{"id":9640,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/aortic-aneurysms-aortic-dissection\/"},"modified":"2022-01-04T01:50:45","modified_gmt":"2022-01-03T23:50:45","slug":"aortic-aneurysms-aortic-dissection","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/aortic-aneurysms-aortic-dissection\/","title":{"rendered":"Aortic aneurysms. Aortic dissection"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Aortic aneurysms<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Aortic aneurysms are dilations in the aorta caused due to the weakening of the vessel wall.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Classified as either <strong>true<\/strong> and <strong>false<\/strong> (&#8220;pseudoaneurysm&#8221;). Their shape can be <strong>fusiform<\/strong> or <strong>saccular<\/strong>.<ul><li>True aneurysms involve all three layers of the vessel wall.<\/li><li>False aneurysms are wall defects that essentially form a hematoma contained within the connective tissue around the vessel.<\/li><\/ul><\/li><li>The locations at which aortic aneurysms can appear are the <strong>thoracic aorta<\/strong>, and the <strong>abdominal aorta<\/strong>.<ul><li>Thoracic aorta aneurysms are commonly associated with HTN.<\/li><li>Abdominal aorta aneurysms are commonly associated with atherosclerosis, between the renal arteries and iliac bifurcation.<\/li><\/ul><\/li><li>Important contributing factors include HTN, and atherosclerosis. Other factors include:<ul><li>Infections<\/li><li>Trauma<\/li><li>Connective tissue diseases<\/li><\/ul><\/li><li>Aneurysms are usually asymptomatic, but they may cause pain, ischemia, thrombosis, and may progress to dissection or rupture (fatal).<ul><li>Thoracic aorta aneurysms may compress nearby organs, leading to coughing, breathing and swallowing difficulties.<\/li><\/ul><ul><li>Ruptured aneurysms are fatal; a triad of <strong>sudden hypotension<\/strong>, <strong>pain<\/strong>, and <strong>palpable pulsatile mass<\/strong> suggest rupture and should operated on without delay.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Pathomechanism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Inadequate\/abnormal CT synthesis or repair (connective tissue diseases)<\/li><li>Excessive CT degredation<\/li><li>Degeneration of smooth muscle in the tunica media<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Physical examination.<\/strong> Abdominal pulsatile mass (in abdominal aorta anuerysm).<\/li><li>Ultrasound<\/li><li>CT scan<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Ruptured aneurysms require urgent surgical repair<\/li><li>Unruptured aneurysms<ul><li>If large (>5cm), elective surgical resection with graft placement<\/li><li>If small (&lt;5cm), watchful waiting<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Aortic dissection<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Dissection is the splicing of the layers of the vessel wall, forming a blood channel.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It typically appears in two groups of patients:<ul><li>Older adult men with HTN (90% of cases)<\/li><li>Young adults with connective tissue disease<\/li><\/ul><\/li><li>Presents with a sudden, severe pain in the anterior\/posterior chest, sweating, hyper\/hypotension, altered mental status (due to compression of the carotids), hemiplegia<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Contributing factors<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Hypertension<\/li><li>Atherosclerosis<\/li><li>Previous aneurysm<\/li><li>Trauma<\/li><li>Iatrogenic<\/li><li>Cocaine abuse<\/li><li>Pregnancy-related<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Classified based on the location of the dissection, based on Stanford (type A\/B) and DeBakey (type I-III).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Type A<\/strong> (proximal, worse prognosis)<ul><li><strong>DeBakey type I<\/strong> involves the entire ascending, arch, thoracic, and abdominal aorta<\/li><li><strong>DeBakey type II<\/strong> involves the ascending aorta only<\/li><\/ul><\/li><li><strong>Type B <\/strong>(distal) also known as <strong>DeBakey type III<\/strong>, involve the descending aorta only<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Physical examination. <\/strong>BP differences between the limbs, mid-diastolic murmur (aortic regurgitation)<\/li><li><strong>X-ray.<\/strong> Widened mediastinum.<\/li><li>Ultrasound<\/li><li>CT angiography<\/li><li>MRI<\/li><li>Aortic angiography (no longer in use)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Admit to ICU<\/li><li><strong>Type A dissections require surgical repair<\/strong><ul><li>IV labetalol to reduce CO and lower BP<\/li><li>Perform surgical repair<\/li><\/ul><\/li><li><strong>Type B dissections usually do not require surgical repair<\/strong><ul><li>Antihypertensive (&#8220;anti-impulse&#8221;) therapy to lower the BP (BB, ACEi\/ARB, CCB)<\/li><li>Pain control (morphine)<\/li><\/ul><\/li><li>Avoid hydralazine as it increases shear stress<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Aortic aneurysms<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pathomechanism<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Aortic dissection<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Contributing factors<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Aortic aneurysms Aortic aneurysms are dilations in the aorta caused due to the weakening of the vessel wall. Classified as either true and false (&#8220;pseudoaneurysm&#8221;). Their shape can be fusiform or saccular. True aneurysms involve all three layers of the vessel wall. False aneurysms are wall defects that essentially form a hematoma contained within the [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":23,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9640","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Aortic aneurysms. 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