Cardiology
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Pseudoaneurysm | well defined collection of blood & conn tissue outside vessel wall
🗑
|
||||
| Most common site of AAA formation: | infrarenal abdominal aorta
🗑
|
||||
| Atherosclerotic dz of aorta may produce: | stenotic obstruction or aneurysmal dilatation
🗑
|
||||
| Aneurysm types | Saccular; fusiform
🗑
|
||||
| Most common aneurysm type | Fusiform: symmetrical dilation (involves full circumference of aortic wall)
🗑
|
||||
| Aneurysm defn: | 1.5x or > the normal diameter of the vessel.
🗑
|
||||
| Aneurysm type: comparative prevalence | Abdominal (85%) > thoracic aneurysm (15%)
🗑
|
||||
| Half of newly detected AAAs are: | <5cm (& 2/3 eventually require repair)
🗑
|
||||
| AAAs usually involve: | aortic bifurcation (& often involve common iliac arteries)
🗑
|
||||
| AAA & Rupture | 80% rupture into left retroperitoneum (may contain it); remainder rupture into peritoneal cavity (=> uncontrolled hemorrhage & rapid circulatory collapse)
🗑
|
||||
| Healthy, young normal aorta: size | about 2 cm
🗑
|
||||
| Considered Aneurysm at size: | > 3 cm
🗑
|
||||
| AAAs arise in areas of: | dense athero-sclerosis, eroding & weakening the wall which leads to dilatation then rupture
🗑
|
||||
| 90% of AAAs originate where: | below renal arteries (infrarenal); 10% suprarenal
🗑
|
||||
| Infrarenal aneurysm may exhibit: | stenosis (narrowing) of aorta
🗑
|
||||
| AAA: Surgery recommended when: | >5 cm; women: appropriate at 4.5 - 5.0 cm
🗑
|
||||
| Decline of aortic elasticity & distensibility is accelerated in pts with: | HTN, hyperlipidemia, & atherosclerosis of coronaries & other arteries.
🗑
|
||||
| AAA: Risk Factors | Tobacco; Age; HTN; lipid; Atherosclerosis; Male; FH
🗑
|
||||
| FH in AAA: | 1/4 of AAA pts have first degree relative with hx of AAA
🗑
|
||||
| AAA Risk Factors for Rupture | Size (5cm female, 6 cm male); rapid progression (>1cm/yr); female; FH; unctrld HTN; SMK; COPD
🗑
|
||||
| AAA: what may prompt earlier endovasc repair? | Rapid expansion (>1 cm/yr) & pt preference (in 4.5-5.5 cm range)
🗑
|
||||
| AAA Prognosis | 80% mortality with rupture
🗑
|
||||
| Cystic medial necrosis occurs most frequently in: | ascending aorta; aortic wall weakening => fusiform aneurysm
🗑
|
||||
| Cystic medial necrosis assoc with: | conn tissue dz (Marfan, Ehlers-Danlos syndrome, RA); aortic valve replacement
🗑
|
||||
| Asc TA: Etiologies | CMN, Bicuspid valve; AI; Arteritis/ Vasculitis; Collagen vasc dz (RA, Marfan, Ehlers-Danlos, Reiter); HTN; Syphilis; Atherosclerosis
🗑
|
||||
| Desc TA: predominant cause = | atherosclerosis
🗑
|
||||
| Desc TA: called thoracoabdominal if they: | extend below level of diaphram into abd aorta
🗑
|
||||
| TAA: Tx: >5 cm | surgery (if Sx or rapid expansion: then sooner)
🗑
|
||||
| TAA: Clinical Findings | > 50% pts ASx at dx; Sx due to vascular consequence or mass effect
🗑
|
||||
| TAA: if surgery required, need: | coronary angiography
🗑
|
||||
| TAA: Inc rupture risk at smaller diameters with: | Marfan; bicuspid valve
🗑
|
||||
| TAA: Asc Aorta: surgery indicated at: | ≥ 5.5 cm (=/> 5.5)
🗑
|
||||
| TAA Marfan/ Bicuspid Valve: surgery indicated at: | ≥ 5.0 cm (=/> 5.0)
🗑
|
||||
| TAA Aortic valve replacement: surgery indicated at: | ≥ 4.0 cm (=/> 4.0)
🗑
|
||||
| TAA Desc Aorta: surgery indicated at: | ≥ 6.0 cm (=/> 6.0)
🗑
|
||||
