Def. of aneurysm
abnl vessel dilation 1.5-2 times normal size/ greater than 50% enlargement
def of dissection
tear in vessel wall creating a true and false lumen
risk factors for atherosclerotic aneurysms
tobacco and hypertension
sxs of thoracic aortic aneurysm
compression, pain, hoarseness, valve regurg
repair of thoracic AA
- ascending/arch=sternotomy and surgical repair
- descending=left thoracotomy and surgical repair or endovascular repair/graft
debakey classification
type1-entire aorta
type2-only ascending
type3-only descending
signs/sxs of aortic dissection
chest pain, back pain (b/t shoulder blades), HYPERtension, transient or permanent neuro changes, distal ischemia, acute cardiac failure, widened mediastinum, pleural capping/effusion; rupture=HYPOtension and shock
triad of aortic dissection
abrupt onset of thoracic/abd pain, mediastinal +/- aortic widening on CXR, HYPERtension +/- discrepant BP
gold standard imaging for aortic dissection
spiral CT
tx of aortic dissection
beta blockers (esmolol) then add vasodilators (Nipride), decrease systolic BP to 100-120, decrease LVP, pain control
tx of type A (proximal) aortic dissection
emergent surgery
complications of type A (proximal) aortic dissection
aortic rupture, cardiac tamponade, acute aortic regurg, acute coronary ischemia
tx of type B (descending aorta) aortic dissection
uncomplicated-medical therapy
complicated-surgery or endovascular tx
AAA rupture sxs/signs
abdominal pain, pulsatile abd mass, tenderness, and HYPOtension
constellation of ruptured/symptomatic AAA
flank/back pain, HD instablity, pulsatile abdominal mass
tx of ruptured/symptomatic AAA
ABC, T&C for 10U of PRBCs, U/S, pain control, EKG, go to OR!
cause of thoracic aortic transection
rapid deceleration from MVA
clinical clue of thoracic aortic transection
respond to fluid->hypotension->respond to fluids->hypotension
dx of thoracic aortic transection
CXR then CT
- “funny-looking mediastinum”
- blurred aortic knob
- widened mediastinum
- 2nd rib fracture
- pleural effusion
- apical cappin
pts with thoracic aortic transection are at a high risk for what
paraplegia (artery of adamkiewicz)
causes of myocardial contusion
MVA, falls, car vs peds, direct chest trauma
sxs of myocardial contusion
similar to MI, chest pain, N/V, SOB
most common compartments of heart involved in myocardial contusion
RV and RA
dx of myocardial contusion
serial EKG, tele monitoring, serial enzymes (troponin), echo
acute VSD seen on what day
post-MI day 2-5
most common location of MI a/w acute VSD
transmural anterolateral MI
murmur heard with acute VSD
harsh holosystolic murmur +/- thrill
dx of acute VSD
Echo wtih color flow
tx of acute VSD
urgent surgical repair
timeframe for acute mitral regurg
13 hours up to 5-7 days post MI
most common involvement of acute mitral regurg.
posteromedial papillary muscle rupture
murmur heard with acute mitral regurg
pansystolic
tx of acute mitral regurg
afterload reduction and surgery
vessels commonly used in CABG
LIMA and saphenous vein
most common arrhythmia to develop following CABG
a fib
causes of acute mesenteric ischemia
arterial embolism, arterial thrombus, venous thrombus, non-occlusive etiologies
triad of SMA embolism
GI empyting, abdominal pain, underlying cardiac disease
non specific labs that are helpful in dx acute mesenteric ischemia
leukocytosis, increased D-dimer, increased lactate
dx of acute mesenteric ischemia
CT scan +/- angio
tx of acute mesenteric ischemia
ABC, cardiac monitor, O2, IV access, abx, pain control; papaverine infusion, surgical embolecctomy, intraarterial thrombolysis
presentation of mesenteric venous thrombosis (MVT)
acute, subacute, or chronic; acute presents with abd pain that is severe in the mid abdomen and out of proportion to physical signs
presentation of aorto-iliac occlusive disease
neuro deficit including paralysis, absent femoral pulses
tx of aorto-iliac occlusive ds
aorto-bifemoral bypass
what is blue toe syndrome
cool, painful, cyanotic toe with preserved pulses; result of embolic occlusion; Bil. involvement indicates an embolic source that is located above the aortic bifurcation
most common cause of acute limb ischemia
embolism
6 P’s of acute obstruction
same as compartment syndrome
pain, pallor, paresthesia, paralysis, pokilothermia, pulselessness
tx of acute obstruction
heparin, endovascular thrombolytics, percutaneous removal, etc
-watch for reperfusion phenomenon and for compartment syndrome
