for aortic regurgitation

2. or crescnedo-decrescendo systolic murmor of BAV

Question 7

acquired inflammation of aortic root

Answer 7

• Syphillis
• Takayasu
• giant cell

Question 8

who should be considered to 5.0 cm thoracic root

Answer 8

1. Marfan
2. women considered pregnancy
3. BAV

Question 9

AAA screening

Answer 9

one-time ultrasonographic screening in men aged 65 to 75 years who are active or former smokers

Question 10

TX AAA ANYEURMS

Answer 10

Elective repair should be considered for AAA of 5.5 cm in diameter, for those that increase in diameter by more than 0.5 cm within a 6-month interval, and for those that are symptomatic (tenderness or abdominal or back pain).

Question 11

if AAA is big, how often

Answer 11

> 4.0, then annually

Question 12

surveillance AAA in Marfan’s

Answer 12

American College of Cardiology Foundation/American Heart Association guidelines recommend follow-up imaging 6 months after diagnosis, with annual surveillance thereafter if the aortic root is less than 4.5 cm in diameter and otherwise stable.

Question 13

main complication for endovascular repair of anyeursm

Answer 13

endoleaks

Question 14

Minor criteria Dukes

Answer 14

Fever
Immunological Crtiera
VAscular embolia
Predisposition
Micro

Question 15

+ dukes

Answer 15

2 Major (+ blood + evidence of endocardial involvement) + 5 Minor
or
1 M and 3 minor

Question 16

surgical indications for endocarditis

Answer 16

1. Heart failure
2. Left sided with fungal or highly resistant organism
3. heart block/abscess/destructive penetrating
4. persistent infection 5-7 days on abx
5. recurrent phenomoni despite abx
6. prothestic valve

Question 17

patients requiring prophylactic abx for endocardiats

Answer 17

1. prostethic valve
2. Congenital heart disease, cyanotic or repaired with residual shunts
3. previous hx of endocarditis
4. cardiac transplant with valve issues

Question 18

which procedures required prophylactic

Answer 18

dental

Question 19

abx used for prophylaxis endocarditis

Answer 19

Amox/amp or clinda (pen allergic)

Question 20

medication timing in type b aortic dissection

Answer 20

IV BB (labetolol or esmolol) should be given first and if the SBP remains above 120 then nitroprusside shoudl be added.
Don't do nitroprusside first because of the risk of reflex tachycardia