| TAA: Prognosis | M&M higher than with AAA; 5 yr if unrepaired (>6 cm) is 20-25% (most deaths due to rupture or CAD)
🗑
|
||||
| Aortic dissection: usual direction of extension | antegrade (driven by the forward force of aortic blood flow); sometimes retrograde from site of intimal tear
🗑
|
||||
| Aortic dissection: intimal tear in aorta creates a false lumen between: | media & adventitia
🗑
|
||||
| Aortic dissection: >95% occur in the: | Ascend aorta just distal to aortic valve or just distal to left subclavian at ligamentum arteriosum
🗑
|
||||
| Aortic Dissection: Increased risk in: | pregnancy (1/4 of all female cases <40 yrs & most in last trimester); conn tissue dz (Marfan, Ehlers Danlos); Bicuspid Aortic Valve or Coarctation
🗑
|
||||
| Aortic Dissection: Debakey I = | Ascending A extending to distal
🗑
|
||||
| Aortic Dissection: Debakey II = | Ascending aorta only
🗑
|
||||
| Aortic Dissection: Debakey III = | Descending aorta only
🗑
|
||||
| Aortic Dissection: Stanford A = | Any involvement of ascending aorta
🗑
|
||||
| Aortic Dissection: Stanford B = | Not involving ascending aorta
🗑
|
||||
| Aortic Dissection: Proximal = | DeBakey Types I & II or Stanford Type A
🗑
|
||||
| Aortic Dissection: Distal = | DeBakey Type III & Stanford type B
🗑
|
||||
| Aortic Dissection: Clinical Findings | Acute: sudden, severe excruciating ripping chest pain (ascending) or scapular (descending); most hypertensive or nml
🗑
|
||||
| Aortic Dissection: PE | Increased or decreased BP; pt may be in shock; wide pulse pressure; diminished / asymmetric peripheral pulses; aortic insufficiency murmur if ascending aorta; syncope
🗑
|
||||
| Aortic Dissection: poss Sx devt | Acute aortic regurgitation (CHF indicates valve involvement); focal neuro (CVA may develop)
🗑
|
||||
| Aortic Dissection: mgmt: Type A = | Surgical repair, may require AVR
🗑
|
||||
| Aortic Dissection: mgmt: Type B = | Medical therapy (IV propranolol or nitroprusside)
🗑
|
||||
| Aortic Dissection: mgmt: All pts = | aggressive BP control; yearly imaging or if increased Sx
🗑
|
||||
| Aortic Dissection: Prognosis | Op mortality of type B 2x that of type A (bc comorbid illness); 30% have prog enlarging aneurysm that eventually req repair
🗑
|
||||
| Sudden onset ripping, tearing chest pain, diminished pulses = | Aortic dissection
🗑
|
||||
| Flank pain, hypotension, pulsatile abdominal mass = | AAA
🗑
|
||||
| RF/etiology of ascending aortic aneurysm: | CMT (cystic medial necrosis)
🗑
|
||||
| RF for TAA/AAA: | In order: tobacco, age, HTN, HLD, other atherosclerosis
🗑
|
||||
| 2 components of Aorta | thoracic (ascending, arch, descending); Abdominal
🗑
|
||||
| 3 layers of aorta: | Intima; Media; Adventitia
🗑
|
||||
| Intima: | thin, inner layer (delicate, easily traumatized)
🗑
|
||||
| Media: | thick middle layer (*strength of the aorta comes from media)
🗑
|
||||
| Adventitia: | somewhat thin outer layer (contains mainly collagen)
🗑
|
||||
| Strength of the aorta lies in: | media (= laminated, intertwining elastic tissue/ multiple layers, in a spiral manner, max tensile strength w/ distensible & elastic
🗑
|
||||
| Pseudoaneursym | well defined collection of blood & conn tissue outside vessel wall
🗑
|
||||
| Atherosclerotic vs inflammatory | inflame = extreme of atherosclerotic aneurysm
🗑
|
||||
| pathogenesis of AAAs: | multifactorial: genetic, environ, hemodynamic & immunological; Chlamydia pneumoniae?
