Term
| What is a common causative factor in aortic aneurysms and aortic dissection and is the leading cause of morbidity/mortality in the US? |
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Definition
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Term
| What is atherosclerotic plaque composed of? (5) |
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Definition
| 1) Inflammatory cells (macrophages and T cells) 2) smooth mus. cells 3) connective tissue 4) thrombi 5) Ca deposits |
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Term
| what causes the development of plaques? |
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Definition
| Repeated injury to endothelial lining (HTN, chlamydia, DM, hyperlipidemia) |
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Term
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Definition
| Regress, remain static, or progress slowly over sev. decades until they cause stenosis or occlusion |
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Term
| What are unstable plaques? |
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Definition
| vulnerable to spontaneous rupture causing acute thrombosis, occlusion, and infarction long before they cause stenosis |
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Term
| How much of the lumen needs to be occluded before sx of ischemia develop? |
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Definition
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Term
| Name 4 reasons tobacco is a major risk factor for atherosclerosis. |
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Definition
| 1) Lowers HDL and raises LDL 2) Increased CO in the blood 3) Vasoconstrictors 4) Increased platelet reactivity |
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Term
| 9 risk factors for atherosclerosis. |
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Definition
| 1) Hyperlipidemia 2) HTN 3) DM 4) Obesity 5) Sedentary 6) Diet 7) Homocysteine levels 8) Male 9) Post-menopause |
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Term
| What is a focal dilation of a blood vessel w/ respect to the original or adjacent artery? |
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Definition
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Term
| What is the most common site an aortic aneurysm occurs? |
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Definition
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Term
| What is the normal diameter of the aorta? What diameter is considered aneurysmal? |
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Definition
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Term
| What gender and race are AAA more prevalent? |
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Definition
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Term
| What is the risk factor most strongly associated with AAA? |
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Definition
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Term
| What might the clinical presentation be of a AAA? |
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Definition
| majority asymptomatic, acute or chronic abd pain, back pain,DIC |
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Term
| When might there be a pulsatile epigastric mass? |
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Definition
| Bifurcation of the aorta at the umbilicus, 30% of asymptomatic AAA |
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Term
| What is the best imaging test to detect AAA? |
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Definition
| ultrasound (fasting helps to reduce obscuring gas in bowel) |
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Term
| Where do the majority of AAA occur? |
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Definition
| segement of aorta b/t the renal and inferior mesenteric art. |
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Term
| What are the s/sx of AAA rupture? (4) |
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Definition
| sudden onset abd pain, back pain, profound unstable hypotension, pulsatile abd mass |
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Term
| What is the survival rate of AAA rupture? |
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Definition
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Term
| Which type of pt w/ which c/o would you a/w include AAA on the list of DDx? |
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Definition
| Older pt w/ c/o abd or back pain |
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Term
| At which diameter does the risk for AAA rupture markedly increase? What diameter has a 30-50% chance of rupture? |
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Definition
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Term
| At which diameter does the risk for AAA rupture markedly increase? What diameter has a 30-50% chance of rupture? |
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Definition
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Term
| What growth rate of aneurysms is considered high risk for rupture? |
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Definition
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Term
| What causes the growth rate of aneurysms to become faster? What causes it to be slower? |
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Definition
| Faster in smokers, slower in DM or dyslipidemia |
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Term
| What gender has an increased risk for rupture? Why? |
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Definition
| women, normal diameter of aorta is smaller in women |
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Term
| What is surgery indicated? |
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Definition
| aneurysm >5.5cm or symptomatic aneurysm of any size |
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Term
| What meds can be used in the tx of aneurysm? |
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Definition
| Beta blockers may reduce expansion |
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Term
| Where is the most common place of a throacic aortic aneurysm (TAA)? |
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Definition
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Term
| What is the most common cause of TAA? |
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Definition
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Term
| Name 4 other conditions that cause TAA. |
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Definition
| 1) Cystic medial degeneration 2) atherosclerosis 3) marfan's 4) giant cell arteritis |
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Term
| What murmur can occur in TAA? What does it suggest? |
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Definition
| aortic regurgitation due to aortic root dilatation - heart failure |
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Term
| What findings of CXR would suggest a possible TAA? |
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Definition
| widening of the mediastinum, enlargement of aortic knob, or displacement of trachea |
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Term
| What is the medical management of TAA? |
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Definition
| beta blockers for aggressive BP control and serial imaging to evaluate growth (/p 6mths then yearly if no growth) |
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Term
| Name 4 indications for surgery in TAA. |
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Definition
| 1) Symptomatic 2) end-diastolic aortic diameter 50-60mm if ascending or 60-70 if descending 3) Growth rate >10mm/yr 4) Evidence of dissection |
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Term
| Who is aortic dissection more common in? |
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Definition
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Term
| What occurs physiologically in aortic dissection? |
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Definition
| A tear in the wall of the aorta causes blood to surge through the intima into the media layer - results in false lumen |
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Term
| What are the 2 most common risk factors for aortic dissection? |
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Definition
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Term
| What are the most common risk factors in aortic dissection in younger pts? (7) |
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Definition
| preexisting aortic aneurysm, collagen d/o (marfans, ehlers-danlos), bicuspid aortic valve, aortic coarctation, turner syndrome, crack |
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Term
| What is a main sx difference b/t aneurysms and aortic dissection? |
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Definition
| Dissection has severe pain described as ripping or tearing (aneurysms have no or little pain) |
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Term
| What are other sx of aortic dissection? |
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Definition
| syncope, sx of CVA, MI, intestinal infarction, paraplegia |
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Term
| What meds are used to tx aortic dissection? |
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Definition
| Beta blocker (metoprolol) to maintain systolic BP <110mg, continuous IV nitroprusside (vasodilator) |
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Term
| When is surgery a/w indicated for aortic dissection? |
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Definition
| when the proximal aorta is involved |
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Term
| What is the most common cause of sudden death following a MVA or fall from a height? |
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Definition
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Term
| What is the overall mortality rate in aortic rupture? |
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Definition
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Term
| In pts w/ aortic rupture that survive initially, what are 4 presenting sx? |
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Definition
| 1) CP or midscapular pain 2) dyspnea 3) hoarseness 4) dysphagia |
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Term
| What is the tx for aortic rupture? |
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Definition
| immediate surgical referral |
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