Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
38 Cards in this Set
- Front
- Back
|
What are 3 common presenting symptoms of aortic dissection?
|
-Elevated BP
-Unequal BP in arms -New diastolic murmur of aortic insufficiency |
|
|
What is the first step in treatment of an aortic dissection?
|
-IV Beta blocker
-Noninvasive imaging test - TEE, CT, or MRI |
|
|
What does CXR show in aortic dissection?
|
Widening of mediastinum
|
|
|
Why is it vital to differentiate aortic dissection from MI?
|
Because some of the therapies for MI like heparin or thrombolytics could make a dissection WORSE
|
|
|
What is AAA by definition?
|
Abnormal dilation of the abdominal aorta greater than 1.5x the normal diameter
|
|
|
Where do the majority of abdominal aneurysms occur?
|
Below the renal arteries
|
|
|
What is a major predisposing factor that leads to aortic dissections in some people?
|
Cystic degeneration of the MEDIA (elastic layer)
|
|
|
What are 5 other conditions that predispose to aortic aneurysms?
|
CAPHA
-Coarctition of the aorta -Aortic valve abnormalities -Pregnancy -Hypertension -Atherosclerosis |
|
|
What is the consequence if a dissecting hematoma ruptures into the
-Pericardial sac -Pleural space |
Pericardial - Cardiac tamponade
Pleural - Exsanguination |
|
|
What does severe aortic regurgitation due to aortic dissection result in?
|
Fulminant heart failure
|
|
|
How can you differentiate between pain of aortic dissection vs. angina?
|
Ao Diss: maximal at onset
Angina: gradually builds over minutes |
|
|
What heart sound is associated with aortic dissection?
|
Early diastolic murmur of AI
|
|
|
What BP do most patients with ao dissection have?
|
HYPERTENSIVE
|
|
|
What if a patient with suspected ao dissection is hypotensive?
|
Suspect Rupture, Tamponade, or Dissection of Subclavian supplying the arm where BP is being measured!
|
|
|
How do you confirm the diagnosis of aortic dissection?
|
With IMAGING
|
|
|
What 3 imaging studies can be used?
|
TEE
MRI CT |
|
|
What is the classification scheme for aortic dissection?
|
Stanford
A - always involves ascending, but can include any other part B - never involves ascending but can involve any other part |
|
|
Why do we care about classifying aortic dissections?
|
Determines therapy
|
|
|
What fraction of all ao dissections occur in the ascending aorta?
|
2/3
|
|
|
What is the treatment for almost all Type A aortic dissections?
|
Emergent surgical replacement of the aorta and involved aortic valve
|
|
|
What is the mortality rate for type A ao dissections if surgery is not done?
|
90%
|
|
|
What is the initial therapy for type B aortic dissections?
|
Medical management
|
|
|
Where do type B aortic dissections usually originate?
|
Distal to the left subclavian artery
|
|
|
What are the 2 main goals in medical management of type B aortic dissections?
|
-Prevent propagation by reducing MAP
-Slow the rate of rise of arterial pressure |
|
|
What meds are used for type B ao dissections?
|
-IV Sodium nitroprusside - lower MAP
-IV B-blockers - reduce shear forces |
|
|
What is an alternative med for type B ao dissection that kills both birds with one stone?
|
IV Labetalol
|
|
|
How does the presentation of AAA compare to that of ao dissection?
|
Markedly! Most often an incidental finding of midline pulsatile mass in asymptomatic patient
|
|
|
What is a AAA by definition?
|
Dilation of abdominal aorta >3cm
|
|
|
What are 4 risk factors for AAA?
|
Men >50 yrs
Atherosclerotic disease CAD, PVD Smoking |
|
|
What is the feared complication of AAA?
|
Rupture
|
|
|
What type of AAA rupture is better; anteriorly or posteriorly?
|
Posteriorly - anteriorly exsanguinates and dies within minutes
|
|
|
How will a patient that has ruptured posteriorly present?
|
Severe lower back or midabdominal pain
|
|
|
What is the overall mortality rate of ruptured AAA?
|
80%
|
|
|
What determines the risk of rupture of an AAA?
|
Size
Low risk if <5cm High risk if >6cm |
|
|
What is the repair for AAA?
|
Excision of diseased aorta, replacement with dacron graft
|
|
|
At what size of a AAA is elective repair recommended?
|
5.5 cm or greater
Expanding >0.5cm per year |
|
|
How often should patients with AAA undergo surveillance?
|
Every 3-12 months
|
|
|
In which trimester of pregnancy are women at risk for aortic dissection?
|
Third
|