🗑
|
||||
| Aorta most affected by atherosclerotic process: | infrarenal abdominal aorta
🗑
|
||||
| most common site of AAA formation: | infrarenal abdominal aorta
🗑
|
||||
| Atherosclerotic dz of aorta may produce: | stenotic obstrusion or aneurysmal dilatation
🗑
|
||||
| Aneurysm types | Saccular; fusiform
🗑
|
||||
| Most common aneurysm type | Fusiform
🗑
|
||||
| Has a fairly symmetrical dilation (involves full circumference of aortic wall) | Fusiform
🗑
|
||||
| More localized dilation (outpouching of a portion of aortic wall) | Saccular aneurysms
🗑
|
||||
| Flow disturbance thru the aneurysmal aortic segment: | blood may stagnate along walls, cause mural thrombus (may embolize)
🗑
|
||||
| Aneurysm defn: | 1.5x or > the normal diameter of the vessel.
🗑
|
||||
| Aneurysm type cf prevalence | Abdominal more common than thoracic aneurysm
🗑
|
||||
| Half of newly detected AAAs are: | <5cm (& 2/3 eventually require repair)
🗑
|
||||
| AAA & COPD: | COPD pts: rupture of smaller AAAs more likely
🗑
|
||||
| AAAs usually involve: | aortic bifurcation (& often involve common iliac arteries)
🗑
|
||||
| AAA & Rupture | 80% rupture into left retroperitoneum (may contain it); remainder rupture into peritoneal cavity (=> uncontrolled hemorrhage & rapid circulatory collapse)
🗑
|
||||
| Healthy, young normal aorta: size | about 2 cm
🗑
|
||||
| Considered Aneurysm at size: | > 3 cm
🗑
|
||||
| AAA Incidence in Men vs Women | 10:1
🗑
|
||||
| AAA: men over 55 | 2%
🗑
|
||||
| AAAs arise in areas of: | dense athero-sclerosis, eroding & weakening the wall which leads to dilatation then rupture
🗑
|
||||
| 90% of AAAs originate where: | below renal arteries (infrarenal); 10% suprarenal
🗑
|
||||
| Infrarenal aneurysm may exhibit: | stenosis (narrowing) of aorta
🗑
|
||||
| AAA: Surgery recommended when: | >5 cm or if growing >0.5cm in 6 months or >1cm per year
🗑
|
||||
| Decline of aortic elasticity & distensibility is accelerated in pts with: | HTN, hyperlipidemia, & atherosclerosis of coronaries & other arteries.
