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Fall '23 Echo > Exam #3 Ppt Aortic Abnormalities > Flashcards

Exam #3 Ppt Aortic Abnormalities Flashcards

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1
Q

the most common aortic abnormality is

A

aortic dilation

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2
Q

multiple measurements should be taken at different areas of aorta if this patient has

A

dilated aorta

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3
Q

when dilation is severe it is classified as an

A

aneurysm

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4
Q

how is an aneurysm defined?

A

an increase of more than 50% above the normal diameter range

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5
Q

causes of aneurysms (7)

A

Atherosclerosis or degenerative causes (most common), syphilis, trauma, aortic stenosis, genetically triggered ex aortic coarctation, PDA, aortitis

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6
Q

3 types of aneurysms

A
  1. dissecting
  2. saccular
  3. fusiform
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7
Q

When doing echo, aortic sizes measure from PLAX at (what part of cardiac cycle)

A

end diastole

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8
Q

TTE and TEE are limited in seeing this part of the aorta

A

distal ascending aorta (rt parasternal may help)

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9
Q

In echo, measure at these 4 places when measuring aortic sizes

A
  1. annulus
  2. sinuses of vasalva
  3. supraoptic ridge
  4. proximal ascending aorta
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10
Q

In echo, with aneurysms you can measure either ___________ or ___________. one is a preferred method.

A

leading edge to leading edge
OR
inner edge to inner edge (preferred - could underestimate tho)

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11
Q

most common type of aneurysm is

A

an atherosclerotic aneurysm

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12
Q

what percentage of atherosclerotic aneurysms are thoracic?

A

25%

75% are abdominal

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13
Q

thoracic aortic aneurysms - most common sites?

A

aortic arch
descending aorta

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14
Q

atherosclerotic process

A

weakening of ao wall
medial degeneration
localized vessel dilation

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15
Q

causes disease of the aorta and undermines strength of the ao wall, resulting in expansion to aneurysm

A

hypertension!

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16
Q

Symptoms of aneurysms

A

wheezing
coughing
dyspnea
hemoptysis
hoarseness
dysphagia

occurs when aneurysm is large enough to impinge on surrounding structures such as
- lt main bronchus
- recurrent laryngeal nerve
- esophagus

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17
Q

in diagnosing aneurysms, what is the gold standard? what are the runner-ups?

A

gold standard is angiography!

MRI is excellent
CT w/ contrast is reliable
Chest x-ray can detect mediastinal widening

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18
Q

this aneurysm is a rare anomaly, may present ruptured or unruptured, can be acquired or congenital

A

sinus of vasalva aneurysm

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19
Q

LSOVA (2)

A
  1. may rupture into the LA or RA
  2. can cause LA compression
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20
Q

NCSOVA (1)

A
  1. May rupture into the LA, RA, LV, or ventricular septum
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21
Q

RSOVA (5)

A
  1. May rupture into the RA, RV, or adjacent main pulmonary artery
  2. Can cause RVOT obstruction
  3. May result in RCA dissection or compression and acute MI
  4. May compress the conduction system and cause heart block
  5. may rupture into the pericardium and cause tamponade
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22
Q

aortitis is

A

inflammation of the aortic wall caused by a broad group of conditions

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23
Q

clinical signs of “this” are nonspecific, including nonspecific pain, fever, malaise, and elevated levels of acute phase reactants

