Diseases Of The Aorta / Cardiac Patho Test 2/2 Flashcards Preview

CVPR 312 Cardiac Pathophysiology > Diseases Of The Aorta / Cardiac Patho Test 2/2 > Flashcards

Flashcards in Diseases Of The Aorta / Cardiac Patho Test 2/2 Deck (70):
0

The ascending aorta and arch are:

Mobile

1

The descending aorta becomes fixed to the thorax by the intercostal arteries, LSCA, and _____?

Ligamentum arteriosum

2

At what point does the descending aorta become fixed to the thorax?

Aortic Isthmus

3

Recite the regions of the aorta starting from the valve?

Ascending Aorta
Transverse Arch
Descending Aorta
Abdominal Aorta

4

Weakening of an artery involving all three layers of the vessel is called what?

Localized Dilation

5

Aortic aneurysm that represents 3/4 of atherosclerotic aneurysms?

Where or what level do they occur?

Abdominal

Between the renal arteries and the bifurcation.

6

Thoracic dilation can occur anywhere along the thoracic aorta, what is the most common site ?

Arch and descending aorta

7

Perianeurysmal fibrosis (10%) May cause what?

Urethral obstruction

8

90% of abdominal aortic aneurysms are ?

Infrarenal

9

Abdominal aortic aneurysm statistics?

Focal widening >3 cm
> 60 yrs
M:F = 5:1

10

What is one major Abdominal aortic aneurysm complication?

25% rupture into the left retroperitoneum, GI tract, IVC.

11

What are 3 other Abdominal aortic aneurysm complications?

Peripheral embolization
Infection
Spontaneous occlusion of the Aorta

12

What is the normal size of a thoracic aortic aneurysm and wt what point does it tend to rupture?

Normal size = 4-5 cm
Rupture at = 10 cm

13

Statistics of thoracic aortic aneurysms?

Mean age = 65 yrs
M:F = 3:1

14

thoracic aortic aneurysm are associated with ?

HTN
CAD
AAA

15

Symptoms of a thoracic aortic aneurysm ?

Subsepternal, back, and shoulder pain experienced by 25%.
SVC syndrome
Dysphagia
Stridor
Dyspnea
Hoarseness

16

What is the gold standard for evaluation of aneurysm?

Angiography

17

Etiology of descending aortic aneurysms?

80% atherosclerotic

18

Percentage of descending aortic aneurysms do to post traumatic circumstances ?

15%

19

CHDs that can lead to descending aortic aneurysms?

2% post coarctation, & ductus diverticulum

20

Syphilis can lead to what type of aneurysms?

Ascending aortic aneurysms
And
Arch aneurysms

21

3 conditions that can lead to arteritis?

Takayasu
Giant cell
Relapsing polychondritis

22

3 conditions that can lead to cystic medial necrosis ?

Marfan
Ehlers-Dantos
Annuloaortic ectasia

23

Aneurysms arise in areas of dense ?

Atherosclerosis

24

Atherosclerosis erodes into the aortic wall and destroys ?

Medial elements

25

During atherosclerotic aortic aneurysms the aorta widens and then what happens?

Tension increases, which accelerates the process.

26

Blunt trauma to the chest AKA

De-acceleration injury

27

Rupture of the Aorta occurs in ____ of all fatal auto accidents?

1/6

28

What is the most common site of aortic rupture during fatal car accidents ?

Ligamentum Arteriosum

29

What does syphilitic heart disease primarily effect?

Media of the Thoracic Aorta.

AI is common

30

Etiology of Mycotic Aneurysm of the Aorta?

IV drug use
Bacterial endocarditis 12%
Immunocompromise
S/P AV surgery, CABG

31

Organisms that cause Mycotic Aneurysm of the Aorta?

S. Aureus (53%)
Salmonella (33-50%)
Streptococcus

32

Sites of Mycotic Aneurysm of the Aorta?

Ascending aorta >
Visceral artery >
intracranial Artery >
upper/lower extremity arteries

33

Inflation of the aorta ?