🗑
|
||||
| Loss of aortic elasticity | loss of elastin & increase in collagen (=> lack of distensibility)
🗑
|
||||
| AAA: Risk Factors | Tobacco; Age; HTN; lipid; Atherosclerosis; Male; FH
🗑
|
||||
| FH in AAA: | 1/4 of AAA pts have first degree relative with hx of AAA
🗑
|
||||
| Initial dx test to screen for & follow known AAA = | Abdominal US:
🗑
|
||||
| Abdominal US: advantages | 100% sensitivity, no contrast, low cost
🗑
|
||||
| AAA: CT scan | pre-op or if US indeterminate; better defines shape & location/ extent of AAA
🗑
|
||||
| AAA: Catheter aortography may: | underestimate diameter
🗑
|
||||
| AAA Risk Factors for Rupture | Size (5cm female, 6 cm male); rapid progression (>1cm/yr); female; FH; unctrld HTN; SMK; COPD
🗑
|
||||
| AAA Surveillance | Trend: bigger AAA, more frequent surveil
🗑
|
||||
| AAA: for average risk pts, a threshold of ?? cm in diameter is appropriate for elective repair | 5.5 cm
🗑
|
||||
| AAA: what may prompt earlier endovasc repair? | Rapid expansion (>1 cm/yr) & pt preference (in 4.5-5.5 cm range)
🗑
|
||||
| AAA Endovascular repair: No justification for: | endovascular repair at smaller diameters
🗑
|
||||
| AAA: for women, elective endovasc repair is appropriate at: | 4.5 or 5.0 cm
🗑
|
||||
| AAA Prognosis | 80% mortality with rupture
🗑
|
||||
| AAA mgmt: | Risk factor mod (stop SMK, aggressive HTN & Lipid Rx), med mgmt to slow progression
🗑
|
||||
| AAA operative mortality: | Elective = 2-5%, Expanding = 5-15%, Ruptured: >50%
🗑
|
||||
| Criteria for Endovascular Repair: Proximal neck: | length: min 15 mm; diameter: max 28 mm; angulation: <60 degrees
🗑
|
||||
| Criteria for Endovascular Repair: Iliac arteries | Common iliac a.: variable diameters; ext iliac a. <7 mm
🗑
|
||||
| USPSTF Screening Guidelines for AAA: repair what in who? | large AAA (> 5.5 cm) in men btw 65-75 w/ Hx of SMK; No gdln for men 65-75 no hx SMK; gdln against screen in women
🗑
|
||||
| USPSTF AAA Screen Consensus stmt | All M 60-85; All F 60-85 w/ 1 or more CVD risk factor; M&F > 50 w/ FH AAA
🗑
|
||||
| Thoracic aneurysm: prevalence | Far less common than AAAs
🗑
|
||||
| Thoracic aneurysm: classified by: | pt of aorta involved ( ascending, arch or descending TA)
🗑
|
||||
| Thoracoabdominal AA = | desc TA extends distally to involve AA
🗑
|
||||
| TAA: prevalence | Less common than AAA w/ diff pathogenesis; 60% = aortic root & ascend A; 40% desc A; 10% arch
🗑
|
||||
| Sm mx cell drop out & elastic fiber degen w/ media of cystic spaces filled w/ mucoid matl = | Cystic medial necrosis
🗑
|
||||
| Cystic medial necrosis occurs most frequently in: | ascending aorta
🗑
|
||||
| Cystic medial necrosis leads to: | aortic wall weakening => fusiform aneurysm
🗑
|
||||
| Aneurysm from cystic medial necrosis often involve: | aortic root & may consequently result in AI
🗑
|
||||
| CMN is accelerated by: | HTN (occurs somewhat w/ aging)
🗑
|
||||
| CMN assoc with: | conn tissue dz (Marfan, Ehlers-Danlos syndrome, RA); aortic valve replacement
🗑
|
||||
| Ascending TA: Etiologies | CMN, Bicuspid valve; AI; Arteritis/ Vasculitis; Collagen vasc dz (RA, Marfan, Ehlers-Danlos, Reiter); HTN; Syphilis; Atherosclerosis
🗑
|
||||
| Ascending aneurysms usually caused by: | CMN
🗑
|
||||
| If Asc aneurysm due to atherosclerosis, assoc with: | diffuse aortic atherosclerosis
🗑
|
||||
| Aortic Arch aneurysms often contiguous with: | aneurysms of asc OR desc A & can be caused by any of the etiologies above.
