Vascular Disorders

Question 1

What is an aortic aneurysm?

Answer 1

An aortic aneurysm is a weakness and subsequent dilation of the vessel wall, usually caused by a genetic defect or atherosclerotic damage to the intima

Question 2

What is the most common type of aortic aneurysm?

Answer 2

Abdominal aorta is the most common site (90% below the renal artery)

Question 3

What are the risk factors for an aortic aneurysm?

Answer 3

age, smoking, hyperlipidemia and HTN

Question 4

What are the clinical findings of an aortic aneurysm?

Answer 4

May have hypo-epigastric of low back pain that is characterized as a steady gnawing pain.

Question 5

What do we find on physical exam in a patient with an AAA?

Answer 5

Pulsatile abdominal mass

Question 6

What is the diagnostic test of choice for an AAA?

Answer 6

US

Question 7

How do we treat an aortic aneurysm?

Answer 7

• Screen every 6 mo. (aneurysms > 4cm)

- Surgery (aneurysms > 5 cm) – the only effective treatment is endovascular or open surgical repair

Question 8

What is an aortic dissection?

Answer 8

Tear in the intimal layer with blood entering the media

Question 9

Where do most aortic dissections occur?

Answer 9

Majority occur in the ascending aorta within several cm of the valve (65%)

Question 10

What are the clinical findings for an aortic dissection?

Answer 10

• Severe chest pain 75-90% of cases

- Sudden onset, severe at inception; ripping/tearing/stabbing pain

Question 11

What are the physical exam findings in a patient with an aortic dissection?

Answer 11

• HTN
• Differences of > 20 mm Hg in BP between arms
• Pulse deficits
• Murmur of aortic regurgitation

Question 12

What is the diagnostic test of choice for an aortic dissection?

Answer 12

MRI

Question 13

What is the treatment for an aortic dissection?

Answer 13

• Untreated mortality about 1% per hour
• Monitor BP, rhythm, and urine output
• Start 2 large bore IVs
• Beta blockers to reduce contractility
• Morphine to treat chest pain
• Surgical consultation

Question 14

What is an arterial embolism?

Answer 14

A cause of arterial insufficiency, an arterial embolism is a sudden interruption of blood flow to an organ or body part due to a clot (embolus)

Question 15

What are the clinical and physical exam findings for a patient with an arterial embolism?

Answer 15

Severe pain, cold limbs, diminished pulses, cyanosis

5 P’s: Pain, Pallor, Pulseless, Parasthesias and Paralysis

Question 16

What is the diagnostic modality of choice in a patient with an arterial embolism?

Answer 16

Echo and arterialgram

Question 17

How do we treat an arterial embolism?

Answer 17

Heparin and embolectomy