Diseases Of The Aorta / Cardiac Patho Test 2/2

Question 0

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

Answer 0

Ligamentum arteriosum

Question 1

The ascending aorta and arch are:

Answer 1

Mobile

Question 2

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

Answer 2

Aortic Isthmus

Question 3

Recite the regions of the aorta starting from the valve?

Answer 3

Ascending Aorta
Transverse Arch
Descending Aorta
Abdominal Aorta

Question 4

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

Answer 4

Localized Dilation

Question 5

Aortic aneurysm that represents 3/4 of atherosclerotic aneurysms?

Where or what level do they occur?

Answer 5

Abdominal

Between the renal arteries and the bifurcation.

Question 6

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

Answer 6

Arch and descending aorta

Question 7

Perianeurysmal fibrosis (10%) May cause what?

Answer 7

Urethral obstruction

Question 8

90% of abdominal aortic aneurysms are ?

Answer 8

Infrarenal

Question 9

Abdominal aortic aneurysm statistics?

Answer 9

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

Question 10

What is one major Abdominal aortic aneurysm complication?

Answer 10

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

Question 11

What are 3 other Abdominal aortic aneurysm complications?

Answer 11

Peripheral embolization
Infection
Spontaneous occlusion of the Aorta

Question 12

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

Answer 12

Normal size = 4-5 cm

Rupture at = 10 cm

Question 13

Statistics of thoracic aortic aneurysms?

Answer 13

Mean age = 65 yrs

M:F = 3:1

Question 14

thoracic aortic aneurysm are associated with ?

Answer 14

HTN
CAD
AAA

Question 15

Symptoms of a thoracic aortic aneurysm ?

Answer 15

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

Question 16

What is the gold standard for evaluation of aneurysm?

Answer 16

Angiography

Question 17

Etiology of descending aortic aneurysms?

Answer 17

80% atherosclerotic

Question 18

Percentage of descending aortic aneurysms do to post traumatic circumstances ?

Answer 18

15%

Question 19

CHDs that can lead to descending aortic aneurysms?

Answer 19

2% post coarctation, & ductus diverticulum

Question 20

Syphilis can lead to what type of aneurysms?

Answer 20

Ascending aortic aneurysms
And
Arch aneurysms

Question 21

3 conditions that can lead to arteritis?

Answer 21

Takayasu
Giant cell
Relapsing polychondritis

Question 22

3 conditions that can lead to cystic medial necrosis ?

Answer 22

Marfan
Ehlers-Dantos
Annuloaortic ectasia

Question 23

Aneurysms arise in areas of dense ?

Answer 23

Atherosclerosis

Question 24

Atherosclerosis erodes into the aortic wall and destroys ?

Answer 24

Medial elements

Question 25

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

Answer 25

Tension increases, which accelerates the process.

Question 26

Blunt trauma to the chest AKA

Answer 26

De-acceleration injury

Question 27

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

Answer 27

1/6

Question 28

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

Answer 28

Ligamentum Arteriosum

Question 29

What does syphilitic heart disease primarily effect?

Answer 29

Media of the Thoracic Aorta. AI is common

Question 30

Etiology of Mycotic Aneurysm of the Aorta?

Answer 30

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

Question 31

Organisms that cause Mycotic Aneurysm of the Aorta?

Answer 31

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

Question 32

Sites of Mycotic Aneurysm of the Aorta?

Answer 32

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

Question 33

Inflation of the aorta ?

Answer 33

Takayasu Arteritis AKA Giant cell Arteritis Aortic arch syndrome Pulseless disease

Question 34

thickening of wall of aortic arch + thoracic aorta. chronic obliterative arteritis of + carotid arteries subclavian. diminished pulses in upper extremities may ==>

Answer 34

rib notching

Question 35

Cystic Medial Necrosis of the Aorta Seen in

Answer 35

elastic arteries

Question 36

Cystic Medial Necrosis of the Aorta Characterized histologically by

Answer 36

deposits of amorphous basophilic accumulations “Microcysts” | within the media

Question 37

“Microcysts” can coalesce and interrupt the elastic fibers causing

Answer 37

weakening.

Question 38

Marfan’s Syndrome

Answer 38

Connective-tissue disorder: autosomal dominant, | 15% sporadic

Question 39

Marfan’s Syndrome

Answer 39

* 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

Question 40

Aortic dissection Caused by

Answer 40

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

Question 41

What is a prerequisite for Aortic dissection?

Answer 41

Degeneration of media

Question 42

Aortic dissection can be described as ?

Answer 42

Cystic medial necrosis-deterioration of collagen and elastic tissues

Question 43

Aortic dissection is common in what medical syndrome?

Answer 43

Marfan's syndrome

Question 44

DeBakey Type I Aortic dissection

Answer 44

ascending Ao and beyond

Question 45

DeBakey Type II Aortic dissection

Answer 45

confined to ascending Ao

Question 46

DeBakey Type IIIa Aortic dissection

Answer 46

descending, confined to thorax

Question 47

DeBakey Type IIIb Aortic dissection

Answer 47

descending, extends beyond diaphram

Question 48

Shumway/Stanford Type A

Answer 48

origin in ascending

Question 49

Shumway/Stanford Type B

Answer 49

origin in descending

Question 50

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

Answer 50

Clamp & run Shunt Left heart bypass

Question 51

Explain the shunt surgical option for descending aortic lesions?

Answer 51

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

Question 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?

Answer 52

Paraplegia Renal failure Ischemia-reperfusion injury

Question 53

What is Left Heart Bypass?

Answer 53

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

Question 54

Is an oxygenator required for Left Heart Bypass ?

Answer 54

No, blood in LA is fully oxygenated

Question 55

When would we need to use left heart bypass?

Answer 55

Type III Aortic Aneurysms To assist/support a failing ventricle LVAD, RVAD, BiVAD

Question 56

Perfusion Parameters for left heart bypass?

Answer 56

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!

Question 57

Cardiac index for lowerbody perfusion?

Answer 57

1.0

Question 58

Treatment for an Aortic disses ton Type A ?

Answer 58

Ascending dissection requires surgery

Question 59

Treatment for an Aortic disses ton Type B ?

Answer 59

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

Question 60

What are the 2 components of the surgical adhesive?

Answer 60

Bovine Serum Albumin | Glutaraldehyde

Question 61

Bioglue curing time?

Answer 61

Starts 20-30seconds | Finished in 3 minutes

Question 62

Aortic dissection outcomes with medical treatment ?

Answer 62

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

Question 63

Operational mortality for ascending ?

Answer 63

5 -10%

Question 64

Operational mortality for descending ?

Answer 64

10%

Question 65

Operational mortality for arch ?

Answer 65

10 -25%

Question 66

Operational 10yr survival for aortic dissection?

Answer 66

46%

Question 67

Percentage risk for a | re-dissection?

Answer 67

10%

Question 68

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

Answer 68

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

Question 69

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

Answer 69

a inverse relationship between pressure and pump flow