🗑
|
||||
| Desc TA: predominant cause = | atherosclerosis
🗑
|
||||
| Desc TA: tend to originate: | just distal to origin of L subclavian; may be fusiform or accular
🗑
|
||||
| Aortic Arch Aneurysm: Etiologies | Ext of Asc or Desc aneurysms; Hx trauma or deceleration injury
🗑
|
||||
| Desc TA: called thoracoabdominal if they: | extend below level of diaphram into abd aorta
🗑
|
||||
| TAA: Spontaneous rupture prevalence | less common than AAA (bc inc of Sx due to compression of surrounding structures)
🗑
|
||||
| TAA: Tx: >5 cm | surgery (if Sx or rapid expansion: then sooner)
🗑
|
||||
| Sx pts or w/ AI: | Inc incidence of rupture
🗑
|
||||
| TAA: Clinical Findings | > 50% pts ASx at dx; Sx due to vascular consequence or mass effect
🗑
|
||||
| TAA: Vascular Sx | AI with CHF, or thromboembolism causing stroke, lower extremity or mesenteric ischemia, renal infarct
🗑
|
||||
| TAA: Mass Effect | SVC syndrome, tracheal deviation, cough, hemoptysis, dysphagia, hoarseness
🗑
|
||||
| Ascending or arch An can cause compression of: | SVC or innominate v. => obstruction of venous return
🗑
|
||||
| Desc/ arch An: may cause compression of: | trachea or main stem bronchus => tracheal deviation, wheezing, cough & positional dyspnea, hemoptysis or recurrent pneumonitis
🗑
|
||||
| Desc/ arch An: Compression of esophagus can cause: | dysphagia & compression of recurrent laryngeal n. can cause hoarseness
🗑
|
||||
| TAA: Clinical Findings | Pain ( 25% pts) from direct compression of intrathoracic structures or chest wall; substernal or in back/ neck; steady, deep & severe?
🗑
|
||||
| TAA Rupture: | excruciating pain; may be assoc w/ aortic dissection
🗑
|
||||
| Rupture occurs most commonly into: | L intrapleural space or mediastinum; results in severe hypotension
🗑
|
||||
| Desc An rupture into: | adjacent esophagus => life threatening hematemesis
🗑
|
||||
| TAA Evaluation | CXR (only rule in, cannot R/O); Echo (TTE vs TEE); CT/ MRI
🗑
|
||||
| TAA: Pos CXR: | Must differentiate from anterior mediastinal mass (ie thymoma, lung CA)
🗑
|
||||
| TAA: if surgery required, need: | coronary angiography
🗑
|
||||
| Echo: TTE vx TEE | TTE only good to visualize aortic root (good for Marfan); TEE to visualize entire aorta, but is semi invasive (CT/ MRI better)
🗑
|
||||
| TAA Mgmt: major factors in rupture risk | Size & rate of growth
🗑
|
||||
| TAA Mgmt: Annual growth rate for <5cm aneurysm | 2%
🗑
|
||||
| TAA Mgmt: Annual growth rate for 5-5.9 cm | 3%
🗑
|
||||
| TAA Mgmt: Annual growth rate for >6 cm | 7%
🗑
|
||||
| TAA: Inc rupture risk at smaller diameters with: | Marfan; bicuspid valve
🗑
|
||||
| Asc Aorta: surgery indicated at: | ≥ 5.5 cm (=/> 5.5)
🗑
|
||||
| Marfan/ Bicuspid Valve: surgery indicated at: | ≥ 5.0 cm (=/> 5.0)
🗑
|
||||
| Aortic valve replacement: surgery indicated at: | ≥ 4.0 cm (=/> 4.0)
🗑
|
||||
| Desc Aorta: surgery indicated at: | ≥ 6.0 cm (=/> 6.0)
🗑
|
||||
| Aortic Root Replacement: Bentall: | Dacron graft w/ prosthetic valve sewn directly into aortic annulus; coronary arteries reimplanted into the graft (op mortality risk 5%)
🗑
|
||||
| Aortic Root Replacement: David = | valve sparing Bentall (re-implant native valve within dacron graft)
🗑
|
||||
| TAA: Prognosis | M&M higher than with AAA; 5 yr if unrepaired (>6 cm) is 20-25% (most deaths due to rupture or CAD)
🗑
|
||||
| TAA: 1 month op mortality = | 8-20%
🗑
|
||||
| TAA: operative complications | pulmo comps & damage to laryngeal or phrenic n., carotid or subclavian a. poss
🗑
|
||||
| Tear in aortic intima usu preceded by medial wall degen/ CMN = | aortic dissection
🗑
|
||||
| Aortic dissection: intimal tear in aorta creates a false lumen between: | media & adventitia
🗑
|
||||
| Aortic dissection: time course | May be acute or chronic
🗑
|
||||
| Aortic dissection: >95% occur in the: | Ascend aorta just distal to aortic valve or just distal to L subclavian at lig arteriosum
🗑
|
||||
| Intimal tears resulting in dissection: prevalence: | 65% Ascend A; 20% Desc A; 10% A Arch; 5% Abd A.
