Unit 3 Lecture 3

Question 1

Def. of aneurysm

Answer 1

abnl vessel dilation 1.5-2 times normal size/ greater than 50% enlargement

Question 2

def of dissection

Answer 2

tear in vessel wall creating a true and false lumen

Question 3

risk factors for atherosclerotic aneurysms

Answer 3

tobacco and hypertension

Question 4

sxs of thoracic aortic aneurysm

Answer 4

compression, pain, hoarseness, valve regurg

Question 5

repair of thoracic AA

Answer 5

• ascending/arch=sternotomy and surgical repair

- descending=left thoracotomy and surgical repair or endovascular repair/graft

Question 6

debakey classification

Answer 6

type1-entire aorta
type2-only ascending
type3-only descending

Question 7

signs/sxs of aortic dissection

Answer 7

chest pain, back pain (b/t shoulder blades), HYPERtension, transient or permanent neuro changes, distal ischemia, acute cardiac failure, widened mediastinum, pleural capping/effusion; rupture=HYPOtension and shock

Question 8

triad of aortic dissection

Answer 8

abrupt onset of thoracic/abd pain, mediastinal +/- aortic widening on CXR, HYPERtension +/- discrepant BP

Question 9

gold standard imaging for aortic dissection

Answer 9

spiral CT

Question 10

tx of aortic dissection

Answer 10

beta blockers (esmolol) then add vasodilators (Nipride), decrease systolic BP to 100-120, decrease LVP, pain control

Question 11

tx of type A (proximal) aortic dissection

Answer 11

emergent surgery

Question 12

complications of type A (proximal) aortic dissection

Answer 12

aortic rupture, cardiac tamponade, acute aortic regurg, acute coronary ischemia

Question 13

tx of type B (descending aorta) aortic dissection

Answer 13

uncomplicated-medical therapy

complicated-surgery or endovascular tx

Question 14

AAA rupture sxs/signs

Answer 14

abdominal pain, pulsatile abd mass, tenderness, and HYPOtension

Question 15

constellation of ruptured/symptomatic AAA

Answer 15

flank/back pain, HD instablity, pulsatile abdominal mass

Question 16

tx of ruptured/symptomatic AAA

Answer 16

ABC, T&C for 10U of PRBCs, U/S, pain control, EKG, go to OR!

Question 17

cause of thoracic aortic transection

Answer 17

rapid deceleration from MVA

Question 18

clinical clue of thoracic aortic transection

Answer 18

respond to fluid->hypotension->respond to fluids->hypotension

Question 19

dx of thoracic aortic transection

Answer 19

CXR then CT

• “funny-looking mediastinum”
• blurred aortic knob
• widened mediastinum
• 2nd rib fracture
• pleural effusion
• apical cappin

Question 20

pts with thoracic aortic transection are at a high risk for what

Answer 20

paraplegia (artery of adamkiewicz)

Question 21

causes of myocardial contusion

Answer 21

MVA, falls, car vs peds, direct chest trauma

Question 22

sxs of myocardial contusion

Answer 22

similar to MI, chest pain, N/V, SOB

Question 23

most common compartments of heart involved in myocardial contusion

Answer 23

RV and RA

Question 24

dx of myocardial contusion

Answer 24

serial EKG, tele monitoring, serial enzymes (troponin), echo

Question 25

acute VSD seen on what day

Answer 25

post-MI day 2-5

Question 26

most common location of MI a/w acute VSD

Answer 26

transmural anterolateral MI

Question 27

murmur heard with acute VSD

Answer 27

harsh holosystolic murmur +/- thrill

Question 28

dx of acute VSD

Answer 28

Echo wtih color flow

Question 29

tx of acute VSD

Answer 29

urgent surgical repair

Question 30

timeframe for acute mitral regurg

Answer 30

13 hours up to 5-7 days post MI

Question 31

most common involvement of acute mitral regurg.

Answer 31

posteromedial papillary muscle rupture

Question 32

murmur heard with acute mitral regurg

Answer 32

pansystolic

Question 33

tx of acute mitral regurg

Answer 33

afterload reduction and surgery

Question 34

vessels commonly used in CABG

Answer 34

LIMA and saphenous vein

Question 35

most common arrhythmia to develop following CABG

Answer 35

a fib

Question 36

causes of acute mesenteric ischemia

Answer 36

arterial embolism, arterial thrombus, venous thrombus, non-occlusive etiologies

Question 37

triad of SMA embolism

Answer 37

GI empyting, abdominal pain, underlying cardiac disease

Question 38

non specific labs that are helpful in dx acute mesenteric ischemia

Answer 38

leukocytosis, increased D-dimer, increased lactate

Question 39

dx of acute mesenteric ischemia

Answer 39

CT scan +/- angio

Question 40

tx of acute mesenteric ischemia

Answer 40

ABC, cardiac monitor, O2, IV access, abx, pain control; papaverine infusion, surgical embolecctomy, intraarterial thrombolysis

Question 41

presentation of mesenteric venous thrombosis (MVT)

Answer 41

acute, subacute, or chronic; acute presents with abd pain that is severe in the mid abdomen and out of proportion to physical signs

Question 42

presentation of aorto-iliac occlusive disease

Answer 42

neuro deficit including paralysis, absent femoral pulses

Question 43

tx of aorto-iliac occlusive ds

Answer 43

aorto-bifemoral bypass

Question 44

what is blue toe syndrome

Answer 44

cool, painful, cyanotic toe with preserved pulses; result of embolic occlusion; Bil. involvement indicates an embolic source that is located above the aortic bifurcation

Question 45

most common cause of acute limb ischemia

Answer 45

embolism

Question 46

6 P’s of acute obstruction

same as compartment syndrome

Answer 46

pain, pallor, paresthesia, paralysis, pokilothermia, pulselessness

Question 47

tx of acute obstruction

Answer 47

heparin, endovascular thrombolytics, percutaneous removal, etc
-watch for reperfusion phenomenon and for compartment syndrome