Medicine- Aortic Coarction + Epilepsy Flashcards
Who is most commonly affected by coarctation of the aorta?
a) Infants
b) Teenagers
c) Adults
d) The elderly
a) Infants
Where is the ductus arteriosus (DA) in fetal life
a) Between the liver and the IVC
b) Between the right and left atria
c) Between the placenta and the baby
d) Between the pulmonary artery and aorta
d) Between the pulmonary artery and aorta
The ductus arteriosus can be found between the pulmonary artery and the aorta – it prevents too much blood from going to the lungs
What does ‘coarctation’ mean?
a) Expansion
b) Blind ended pouch
c) Shunt
d) Narrowing
d) Narrowing
What is ‘Coarctation of the aorta’?
Simply put, it is a narrowing of the aorta- one of our body’s great arteries
- The duct referred to here is the ductus arteriosus (DA- this is an embryological structure that should close and become the ligamentum arteriosum)
- Due to the narrowing, blood is at a higher pressure above this narrowing and a lower pressure below it
• In infants, the coarctation is mostly preducta
WHat does this mean?
, this means that there is lower bp just before the DA causing the deoxygenated blood on the right side (which should have a lower BP) to shunt to the left side through the patent DA as it has a relatively higher pressure.
Therefore deozygenated blood goes through the DA duct to the aorta and rest of the body
Causes cyanosis
What are the 3 main types of Aortic Coarctation ?
preductal,
ductal
post ductal coarctation
Symptoms for aortic coarctation
- Arterial hypertension in the right arm with normal to low bp in the lower limbs is typical
- Poor peripheral pulses in femoral arteries if severe case
- Radial- radial delay/ radial- femoral delay (of pulses)
- Dizziness or fainting
- Shortness of breath
- Pounding headache
- Chest pain
- Cold feet or legs
Neonatal presentation of aortic coaraction?
Neonatal presentation If severe, usually presents in first 3 weeks of life with poor feeding, lethargy, tachypnoea or overt congestive cardiac failure and shock. Initially the baby may be well but become ill after closure of the ductus arteriosus
Epidemiology of aortic coractation?
- It is not known exactly what causes coarctation of the aorta but it is more common in people with certain genetic disorders such as Turners syndrome
- It can also be due to birth defects of the aortic valve, such as bicuspid aortic valve
- It occurs approximately 1 out of 10,000 people and is usually diagnosed in children or adults under the age of 40.
Ix for aortic coartation?
- Chest x-ray —> can see notching of ribs depending on where the coarctation is, as CoA causes increased bp in blood vessels above the narrowing, this causes the vessels such as the intercostal arteries to bulge and slowly ware away parts of the ribs
- Echocardiography à CoA can cause hypertrophy of left ventricle
- ECG
- Doppler ultrasound of the aorta
- Chest CT
- MRI of the chest
- Cardiac catheterisation and aortography
Differentials for aortic coarctation?
- Hypertension
- Heart Failure (if diagnosed late in adulthood)
- Atherosclerosis
- Raynaud’s (poor peripheral perfusion)
Management for aortic coarctation?
- Through history + examination to form differential diagnosis
- Appropriate investigations
- Mainstay of treatment is surgery; the coarctation can be removes and the two free parts of the aorta will be joined back together, this is called anastomosis
- Alternatively a balloon angioplasty could be preformed where a catheter with an inflatable balloon is introduced from an artery in the leg. The balloon is inflated to enlarge the narrow area.
- After the coarctation is repaired, you’ll need your blood pressure checked every 1-2 years. The reason is that you’re at higher risk of developing generalized high blood pressure or problems with your aortic valve.
What are the clinical examination findings for aortic coarctation?
General inspection: does the patient appear to be short of breath or particularly pale in the limbs?
Main thing to feel for is radial- radial/ radial-femoral delay, this should be assessed over 10 seconds
Systolic or continuous murmur can be heard in left infraclavicular area and under the left scapula. An ejection click may signify associated bicuspid aortic valve
. On top of this look out for the symptoms mentioned earlier, in an examination, feel the peripheral pulses and asses the temperature of the distal parts of the limbs
- Peter is 8 days old and his mother notices that he seems generally unwell so she brings him to the GP.
- On inspection Peters legs are cyanotic when compared to the rest of him and he has radial- femoral delay
Where is the coarctation most likely to be in peter?
a) Before the ductus arteriosus
b) At one end of the ductus arteriosus
c) After the ductus arteriosus
d) At the bifurcation of the internal iliac
a) Before the ductus arteriosus
Pre- ductal is the most common form of coarctation in infants
- Peter is 8 days old and his mother notices that he seems generally unwell so she brings him to the GP.
- On inspection Peters legs are cyanotic when compared to the rest of him and he has radial- femoral delay
What other condition could Peter have?
a) Heart failure
b) Marfans
c) Turners syndrome
d) Atherosclerosis
c) Turners syndrome
What to ask for in a suspected patient with epilepsy?
Ix for Epilepsy?
Differentials for epilepsy?
Management for epilepsy?
Management – Anti-epileptic drugs
Generalised tonicclonic seizure
Focal seizures
Myoclonic seizures
