Flashcards in Cardiovascular Deck (317)
What is an abdominal aortic aneurysm?
An unruptured AAA is > 3cm across.
What are aneurysms of the arteries?
An artery with a dilatation >50% of it's original diameter .
True aneurysms are abnormal dilatations that involve all layers of the arterial wall.
What are the causes of an abdominal aortic aneurysm?
- Infection, e.g. mycotic aneurysm in endocarditis, tertiary syphillis
- Connective tissue disorders (e.g. Marfan's, Ehler's-Danlos)
- Inflammatory e.g. Takayasu's aortitis
What are the complications of an abdominal aortic aneurysm?
- Pressure on other structures
What are the symptoms of a ruptured abdominal aortic aneurysm?
- Intermittent or continuous abdominal pain (radiates to the back, iliac fossae or groans)
- Expansile abdominal mass (expands and contracts)
What are the symptoms of an unruptured aortic aneurysm?
- Might cause abdominal/back pain, often discovered incidentally on abdominal examination
What tests help identify the size, and rate of growth of an aneurysm?
- Abdominal ultrasound
What is an aortic dissection?
A condition where a tear in the aortic intima allows blood to surge into the aortic wall, causing a split between the inner and outer tunica media which creates a false lumen
What is the aetiology of aortic dissection?
Degenerative changes in the smooth muscle of the aortic media are the predisposing event
What are the risk factors of aortic dissection?
- Aortic atherosclerosis
- Connective tissue disease (e.g. SLE, Marfan's, Ehlers-Danlos)
- Congenital cardiac abnormalities (e.g. aortic coarctation)
- Crack Cocaine
How does the Stanford classification categorise aortic dissection?
Type A= ascending aortic tear (most common)
Type B= descending aorta tear distal to the left subclavian artery
What is the epidemiology of aortic dissection?
Most common in males between 40 and 60 years
What are the presenting symptoms of aortic dissection?
Sudden central 'tearing' pain which may radiate to the back (might mimic an MI)
Aortic dissection can lead to occlusion of the aorta and its branches
What are the symptoms of aortic dissection when the carotid is obstructed?
What are the symptoms of aortic dissection when the coronary artery is obstructed?
Chest pain (angina or MI)
What are the symptoms of aortic dissection when the subclavian is obstructed?
- Loss of consciousness
What are the symptoms of aortic dissection when the anterior spinal artery is obstructed?
What are the symptoms of aortic dissection when the coeliac is obstructed?
Severe abdominal pain (ischaemic bowel)
What are the symptoms of aortic dissection when the renal artery is obstructed?
- Renal failure
What are the signs of aortic dissection of physical examination?
Murmur on the back below left scapula, descending to abdomen
BP: Hypertension (discrepancy between arms of >20mmHg), wide pulse pressure. If hypotensive, may signify tamponade, check for pulsus paradoxus
Aortic insufficiency: Collapsing pulse, early diastolic murmur over aortic area.
Unequal arm pulses
Might be palpable abdominal mass
What are the investigations for aortic dissection?
Bloods: FBC, U&E , clotting
CXR: Widened mediastinum, localised bulge in aortic arch
ECG: Often normal, signs of ventricular hypertrophy or inferior MI if dissection compromises the ostia of the right coronary artery
CT-Thorac: False lumen of dissection may be visualsed
Echocardiography: transoesopharangeal is highly specific
Cardiac Catheterization and aortography
What is aortic regurgitation?
Reflux of blood from aorta into left ventricle during diastole.
Also called aortic insufficiency
What is the aetiology of aortic regurgitation?
- Aortic valve leaflet abnormalities or damage
- Aortic root/ascending aorta dilation
What causes aortic valve leaflet abnormalities or damage leading to aortic regurgitation?
- Bicuspid aortic valve
- Infective endocarditis
- Rheumatic fever
What causes aortic root/ascending aorta dilation leading to aortic regurgitation?
- Systemic hypertension
- Aortic dissection
- Marfan's syndrome
- Ehler's-Danlos syndrome
- Osteogenesis imperfecta
What is the epidemiology of aortic regurgitation?
Chronic AR often begins in the late 50s, documented frequently over 80 years
What are the presenting symptoms of aortic regurgitation?
Initially asymptomatic. Later, symptoms of heart failure: exertional dyspnoea, orthopnoea, fatigue. Occasionally angina
Severe acute AR:
Sudden cardiovascular collapse
Symptoms related to the aetiology:
E.g. chest or back pain in patients with aortic dissection
What are signs of aortic regurgitation on examination?
Collapsing 'water-hammer' pulse and wide pulse pressure. Thrusting and heaving (volume-loaded) displaced apex beat.
How is an early diastolic murmur heard in AR?
At lower left sternal edge.
Better head with the patient sitting forward with the breath held in expiration
An ejection systolic murmur is often heard because of increase flow across the valve