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Cardiology > Peripheral Vascular Disease 2 > Flashcards

Peripheral Vascular Disease 2 Flashcards

1
Q

What is a “True Aneurysm”?

A

Bounded by complete but attenuated vessel wall components (Atherosclerotic, syphilitic, congenital)

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2
Q

What is a “False Aneurysm”?

A

Extravascular hematoma that communicates with intravscular space (Pseudoaneurysm, pulsating hematoma)

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3
Q

What is a Fusiform aneurysm?

A

Ovoid Swelling parallel to long axis

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4
Q

What is a saccular aneurysm?

A

Bubble-like outpouching

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5
Q

What is a dissecting aneurysm?

A

Hemorrhage into media separates vessel wall layers

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6
Q

What is an “arteriovenous” aneurysm?

A

Direct communication of artery and vein

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7
Q

Ascending aorta aneurysms tend to be associated with what infection?

A

Syphilis

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8
Q

Ascending and thoracic aortic aneurysms tend to be associated with what disease?

A

Cystic medial degneration

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9
Q

Abdominal aortic aneurysms tend to be associated with what disease?

A

Atherosclerosis

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10
Q

Muscular artery aneurysms tend to be associated with what disease? (E.g. coronary arteries or popliteal)

A

Atherosclerosis

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11
Q

Circle of willis aneurysms tend to be associated with what type of aneurysm?

A

Berry aneurysm

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12
Q

Sites of bacterial infections tend to be associated with what type of aneurysm?

A

Mycotic aneurysm

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13
Q

What is the definition of an abnormal aortic aneurysm?

A

Abnormal dilatation with diameter increased by at least 50%

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14
Q

What are some characteristics of abdominal aortic aneurysms?

A
  • Always associated with severe atherosclerosis
  • Male predominance
  • Half patients with hypertension
  • Familial clustering suggests possible genetic predisposition
  • Most frequent aneurysm type
  • 6% incidence in >80yr population
  • Rare before age 50
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15
Q

What are the characteristics of the morphology of AAA?

A
  • Severe atherosclerosis with ulcerated, calcified plaques, medial destruction, and fibrosis
  • Dilatation, usually fusiform, distal to renal arteries, proximal to iliac bifurcation
  • Less frequently involves common iliacs, aortic arch, descending thoracic
  • Frequent mural thrombosis with potential for thromboembolism
  • Symptomatic aneurysms >5-6 cm diameter
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16
Q

What are the clinical features of AAA?

A
  • Clinical signs depend on location and size (Mass simulating a tumor/pulsatile, abd pain from aneurysm expansion, ureteral compression, vertebral erosion, acute ischemia of lower limb or kidneys from emboli)
  • Rupture is feared and ominous complication (Pain, shock, and pulsatile abdominal mass/Rupture and massive hemorrahge, high mortality)
  • Large aneurysms (>5cm) 25-40% rupture incidence within 5 years
17
Q

What are the classic key features of AAA?

A
  • Severe atherosclerosis
  • Infrarenal location
  • Fusiform dilatation
  • Mural thrombosis
  • Thromboembolism risk
  • Atheroembolism risk
  • Rupture
18
Q

What is the definition of Aortic Dissection?

A

Dissection of blood in between and along the laminar planes of the media, forming a blood-filled channel within the aortic wall. Dissecting intramural hematoma, frequently ruptures, not usually associated with aneurysmal swelling

19
Q

Who are some groups predisposed to aortic dissection?

A
  • Men, 40-60 years old, antecedent HTN

- Younger patients with connective tissue disorder such as marfan syndrome

20
Q

What are some features of pathogenesis of aortic dissection?

A
  • Weakening of aortic media is common factor
  • Most freqent preexisting lesion is cystic medial degeneration (CMD)
  • Aging results in mild degenerative changes, focal elastin loss and medial fibrosis
  • SPontaneous intimal laceration or vasovasorum hemorrhange may trigger event
21
Q

What are some general key features of Marfan Syndrome?

A
  • Tall, slender habitus
  • Long thin extremities
  • Arachnodactyly
  • Rib/sternal abnormalities
  • Hyperextensible joints
  • Kyposcoliosis
  • Lens dislocation, myopia
22
Q

What are some cardiac/vascular anomalies associated with Marfan syndrome?

A
  • Weakness of aortic media, leading to proximal dilatation
  • High incidence of dissection and rupture
  • Aortic regurgitation
  • CHF
  • Mitral valve prolapse
  • CV disorders are most common cause of death
23
Q

What is the etiology of Marfan syndrome?

A
  • Autosomal dominant inherited connective tissue disorder
  • Abnormalities of heart, aorta, skeleton, eyes, skin
  • Missense mutation of fibrillin-1 (FBN1), chromosome 15q21.1
  • Microfibrillar fibers critical for deposition of elastin during development
  • Affected tissues show fragmented elastic fibers
24
Q

What are characteristics of cystic medial degeneration?

A
  • Most frequent preexisting histologic lesion
  • Elastic tissue fragmentation
  • Separation of elastic and fibromuscular elements by small “cystic” spaces filled with extracellular matrix
  • No associated inflammation
  • Frequently seen in Marfan syndrome
  • Occasionally seen in HTN
25
Q

What is the morphology of an Aortic dissection?

A
  • Intimal tear in ascending aorta, within 10cm of aortic valve
  • Dissection separates the aorta along the media, extending proximally or distally
  • May involve great vessels, coronary, renal, mesenteric or iliac arteries
  • Extravascular rupture is the most frequent cause of death (pericardial, pleural, or peritoneal)
  • May reenter aortic lumen forming “double-barreled aorta”
26
Q

What are the types of classifications of aortic dissection?

A
  • Type A: Proximal, proximal and distal
  • Type B: Distal only
    Proximal dissections (Type A) are most common and most dangerous
27
Q

What are the 3 major factors predisposing to thrombosis? (Virchow’s triad)

A
  • Changes in blood constitents (Primary hypercoagulability (eg ATIII def, protein C def/acquired hypercoagulability i.e. malignancy)
  • Changes in intimal surface of blood vessel (Endothelial denudation or dysfunction)
  • Changes in patterns of blood flow (stasis, turbulence)
28
Q

What are common sites of arterial thrombosis?

A

Large and medium muscular arteries, intracardiac

29
Q

What is the pathogenesis of arterial thrombosis?

A
  • endothelial damage
  • altered blood flow (stasis)
  • Hypercoagulability
30
Q

What is the natural history of arterial thrombosis?

A
  • Lysis
  • Propagation
  • Organization
  • Recanalization
  • Embolization
31
Q

Mural thrombosis of heart is associated with what cardiac conditions?

A
  • MI
  • AFib
  • Cardiomyopathy
  • Endocarditis
32
Q

What are clinical features of DVT and PTE?

A
  • DVT frequently asymptomatic
  • Calf tenderness, often associated with forced dorsiflexion of foot (Homan sign)
  • Occlusive DVT associated with congestion, edema, and cyanosis
  • Large venous thrombi represent a potential serious hazard to life, may dislodge and be carried to lungs as PE
33
Q

Massive PE is associated with __.

A

Acute right heart failure

34
Q

What are the percent year risks of rupture for individuals with aneurysm sizes of: <5cm, 5cm, 5.5, 6, 7, 8

A

0, 1, 5, 10, 20, 40

35
Q

What is the treatment indications for an AAA less than 5.5 cm

A

Serial CT scans

Cardiology (18 decks)

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