3. Diseases of Aorta and Pericarditis

Question 1

Most common arterial aneurysm in adults is…

Answer 1

Abdominal aortic aneurysm

Question 2

Criteria for aortic aneurysm

Answer 2

Segmental dilation of all layers of layers of aorta

In adults aneurysm = dilation >3cm (more than 50% of regular diameter)

Question 3

Abdominal aortic aneurysm risk factors

Answer 3

HTN

Smoking

Age

Male

Atherosclerosis

Question 4

Abdominal aortic aneurysm symptoms

Answer 4

None if unruptured

Pain, pulsatile mass, low BP if ruptured

Question 5

Abdominal aortic aneurysm diagnostics

Answer 5

Ultrasound for symptomatic

CT for stable/surgery plan

Screen men 65-75 who ever smoked with ultrasound OR men/women with 1st degree relative

Question 6

Abdominal aortic aneurysm treatment

Answer 6

No surgery until >5.5cm

Question 7

Thoracic aortic aneurysm cause

Answer 7

Collagen disorders (Marfans, Ehrlers-Danlos)

Question 8

Thoracic aortic aneurysm symptoms

Answer 8

Half asymptomatic

Maybe chest pain from trachea, esophagus, RLN compression

Question 9

Thoracic aortic aneurysm signs

Answer 9

Feel aortic impulse at right sternal border

Question 10

Thoracic aortic aneurysm diagnostics

Answer 10

MRI and CT most common

Chest x-ray = widened mediastinum

Question 11

Thoracic aortic aneurysm treatment

Answer 11

Beta blockers to control BP

Worry about rupture >5cm

Question 12

Aortic dissection cause

Answer 12

Tear in aorta leads to hematoma between layers

Question 13

Aortic dissection classifications

Answer 13

Stanford:
A- Ascending involved (connective disorder)
B- Descending only (age, HTN)

DeBakey
1 - whole aorta
2 - only ascending
3 - no ascending/arch involved

Question 14

Aortic dissection risk factors

Answer 14

HTN

Age

Male

Atherosclerosis

Question 15

Aortic dissection symptoms

Answer 15

Abrupt ripping pain in back/chest

Type A = syncope
Type B = pain in back, legs

Question 16

Aortic dissection diagnostics

Answer 16

CT = method of choice

Question 17

Aortic dissection treatments

Answer 17

Depends on status

Emergency = surgical repair

Stable = aggressive BP control with beta blockers

Question 18

Takayasu arteritis cause

Answer 18

Inflammatory disease of aorta and branches

Autoimmune

Question 19

Takayasu arteritis symptoms

Answer 19

Fever

Constitutional symps

Claudication

Light headed

Cyanosis

Question 19

Takayasu arteritis risk factors

Answer 19

Asian female, age 10-40

Question 20

Takayasu Arteritis signs

Answer 20

BP discrepancy between arms

Question 22

Takayasu arteritis diagnostics

Answer 22

CBC - Normocytic normochromic anemia (body hordes iron)

MRA or CTA best imaging

Inflammatory markers

Question 23

Takayasu arteritis treatment

Answer 23

Systemic glucocorticoids

Question 24

Giant cell/temporal arteritis cause

Answer 24

Inflammation of temporal artery

Question 25

Giant cell/temporal arteritis risk factors

Answer 25

Scandinavian, age 50+

Question 26

Giant cell/temporal arteritis symptoms

Answer 26

POTENTIAL PERMANENT BLINDNESS Headache Fever Jaw pain

Question 27

Giant cell/temporal arteritis diagnostics

Answer 27

Arterial biopsy ESSENTIAL

Question 28

Giant cell/temporal arteritis treatment

Answer 28

Start steroids ASAP

Question 29

Coarctation of aorta cause

Answer 29

Localized narrowing of aorta (usually after left subclavian) Congenital

Question 30

Coarctation of aorta symptoms

Answer 30

DECREASED PULSE/BP IN LEGS COMPARED TO ARMS Secondary hypertension (young, refractory, very high BP)

