Aortic Aneurysm - PVD

Question 1

What does high content elastin in the media allow?

Answer 1

significant destinsibility
- expands during systole and recoils during diastole

Question 2

How does advancing age change for the aorta?

Answer 2

elastin degenerates and the aorta becomes stiffer which increases in systolic BP

Question 3

What are the three most common clinical conditions for the aorta?

Answer 3

aneurysm
dissection
obstruction

Question 4

How do you classify localized dilatation?

Answer 4

when increased by 50% compared to normal

Question 5

What is a true aneurysm?

Answer 5

dilatation of all 3 layers of the aorta
- creating a large bulge in the vessel wall

Question 6

What is pseudoaneurysm?

Answer 6

contained rupture of the vessel lumen that develops when blood leaks out the hole in the intima and media layer
- contained by the adventitia
- very unstable and prone to rupture

Question 7

What is the cause of pseudoaneurysm?

Answer 7

infection, trauma, puncture (cardiac cath)

Question 8

What are some conditions associated with?

Answer 8

• medial degeneration (Marfan’s, Elher-Danlos, Loeys-Dietz, Aortic valve problems, genetic)
• Atherosclerosis
• Infections
• Vasculitis
• Trauma/aortic dissection

Question 9

What are the causes of descending aortic and abdominal?

Answer 9

• atherosclerosis (smoking, HTN, male, dyslipidemia, older, caucasian)
• genetic predisposition
• vessel inflammation
• weak media due to infections (salmonella, staph, strep, TB, syphilis)

Question 10

What are the clinical presentation?

Answer 10

mostly asx but can:
- feel a pulsating mass or sensation in abdomen (detect imaging)
- feeling organs being constricted or pressed
- non-specific back pain
- nausea
- abdominal pain
- pain in flanks radiating to legs
- general malaise due to infection
- weight loss if due to inflammation

Question 11

What are the sx of thoracic aneurysm?

Answer 11

compression of neighboring stractures: trachea, mainstem bronchus, esophagus

• cough
• dysphagia
• hoarseness (due to recurrent laryngeal nerve)

Question 12

When the aortic ring dilates, what are the sx?

Answer 12

aortic regurgitation and sx of CHF

Question 13

What is the most devastating consequence of an aortic aneurysm?

Answer 13

a rupture
- often fatal

Question 14

What are the sx of slow leaks of aortic aneurysm?

Answer 14

• diffuse
• deep belly pain
• GI sx
• bloating
• cramping

Question 15

What are the sx of a rupture?

Answer 15

• hypovelima and hypotension
• deep pain in the back or abs
• vomitting
• diaphoresis
• loss of consciousness

Question 16

What are the risk factors of a rupture?

Answer 16

• increased size
• rapid expansion
• tobacco use
• increasing or uncontrolled HTN
• cardiac or renal transplants - from steroids for immunosuppression
• COPD
• Female
• Recent surgery

Question 17

Why is gender a strong predictor for aortic aneurysm?

Answer 17

More prevalen possibly due to decreased tensile strength and increased wall stress in women

Question 18

How is it diagnosed?

Answer 18

Imaging on screening
US (americaaaaaa) screeening
Abdominal palpation (more reliable in larger AA)

Question 19

How is an unrupture treated?

Answer 19

• manage the underlying disease process and its risk factors
• repair surgically or endovascularly

Question 20

How is a ruptured treated?

Answer 20

emergent surgical repair

Question 21

What is the survival rate of an aortic aneurysm?

Answer 21

less than 50% do not survive to reach the ED
- even if they do reach, rate decreased by 1% every minute that passes

Question 22

What is aortic dissection?

Answer 22

tear in the intima into the media which spreads along the artery
- blood then flows in between the layers of the blood vessels

Question 23

Aortic Dissection

What can it lead to?

Answer 23

can lead to an aortic rupture
- life threatening

Question 24

Aortic Dissection

Where does it usually occur?

Answer 24

in the thoracic aorta

Question 25

# Aortic Dissection What are the risk factors?

Answer 25

* artherosclerosis * blunt trauma to chest * HTN

Question 26

# Aortic Dissection What is the sudden onset that hints at a dissection?

Answer 26

onset of chest or back pain with a tearing or ripping sensation - can radiate to shoulder, jaw, arm, neck

Question 27

# Aortic Dissection What are the other sx?

Answer 27

* signs of hypoperfusion: dizziness or syncope * nausea and vomiting * rapid, weak pulse