Term
| what is a common causative factor in aortic aneurysm & aortic dissection? |
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Definition
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Term
| athersclerosis stems from: |
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Definition
| endothelial injury; turbulent blood flow in areas of bifurcation, HTN, inflammatory stresses, hyperlipidemia, DM |
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Term
| how does tobacco contribute to athersclerosis? 4 |
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Definition
1. decreases level f HDL
2. increases levels of CO
3. vasoconstrictor
4. increase platelet reactivity |
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Term
| 7 risk factors for athersclerosis: |
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Definition
| 1. hyperlipidemia 2. HTN 3. DM 4. Obesity 5. homocystein levels 6. male or postmenopausal women 7. smoking |
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Term
| the presence of athersclerotic dz in one area of vascular territory increases the liklihood of dz in: |
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Definition
| other vascular territories |
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Term
| what % of the lumen of the artery must be occluded in order to develop ischmia Sx? |
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Definition
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Term
| a diameter greater than ___ is generally considered an aneurysm. |
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Definition
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Term
| where is the most common spot for AAA? |
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Definition
| between renal and inferior messenteric arteries |
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Term
| AAA more common in men or women? |
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Definition
| 4-5X more likely in men, usually over 60yo |
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Term
| 3 risk factors for aneurysms: |
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Definition
1. smoking; directly related to yrs of smoking
2. athersclerosis
3. family Hx |
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Term
| How are the majority of aneurysms discovered? |
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Definition
| detected as incidental finding on imaging studies for other reasons |
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Term
| clinical presentation of aneurysm: 4 |
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Definition
1. majority asymptomatic
2. abdominal pain (acute or chronic)
3. back pain
4. DIC |
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Term
| what is a MAJOR finding on physical exam that leads you toward AAA? |
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Definition
| pulsatile epigastric mass (30% of asymptomatic AAA) |
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Term
| what are the prefered imaging studies for detecting aneurysms? 3 |
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Definition
1. Ultrasonography
2. CT & MRI
3. Angiography |
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Term
| what is the survival rate for ruptured AAA? |
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Definition
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Term
| which patients must the AAA be included in the differential dx? |
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Definition
| older patient iwth abdominal or back pain |
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Term
| at what diameter are AAAs likely to rupture? |
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Definition
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Term
| what is the rate of rupture for AAA at >8.0cm? |
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Definition
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Term
| what are other factors to consider when weighing the risk for rupture? 4 |
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Definition
1. rate of expansion
2. smoker
3. women greater risk for rupture
4. HTN |
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Term
| what diameter of aneurysm is surgery indicated? |
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Definition
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Term
| management of aneurysms 4.0-5.4cm: |
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Definition
| monitor by US or CT every 6-12mo |
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Term
| management of aneurysms 3-4cm: |
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Definition
| monitor by US every 2-3yrs |
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Term
| management of symptomatic aneurisms: |
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Definition
| symptomatic aneurysms should undergoe repair no matter the size |
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Term
| medical therapy for aneurysms includes: |
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Definition
risk factor reduction; no smoking, reduce HTN
beta blockers; reduce expansion |
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Term
| what is the operative risk vs. the ruptured risk of mortality? |
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Definition
4.2% mortality assoc w surgery
>50% mortality assoc w rupture |
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Term
| 4 categories of thoracic aortic aneurysm: |
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Definition
1. ascending (60%)
2. aortic arch (10%)
3. descending to left subclavian
4. Thoracoabdominal |
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Term
| which syndrome has a high correlation with thoracic aortic aneurysms? |
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Definition
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Term
| 5 clinical presentations for thoracic aortic aneurism: |
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Definition
1. asymptomatic
2. chest/back/flank/abd pain
3. aortic regurge
4. emboli to peripheral arteries
5. hoarseness/cough/dyspnea/hemoptysis |
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Term
| CXR of thoracic aortic aneurysm shows: |
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Definition
1. widening of mediastinum
2. enlargement of aortic knob
3. displaced trachea |
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Term
| what imaging studies are used for diagnosis of thoracic aortic aneurysm? |
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Definition
1. transthoracic echocardiography
2. transesophageal echcardiography
3. CT w contrast
4. MRI
5. Contrast angiography |
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Term
| what medical management is involved in thoracic aortic aneurysms? |
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Definition
agressive BP control; beta blockers
serial imaging to monitor growth |
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Term
| 5 indications for surgery on throacic aortic aneurysm: |
|
Definition
1. symptomatic
2. ascending aortic diameter - 50-60mm
3. descending aortic aneurysm = 60-70mm
4. growth rate >10mm/year
5. evidence of dissection |
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Term
| who is most at risk for aortic dissections? |
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Definition
| 60-80yo males (65% of dissections) |
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Term
| what are the 2 major risk factors for aortic dissection? |
|
Definition
1. HTN (72%)
2. Hx of athersclerosis (31%) |
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Term
| what are the risk factors for thoracic aortic dissections in younger patient groups? 6 |
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Definition
1. preexisting aneurysm
2. collagen disorders; marfans, ehlers-danlos
3. bicuspid aortic valve
4. aortic coarctation
5. turner syndrome
6. crack cocaine |
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Term
| S/Sx of thoracic aortic dissection: |
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Definition
acute tearing/ripping pain in chest or back
syncope
pulse deficit |
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Term
| aortic dissection CXR shows: |
|
Definition
1. mediastinum widened
2. often left pleural effusion |
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Term
| what are 3 other imaging studies that can detect aortic dissection? |
|
Definition
1. TEE
2. CT w contrast
3. MRI |
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Term
| medical Tx of aortic dissection: |
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Definition
1 stabilize patient - intubation, intra-arterial BP monitor, urinary cath
2. maintain systolic BP<110 with beta blockers/nitropruside |
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Term
| what is the most common cause of death folowing an MVA or a fall from a height? |
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Definition
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Term
| of those who survive the aortic rupture initialy, what percent will die within 24hrs? |
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Definition
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Term
| overall mortality rate for aortic rupture = |
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Definition
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Term
| aortic rupture clinial presentation: |
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Definition
| patients that survive present with few or nonspecific Sx |
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Term
|
Definition
| CXR, CT, TEE, Angiography, MRI |
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Term
|
Definition
| immediate surgical referal |
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