SEARCH
You are in browse mode. You must login to use MEMORY

   Log in to start

level: Aortic Diseases

Questions and Answers List

level questions: Aortic Diseases

QuestionAnswer
How is aortic anatomy?Ascending thoracic aorta, aortic arch, descending thoracic aorta, abdominal aorta Stress of aorta: • The aorta has continuous exposure to high pulsatile pressure and shear stress. • The aorta is more prone to rupture than any other vessel especially with the development of aneurysmal dilatation. Types of aneurysms: • True aneurysm - Saccular - Fusiform • False aneurysm or pseudoaneurym
How are types of aneurysms?• True aneurysm involves all three layers of the vessel. - A fusiform aneurysm affects the entire circumference of segment of the vessel resulting in a diffusely dilated lesion. - A saccular aneurysm involves only a portion of the circumference resulting in an outpouching of the vessel wall. • False aneurysms involve the inner layers of the aorta. It is a partial rupture of the aorta, contained by the adventitia
How is etiology of fusiform aortic aneurysms?• The most common pathologic condition associated with aortic aneurysm is Atherosclerosis. • Cystic medial necrosis is the degeneration of collagen and elastic fibers in the tunica media of the aorta. • It affects the proximal part of the aorta causing a fusiform aneurysm. • The fusiform aneurysm is particularly prevalent in patients with: (Marfan’s syndrome. Pregnant women. Hypertensive patients., Valvular heart disease patients. ) • Syphyllis is an uncommon cause of aortic aneurysm. • Tuberculous and mycotic aneurysms are rare conditions. • Vasculitis. • Spondyloarthropathies. • Traumatic. • Congenital aortic anuerysms (usually associated with bicuspid aortic valve or aortic coartation).
How are thoracic aortic aneurysms?Thoracic aortic aneurysms (• The average growth of the aneurysm is 0.1 to 0.4 cm/year. The risk of rupture is related to the size of the aneurysm especially when > 55 mm in diameter for the ascending aorta and > 60 mm for the descending aorta • Most often is asymptomatic. • Compression or erosion of adjacent tissue may cause chest pain, dyspnea, cough, hoarseness, dysphagia. • Congestion of head, neck and upper extremities secondary to compression of the superior vena cava. • Dilated aortic root with aortic valve regurgitation. • Congestive heart failure secondary to aortic regurgitation • Imaging includes: Chest X-ray (might show mediastinal enlargement). Echocardiogram: trans-thoracic, trans-esophageal, or both. CT angio-scanner (Gold Standard). Magnetic Resonance Imaging (MRI).
How are abdominal aortic aneurysms?• It occurs in males more than females. • The incidence increases with age. • Atherosclerosis affects more than 90% of the aneurysms > 40 mm in diameter. • Most of them are below the renal arteries. • The 5 year risk of rupture for aneurysms < 50 mm is 1 to 2%. • The 5 year risk of rupture for aneurysm > 50 mm is 20 to 40%. • The formation of mural thrombi within the aneurysm may predispose to peripheral embolization. • AAA produces no symptoms and it is usually detected on routine examination as a palpable pulsatile and non tender mass. • It is usually an incidental finding during an abdominal CT scanner or ultrasound performed for other reasons. • If AAA expands, it may produce severe pain in the abdomen, or lower back due to mass effect. • Aneurysmal pain is an emergency because it is an early sign of rupture
What is aortic dissection?• Blood violates aortic intimal and adventitial layers • False lumen is created • Dissection may extend proximally, distally, or in both directions Effects on aortic root Aortic valve and Coronary arteries flails Classifications: • DeBakey and co-workers classification - Type I: The intimal tear occurs in the ascending aorta but which involves the descending aorta as well. (60%) - Type II: The dissection is limited to the ascending aorta. (10-15%) - Type III: The tear is located in the descending thoracic aorta (25-30%)
How are Debakey's classifications of aortic dissection?.
What are etiologies of aortic dissection?• Hypertension (known or misdiagnosed). • Connective tissue diseases: - Marfan syndrom. - Ehlers-Danlos syndrom. • Congenital malformations: - Bicuspid aortic valve. - Coarctation of the aorta • Traumatic (car accident: frontal shock). • Iatrogenic: - arterial catheterism. - during or after cardiac surgery. • Pregnancy (rare).
How is presentation of aortic dissection?Typical: • Acute chest pain. • Abrupt onset. • Stabbing pain. • Irradiating pain to the back. • Migrating pain to the lower back. • Tearing sensation. • Hypertensive patient. Atypical: • Neurological deficit or syncope: complete or partial obstruction of carotid arteries. • Hypotension: cardiac tamponade or massive bleeding. • Shortness of breath: hemothorax • Acute limb ischemia, acute mesenteric ischemia, acute renal artery obstruction renal failure
How is PE of aortic dissction? DD?• Examine 4 limbs: - Asymetric pulses (not always present). - Asymetric blood pressure values (not always present), > 20 mmHg if present. • Heart auscultation: Diastolic aortic murmur due to aortic valve regurgitation (not always present) DD: • Myocardial infarction: - perform ECG and cardiac enzymes. • Cerebro-vascular accident: - perform carotid ultrasound and/or brain angio-scanner. • Pulmonary embolism: - perform a chest angio-scanner. • Pericarditis or Pericardial effusion and tamponade: - perform a cardiac ultrasound and/or a chest angio-scanner
How is management of aortic aneurysms?• Blood pressure Control: - measure BP in 4 limbs and consider the highest. - if high, administer IV anti-hypertensive drugs (Loxen, Isoket, Ebrantyl, etc…). - if low, administer IV fluids. • Pain Control: - administer IV morphine, to lower pain, and secondarily to lower BP Imaging (CXR [if stable pt, see wide mediastinum sometimes], Angioscanner of thorax, abdopelvis, cardiac US if stable pt to see intimal flap/ AR/ pericardial effusion/tamponade, MRI can be performed but time consuming, arteriography not to be done when doubtful dx due to risk of rupture
How is management after dx?Type A (• Call the Open Heart team for an emergent surgery. • Mortality increases by 2% each hour for total mortality rate of 95% Restore normal anatomy of aortic root, commissural resuspension and glueing of dissecton layers, aortic valve reimplantation [David Operation])
How is cardiac coarctation correction?.