A

aortitis

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24
Q

acute aortic syndrome is

A

an overlapping of several life threatening clinical entities that include

  1. aortic dissection
  2. intramural hematoma penetrating atherosclerotic ulcer
  3. traumatic aortic rupture due to blunt deceleration trauma
  4. aortic aneurysm leak and rupture
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25
least common site for congenital aortic stenosis
congenital narrowing of the ascending ao just distal to insertion of the coronary arteries (very rare)
26
this type of supravalvular ao stenosis is associated with Williams syndrome
"hour glass" shaped
27
2 types of subvalvular obstruction
1. discrete 2. tunnel
28
3 types of supravalvular obstruction
1. hour glass 2. fibrous membrane 3. hypoplasia of descending ao
29
aortic dilation associated conditions
HTN Atherosclerosis Cystic medial necrosis Poststenoic dilation Marfans Reiters Syndrome Rheumatoid Arthritus Systemic Lupus AO dissection causes (study - compare and contrast) HTN Atherosclerosis Marfans Aging Pregnancy Trauma Iatrogenic Injury Inflammatory diseases Cocaine use Renal disease Strenuous physical exercise
30
patient suffering from atherosclerotic ulcer, aortic dissection, trauma from blunt deceleration force, aortic aneurysm and rupture... what syndrome might this be
ACUTE AORTIC SYNDROME
31
Type 1 Debakey Ao Dissection
type 1 includes ascending ao, transverse ao (aortic arch), descending ao - 70%
32
Type 2 Debakey Ao Dissection
type 2 includes ascending ao involved but stops pros to brachiocephalic (5%)
33
Type 3 Debakey Ao Dissection
type 3 includes descending ao and may extend to abdominal ao (25%)
34
Type A Stanford Ao Dissection
ascending ao
35
Type B Standford Ao Dissection
all dissections that do not include ascending ao
36
Ao Dissection caused by:
HTN Atherosclerosis Marfans Aging Pregnancy Trauma Iatrogenic Injury Inflammatory diseases Cocaine use Renal disease Strenuous physical exercise Ao dilation causes (study - compare and contrast) HTN Atherosclerosis Cystic medial necrosis Poststenoic dilation Marfans Reiters Syndrome Rheumatoid Arthritus Systemic Lupus
37
symptoms for dissecting aneurysms
most common are: excruciating pain, severe at onset, clammy, appear as though they are in shock, hypertensive, hypotensive if tamponade is present
38
In 2D findings, abnormal linear density within the aorta creates
a true and false lumen ***can be an ARTIFACT tho, so confirm in not one, but TWO different views.
39
In identifying Ao dissection, distinction from other structures needs to be. clear such as (3)
calcification arteriosclerotic plaque intracardiac monitoring lines
40
True or False! False lumen Is usually larger than true lumen?
TRUE
41
In Ao dissection, the "flap" moves toward _______ lumen in what diastole?
true
42
true lumen expands during _______ and shrinks during _______.
expands during SYSTOLE shrinks during DIASTOLE
43
______ flow in false lumen. _______ flow in true lumen.
SLOW FLOW in FALSE lumen RAPID FLOW in TRUE lumen
44
Complications associated with false lumen in Ao dissection (3)
1. compression of true aortic lumen 2. extends into other branch vessels 3. THROMBOSIS
45
An aortic wall thickness of > 15mm suggests
THROMBOSIS of the FALSE lumen!
46
Most common cause of death in Type A dissections is
tamponade
47
this type of supravalvular ao stenosis is associated with Williams syndrome
"hour glass" shaped
48
what t type of supravalvular ao stenosis can be seen in a normal sized heart?
discrete fibrous membrane
49
this type of supravalvular ao stenosis involves the origins of the brachiocephalic arteries and is also called "strand" stenosis
hypoplasia of ascending aorta
50
what are 4 characteristics of hypoplastic left heart syndrome?
1. very small aorta 2. vessel connecting aorta and pulmonary artery 3. opening between atria 4. underdeveloped left ventricle
51
this is more common in kids, coarctation of aorta... TRUE OR FALSE
TRUE
52
how many types of supravalvular ao stenosis and how many types of subvalvular obstructions
3 supravalvular ao stenosis types 2 subvalvular obstruction types
53
M-mode appearance of membranous sub aortic obstruction
coarse systolic flutter of AoV leaflets from turbulent prevalvular flow Midsystolic partial closure of valve from LVOT obstruction
54
Aortic dilation associated with what conditions
HTN Atherosclerosis Cystic medial necrosis Post stenotic dilation Marfans Reiters Lupus Rheumatoid arthritis
55
"-ectasia" means
expansion (dilation)
56
shapes of aneurysms where these numbers correlate to part of aorta (1) annulus (2) sinus of vasalva (3) sinotubular junction
3 types A) 1 and 2 (called annuloaortic ectasia) B) 1, 2, and 3 (tubular part of asc ao) C) 3 (begins at sinotubuluar)
57
most common echo finding is Ao Dissection in this syndrome
Marfans syndrome
58
When you think of Marfan's conditions, think of a house caving in on itself.
Prox ao dilation Multivalvular prolapse LA compression AI, MR Ao dissection (most common) LVVO pattern - LV dilation with hyperkinesis
59
most common type of aneurysm
atherosclerotic aneurysm 25% are thoracic (most common sites are aortic arch and descending ao) the rest are abdominal
60
describe the atherosclerotic process
1. weakening of the Ao wall 2. medial degneration 3. localized vessel dilation
61
what things contribute to the weakening of the aortic wall?
atherosclerotic process hypertension
62
strength of the Ao wall is important. why?
weak or weakening walls can llead to dilation (expansion) of the walls which can expand into eventual aneurysm
63
angiography is the standard for diagnosing aneurysms. when are aneurysms missed - even at this level of diagnosis?
when aneurysm is layered with thrombus
64
compression of surrounding structures is indicative of what
aneurysm
65
a patient with an aneurysm greater than _______ cm is at risk for rupture and symptoms of aneurysm
7 cm
66
congenital causes of aneurysm (4)
1. bicuspid aortic valve 2. connective tissue disease 3. Ehler Danlos syndrome 4. Marfans syndrome
67
Acquired causes of aneurysm (3)
1. atherosclerotic degeneration 2. iatrogenic post aortic valve surgery / cath lab 3. endocarditis
68
Which Sinus of Vasalva aneurysm can cause the most complications based on location? (5)
RSOVA 1. may rupture into the RA, LA< or adjacent main pulmonary artery 2. can cause RVOT obstruction 3. may result in RCA dissection or compression and acute MI 4. May compress conduction system and cause heart block 5. may rupture into the pericardium and cause tamponade
69
clinical presentation of SOV aneurysm varies depending on (4)
site, size, compression, and rupture
70
Physical exam and auscultation of SOV aneurysm
(auscultation) wide pulse pressure from AI long diastolic murmur (other exams) LVH on EKG CXR : cardiomegaly, signs of CHF, Unfolding of AO
71
Transcatheter repair is being used with increasing success to repair
aneurysm (SOV)
72
Aortitis can have many underlying general causes (4)
1. infection 2. noninfectious 3. radiation induced 4. idiopathic
73
4 main categories of this powerpoint
1. obstructions 2. aneurysms 3. dissection 4. trauma
74
traumatic aortic rupture due to blunt declaration trauma... one symptom of many... what syndrome am I
acute aortic syndrome this syndrome encompasses several life threatening clinical entities with overlapping features: -aortic dissection - intramural hematoma atherosclerotic ulcer - traumatic aortic rupture due to blunt declaration trauma - aortic aneurysm leak and rupture
75
complications associated with false lumen of ao dissection
1. compresses true aortic lumen 2. extends into other branch vessels 3. thrombosis (ao wall thickness >15mm suggests thrombosis of false lumen) 4. malperfusion - coronary/cerebral/spinal/limb/abdominal ischemia 5. rupture - pericardial/pleural/peritoneal space 6. tamponade (common cause of death in TYPE A dissections - asc aorta)

Fall '23 Echo (19 decks)

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