Question 30

Coarctation of aorta diagnostics

Answer 30

Echocardiogram

Question 31

Coarctation of aorta treatment

Answer 31

Surgical stent placement

Question 32

Acute pericarditis cause

Answer 32

Viral infection (cocksackie, echovirus, epstein-barr, flu, covid)

Question 33

Acute pericarditis risk factor

Answer 33

Recent viral infection

Question 34

Acute pericarditis symptoms

Answer 34

Sharp, sudden chest pain (Worse with inspiration and supine position)

Question 35

Acute pericarditis signs

Answer 35

Diffuse ST elevation and PR depression Friction rub Pericardial effusion (new or worsening)

Question 36

Acute pericarditis diagnosis criteria

Answer 36

NEED TWO OF FOUR SIGNS/SYMPTOMS 1. Sharp, sudden chest pain 2. Diffuse ST elevation and PR depression 3. Friction rub 4. Pericardial effusion

Question 37

Acute pericarditis treatment

Answer 37

Ibuprofen/Aspirin + Colchicine (x 1 month) Corticosteroids if can't take NSAIDs Avoid strenuous exercise

Question 38

Untreated acute pericarditis can develop into ....

Answer 38

Constrictive pericarditis

Question 39

Constrictive pericarditis cause

Answer 39

MOST COMMON = TB (worldwide) Constrictive = Tightly Bound (TB) In US, idiopathic/radiation Fibrous scarring of both pericardial layers

Question 40

Constrictive pericarditis signs

Answer 40

MOST COMMON = JVP Edema (anasarca) Pericardial knock

Question 41

Constrictive pericarditis diagnosis

Answer 41

Echocardiography

Question 42

Constrictive pericarditis treatment

Answer 42

Treat cause (TB) NSAID + Colchicine Pericardiectomy

Question 43

Pericardial effusion cause

Answer 43

Excess fluid in pericardial space

Question 44

Pericardial effusion risk factors

Answer 44

Fever/infection Cancer (neoplasm) Radiation

Question 45

Pericardial effusion diagnostics

Answer 45

BEST = echocardiography EKG may have short waves

Question 46

Pericardial effusion treatment

Answer 46

Deal with initial cause Maybe drain or biopsy fluid

Question 47

Cardiac tamponade cause

Answer 47

Pericardial effusion that restricts heart filling and stroke volume Emergency!

Question 48

Cardiac tamponade cause

Answer 48

Traumatic/acute injury

Question 49

Cardiac tamponade symptoms

Answer 49

Chest pain Dyspnea

Question 50

Cardiac tamponade signs

Answer 50

BECK'S TRIAD: Low BP Distended JVP Muffled heart sounds Paradoxical pulse Tachycardia

Question 51

Cardiac tamponade diagnostics

Answer 51

EKG = ELECTRICAL ALTERNANS Echocardiography

Question 52

Cardiac tamponade treatment

Answer 52

URGENT drainage!

Question 53

Cardiac tumors cause

Answer 53

Benign tumors (myxomas) Most often in left atrial wall

Question 54

Cardiac tumor symptoms

Answer 54

Constitutional

Question 55

Cardiac tumor signs

Answer 55

Split S1 Early diastolic plop (Mitral regurge) (Embolism)

Question 56

Cardiac tumor diagnosis

Answer 56

Echocardiography

Question 57

Cardiac tumor treatment

Answer 57

Surgery

Question 58

Cardiac trauma cause

Answer 58

MOTOR VEHICLE ACCIDENT Commotio cordis = baseball to chest

Question 59

Cardiac trauma is most often seen in this chamber of the heart ...

Answer 59

Right ventricle

Question 60

Aortic injury cause

Answer 60

Deceleration = tear in aorta after left subclavian

Question 61

Cardiac trauma diagnosis

Answer 61

Echocardiography = impaired wall motion