Aortic Dissection Flashcards Preview

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Flashcards in Aortic Dissection Deck (31)
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0
Q

Why is it important not to get an MI and aortic dissection confused?

A

The treatment for MI (anticoagulation with heparin or thrombolytics) worsens aortic dissection

1
Q

Patient with aortic dissection. Next steps?

A
  1. Intervenous beta blocker
  2. noninvasive imaging procedure (transesophageal echo, CT angiography, MRI)
  3. Lower BP if hypertensive
2
Q

Definition of an abdominal aortic aneurysm? Typically occurs where?

A

Dilation to more than 1.5 times the normal diameter of the aorta. Below the renal arteries.

3
Q

Cystic degeneration affects what layer of the aorta? Occurs in what connective tissue disorders?

A

Elastic media. Marfan’s and Ehlers-Danlos syndrome

4
Q

Factors predisposing to aortic dissection?

A

Heart problems: aortic valvular abnormalities,

vessel issues: Cystic degeneration, hypertension, coarctation of the aorta, atherosclerotic disease,

other: pregnancy, surgery or catheterization

5
Q

Dissection occurs when there’s a sudden tear to what layer? Followed by?

A

Intima. Followed by propagating dissecting hematoma.

6
Q

Most important factors causing the propagation of the dissection?

A

Hypertension and the associated shear forces

7
Q

How does an aortic dissection cause of organ ischemia or infarction?

A

Produces an intraluminal intimal flap which can occlude branch arteries

8
Q

Complications from an aortic dissection?

A
  1. Organ ischemia
  2. Cardiac tamponade (leads to exsanguination)
  3. Acute aortic regurgitation
9
Q

Anginal pain versus pain of dissection? (Course, alleviation)

A

Builds over minutes versus maximal at onset

Alleviating by nitrates versus not

10
Q

Aortic dissection may cause which murmur?

A

Early diastolic murmur of aortic sufficiency (especially since most dissections begin close to aortic valve)

11
Q

Blood pressure of most patients with dissection? Otherwise?

A

Hypertensive. If hypotensive, suspect aortic rupture, cardiac tamponade, dissection of subclavian artery

12
Q

Plain chest film on patient with aortic dissection would likely show?

A

Widened superior mediastinum

13
Q

Type A versus Type B dissection?

A

Involves the ascending aorta versus does not involve the ascending aorta

14
Q

Horner syndrome results from?

A

Compression of the superior cervical ganglion

15
Q

Superior vena cava syndrome results from?

A

Compression of the superior vena cava

16
Q

Hemopericardium, pericardial tamponade occurs from?

A

Thoracic dissection with retrograde flow to the pericardium

17
Q

Bowel ischemia hematuria occurs from a dissection involving?

A

The mesenteric arteries or renal arteries

18
Q

Hypertension or different blood pressures in the arms result from a dissection involving what?

A

Cardiac dissection involving brachiocephalic artery

19
Q

Hemiplegia results from a dissection involving what?

A

Carotid artery

20
Q

Most aortic dissection originate where?

A

A few centimeters above the aortic valve.

21
Q

Treatment for type A dissection? Mortality without accepted treatment?

A

Surgical therapy with replacement of a order and sometimes aortic valve. 90%.

22
Q

Type B dissections originate where?

A

In the aortic arch distal to the left subclavian artery

23
Q

Surgery for type B dissections when?

A

Surgery performed only for complications such as rupture or ischemia of the branch of the aorta

24
Q

Aim of medical therapy?

A

Prevent propagation of the dissection by reducing mean arterial pressure and rate of rise of arterial pressure (Reduces shear forces)

25
Q

Drugs given for type B dissections?

A
  1. Intravenous vasodilators such as sodium nitroprusside (lowers BP) with beta blockers such as metoprolol (lowers shear forces)
  2. Labetalol
26
Q

Symptoms of Thoracic aortic aneurysm versus abdominal aortic aneurysm

A

Tearing pain radiating to the back versus asymptomatic with midline pulsatile mass

27
Q

Abdominal aortic aneurysm can rupture where? Can lead to?

A
  1. Anteriorly. Patient exsanguinates within minutes

2. Posteriorly. Patient bleeds into retroperitoneum and presents with severe lower back or mid abdominal pain

28
Q

Risk of rupture is related to size of aneurysm. Size to watch for?

A

Low risk of rupture with 5 cm aneurysm but 10 to 20% risk with 6 cm aneurysms

29
Q

Elective repair of abdominal aortic aneurysms with what size aneurysm?

A

5.5 cm

30
Q

Recommendations for surveillance of abdominal aortic aneurysm?

A

Imaging at 3-12 month intervals depending on risk of rupture

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