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Aortic dissections and aneurysms
Clin Med-CV test 2
Terms in this set (33)
A pt presents to the ER w/ a searing chest pain that radiates to the back. Upon physical examination you find that the pt is hypertensive and there is a pulse discrepancy in the extremities. A chest x-ray shows a widened mediastinum. What is your diagnosis?
aortic dissection-this is an EMERGENCY
What is the test of choice for aortic dissection?
CT-get chest and abdomen view
If an aortic dissection occurs proximal to the left subclavian artery, what type of dissection do they have?
Where does the aortic dissection occur in a type B dissection?
proximal descending thoracic aorta
What type of aortic dissection has a worse prognosis?
What is aortic dissection commonly misdiagnosed as?
MI and PE
What is the 1st thing that should be done for aortic dissection?
aggressively decrease BP-->ß blocker (labetalol, esmolol) may add nitroprusside; morphine for pain
Treatment for type A dissections
surgery to replace the diseased arch
treatment for type B dissections
urgent surgery if there is aortic branch compromise causing malperfusion of the renal, visceral, rupture or branch occlusion
Prognosis in type B who do not have surgery
if BP can be controlled quickly and survive the episode they generally have long-term survival and are monitored by yearly CTs
Who is at increased risk for aortic dissection?
pregnant women, those w/ bicuspid aortic valve and coarctation
In what sex do abdominal aortic aneurysms (AAA) occur most in?
mostly men (8:1)
What is the normal aorta diameter?
What is the diameter of an aorta w/ an aneurysm?
When is a pt w/ AAA at an increased risk for rupture?
Which has a better prognosis, an AAA that ruptures into the retoperitoneal space or one that ruptures into the free peritoneum?
one that ruptures into the retroperitoneal space bc there is a possibility of a tamponade which can buy the pt some time
Tx for AAA
pts w/ AAA>5.5 cm, those that have expanded ≥5 mm in 6 months or those w/ pain or tenderness should have surgery
Risks of surgery in AAA
Up to 10% of pts who have an open repair have an MI however, long term survival is similar to those w/ endovascular repair
What is the downside of endovascular repair of AAA?
they require more repeat interventions
Prognosis for AAA
50% who arrive at ED will die
Sxs of AAA
usually none until rupture
Sxs of AAA in not asymptomatic?
severe abdominal pain that radiates to the back, "ripping, tearing pain"
Screening for AAA
abdominal ultrasound is preferred, CT is more reliable
What are most thoracic aneurysms caused by?
What is a rare cause of thoracic aneurysms?
syphilis, connective tissue disorders
What will an xray show if a pt has a thoracic aneurysm?
What is the test of choice in thoracic aneurysm?
SXS of thoracic aorta rupture?
sudden onset of chest pain that radiates to the back
Who gets surgical repair w/ thoracic aortic aneurysm?
What type of procedure is done on pts w/ descending thoracic aorta aneurysm?
What type of procedure is done on pts w/ arch aneurysm?
open repair-there is substantial risk of stroke, neuro injury and intellectual impairment
Why is there so much risk of neurologic complications w/ aortic arch aneurysm repair?
blood flow to the brain is likely to be compromised during surgery
What is the prognosis for thoracic aorta aneurysm rupture?
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