Takayasu Arteritis AKA

Giant cell Arteritis
Aortic arch syndrome
Pulseless disease

34

thickening of wall of aortic arch + thoracic aorta.

chronic obliterative arteritis of + carotid arteries subclavian.

diminished pulses in upper extremities
may ==>

rib notching

35

Cystic Medial Necrosis of the Aorta Seen in

elastic arteries

36

Cystic Medial Necrosis of the Aorta Characterized histologically by

deposits of amorphous basophilic accumulations “Microcysts”
within the media

37

“Microcysts” can coalesce and interrupt the elastic fibers causing

weakening.

38

Marfan’s Syndrome

Connective-tissue disorder: autosomal dominant,
15% sporadic



39

Marfan’s Syndrome

*aortic aneurysm (mostly ascending)
*dilatation of aortic sinuses
*aortic dissection
*coarctation
*tall stature, long limbs
*arachnodactyly
*lax joints
*scoliosis (60%) / kyphosis / pectus
*dural ectasia
*lens subluxation

40

Aortic dissection Caused by

sudden tear in intima allowing for a column of blood to enter the Ao wall

41

What is a prerequisite for Aortic dissection?

Degeneration of media

42

Aortic dissection can be described as ?

Cystic medial necrosis-deterioration of collagen and elastic tissues

43

Aortic dissection is common in what medical syndrome?

Marfan's syndrome

44

DeBakey Type I Aortic dissection

ascending Ao and beyond

45

DeBakey Type II Aortic dissection

confined to ascending Ao

46

DeBakey Type IIIa Aortic dissection

descending, confined to thorax

47

DeBakey Type IIIb Aortic dissection

descending, extends beyond diaphram

48

Shumway/Stanford Type A

origin in ascending

49

Shumway/Stanford Type B

origin in descending

50

what are the three main surgical options for descending aortic lesions?

Clamp & run
Shunt
Left heart bypass

51

Explain the shunt surgical option for descending aortic lesions?

a Gott Shunt is placed from above the aneursym and connected beyond the distal clamp. Simple but one can not easily control flow through shunt

52

Type III Descending Aortic Lesion requires Clamping the aorta to correct the lesion, which then results in hypoxia and ischemia to the lower body. What are three complication s that we can face?

Paraplegia
Renal failure
Ischemia-reperfusion injury

53

What is Left Heart Bypass?

Taking blood from the LA and returning it through the femoral artery. Bypasses the LV.

54

Is an oxygenator required for Left Heart Bypass ?

No, blood in LA is fully oxygenated

55

When would we need to use left heart bypass?

Type III Aortic Aneurysms

To assist/support a failing ventricle LVAD, RVAD, BiVAD

56

Perfusion Parameters for left heart bypass?

Pump Flows can be 1/2 what you would flow with full CPB.

Be careful to balance the upper body and lower body perfusion! Don’t sacrifice good cerebral perfusion!

57

Cardiac index for lowerbody perfusion?

1.0

58

Treatment for an Aortic disses ton Type A ?

Ascending dissection requires surgery

59

Treatment for an Aortic disses ton Type B ?

Descending dissection can be medically managed by controlling BP and preventing extension.

60

What are the 2 components of the surgical adhesive?

Bovine Serum Albumin
Glutaraldehyde

61

Bioglue curing time?

Starts 20-30seconds
Finished in 3 minutes

62

Aortic dissection outcomes with medical treatment ?

80% 1 year survival
50% 3-5 year survival

63

Operational mortality for ascending ?

5 -10%

64

Operational mortality for descending ?

10%

65

Operational mortality for arch ?

10 -25%

66

Operational 10yr survival for aortic dissection?

46%

67

Percentage risk for a
re-dissection?

10%

68

Remember: you are dealing with 2 circuits that share 1 source:

The upper body is perfused by the LV ejections.
The lower body is being perfused by the pump.

69

If you are measuring arterial pressures in the upper body then you have

a inverse relationship between pressure and pump flow