🗑
|
||||
| Aortic Dissection incidence | 3/100,00/year (7,000 cases/year in US); most common in 6th-8th decade; M>F 2:1 2:1
🗑
|
||||
| Aortic Dissection: Increased risk in: | pregnancy (1/4 of all female cases <40 yrs & most in last trimester); conn tissue dz (Marfan, Ehlers Danlos); Bicuspid Aortic Valve or Coarctation
🗑
|
||||
| Aortic Dissection: 80% of pts are: | Hypertensive
🗑
|
||||
| Aortic Dissection: Clinical Findings | Acute: sudden, severe excruciating ripping chest pain (ascending) or scapular (descending); most hypertensive or nml
🗑
|
||||
| Aortic Dissection: poss Sx devt | Acute aortic regurgitation (CHF indicates valve involvement); focal neuro (CVA may develop)
🗑
|
||||
| Aortic Dissection Eval: CXR = | wide mediastinum, poss L sided pleural effusion
🗑
|
||||
| Aortic Dissection Eval: Echo = | 98% sensitive, 99% specific, +/- pericardial effusion
🗑
|
||||
| Aortic Dissection Eval: CT helpful in: | acute presentation
🗑
|
||||
| Aortic Dissection Eval: MRA/MRI useful for: | serial follow up
🗑
|
||||
| Aortic Dissection Eval: EKG = | LVH, nonspecific or inferior abnormalities (dissections preferentially extend into Right coronary ostium)
🗑
|
||||
| Aortic dissection: CXR = | Wide aortic silhouette & mediastinum; Left pleural effusion; 10%-20% normal
🗑
|
||||
| Aortic Dissection: mgmt: Type A = | Surgical repair, may require AVR
🗑
|
||||
| Aortic Dissection: mgmt: Type B = | Medical therapy
🗑
|
||||
| Aortic Dissection: mgmt: Type B: Exceptions to med tx: | Rupture, Limb/ visceral ischemia, Saccular morphology, ongoing pain, uncontrolled HTN, Marfan, AI
🗑
|
||||
| Aortic Dissection: mgmt: Chronic & asymptomatic = | medical Rx
🗑
|
||||
| Aortic Dissection: mgmt: All pts = | aggressive BP control; yearly imaging or if increased Sx
🗑
|
||||
| Aortic Dissection: Prognosis | Op mortality of type B 2x that of type A (bc comorbid illness)
🗑
|
||||
| Aortic Dissection: 5 yr survival: repaired Type A = | 70-80% repaired type A
🗑
|
||||
| Aortic Dissection: 5 yr survival: repaired Type B = | 50-70% repaired type B
🗑
|
||||
| Aortic Dissection: Prognosis: chronic type B | 30% => progressively enlarging aneurysm that eventually requires repair
🗑
|
||||
| Aortic aneurysm etiologies = | atherosclerosis (most common); Marfan (esp TAA); aortitis (mycotic, salmonella, syphilis, other infxn), giant cell arteritis
🗑
|
||||
| Complications of aortic aneurysm | rupture (esp if >5.5cm); thromboembolism; distal ischemia
🗑
|
||||
| Aortic aneurysm dx studies | U/S; CT; aortography (used before surgery); CXR (to show calcifications)
🗑
|
||||
| Aortic dissection etiologies: | HTN; Marfan; cystic medial necrosis; iatrogenic comp of cath
🗑
|
||||
| Aortic dissection pathophysiology | intimal tear with formation of false channel in media by hematoma
🗑
|
||||
| Aortic dissection on CXR = | wide superior mediastinum; displaced trachea; L pleural effusion; enlarged aortic knob
🗑
|
||||
| Which medication (ACE, diuretic, CCB, sotalol) will decrease morbidity of patient with AAA? | Sotalol
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets