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Questions and Answers
What is a common symptom associated with Type B aortic dissection?
Which of the following is a risk factor for aortic dissection?
What is a possible neurological finding in cases of aortic dissection?
What does asymmetric blood pressure indicate during a physical exam for aortic dissection?
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Which imaging finding is commonly associated with aortic dissection on chest X-ray?
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What is a key characteristic of atherosclerosis?
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Which of the following is NOT a type of arteriosclerosis?
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Which risk factor is most associated with developing metabolic syndrome?
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What condition is characterized by resistance to insulin and can lead to type 2 diabetes?
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Which of the following factors is a major risk factor for atherosclerosis?
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What is the main consequence of hyperlipidemia in the context of atherosclerosis?
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Which statement about Moenckberg medial calcific sclerosis is true?
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Which of the following traits is NOT included in the NCEP ATP III criteria for metabolic syndrome?
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What waist circumference defines abdominal obesity in men?
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Which of the following conditions is a significant risk factor for aortic dissection?
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Which type of aortic dissection involves the ascending aorta?
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What is the primary intervention for suprarenal or juxtarenal aneurysms?
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What percentage of aortic dissections are classified as Type B?
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Which of the following symptoms is most commonly associated with aortic dissection?
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What is a significant complication associated with endovascular repair (EVAR) of AAA?
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What is the primary role of B-blockers in the management of AAA?
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Which imaging modality is most commonly used as a first-line study for hemodynamically stable patients in the emergency department?
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What is the primary goal of medical management for acute descending dissection (Type B) without complications?
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Elevated ESR and CRP levels are indicative of which condition?
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What should be done regarding temporal artery biopsy in a patient with a high likelihood of Giant Cell Arteritis?
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Which of the following symptoms is most commonly associated with Giant Cell Arteritis?
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Which medication is typically used first in managing an acute descending dissection (Type B)?
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What is a potential complication of using vasodilators alone in the treatment of aortic dissection?
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What type of inflammation is usually found in a temporal artery biopsy of a patient suspected of having Giant Cell Arteritis?
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Study Notes
Atherosclerosis
- Atherosclerosis is hardening of the arteries and the most common cause of Coronary Artery Disease (CAD).
- It affects the coronary, cerebral, and peripheral arteries.
- Arteriosclerosis is a broader term that encompasses all types of lesions that lead to artery hardening, stiffening, and loss of elasticity.
- Moenckberg medial calcific sclerosis affects small to medium arteries.
- Arteriolosclerosis is the calcification of small arteries and arterioles, leading to systemic hypertension.
Risk Factors for Atherosclerosis
- Advancing age and male sex are risk factors.
- Other risk factors include family history of premature CAD, hypertension, hyperlipidemia (elevated LDL/low HDL), diabetes mellitus II, metabolic syndrome, smoking, lack of physical activity, poor diet, obesity, and lack of sleep.
Metabolic Syndrome
- It is characterized by abdominal obesity, insulin resistance, hyperinsulinemia, hyperglycemia, and abnormal lipid profile.
- It is associated with vascular endothelial dysfunction, hypertension, and vascular inflammation, contributing to the development of atherosclerotic cardiovascular disease.
Aortic Aneurysm
- An aneurysm is a localized dilation of an artery.
- Aortic aneurysms are most commonly found in the abdominal aorta.
- Patients may be asymptomatic.
- Symptomatic patients often experience back pain or abdominal pain.
- Open repair or endovascular repair (EVAR) are treatment options.
- Open repair is often necessary for suprarenal or juxtarenal aneurysms.
- EVAR is associated with a greater need for repeated interventions, endoleak, device failure, and postimplantation syndrome.
- Beta-blockers are used to reduce shearing forces, decrease expansion, and rupture risk.
Aortic Dissection
- It is a life-threatening condition where blood from the vessel lumen passes through a tear in the intima to the medial layer.
- It is often caused by factors that interfere with the integrity of the medial layer, such as hypertension, aging, medial degeneration from genetic disorders, or trauma.
- There are two types:
- Type A: involves the ascending aorta and/or aortic arch.
- Type B: does not involve the ascending aorta or arch, and is confined to the descending thoracic aorta and abdominal aorta.
Aortic Dissection Symptoms
- Chest or back pain is the most common symptom.
- Pain can be sudden onset, severe, and sharp, like tearing or ripping.
- Type A dissection may present with more anterior chest pain.
- Type B dissection may present with more back, abdomen, or interscapular pain.
- Pain may migrate with the progression of the dissection.
- Other symptoms may include abdominal pain, neurological findings (limb weakness or paresthesias), syncope, acute coronary syndrome (ACS), congestive heart failure (CHF), and stroke (CVA).
Aortic Dissection Physical Exam
- Blood pressure may be hypertensive (more common in Type B) or hypotensive (ascending aorta).
- There may be pulse variation, which can be assessed by taking blood pressure in both arms, with a difference of greater than 20 mmHg considered abnormal.
- New onset aortic regurgitation may occur in ascending dissections, presenting as a blowing diastolic decrescendo murmur.
- Neurological deficits can occur in 20% of cases, including stroke, altered mental status, acute paraplegia, Horner's syndrome, and hoarseness.
Aortic Dissection Initial Evaluation
- Electrocardiogram (ECG) is used to rule out myocardial infarction (MI), as Type A dissection can cause coronary ischemia.
- Chest x-ray (CXR) may show widening of the mediastinum or widened aortic silhouette, but can be normal in 10% of cases.
- CT angiography (CTA), transesophageal echocardiogram (TEE), and magnetic resonance (MR) angiography are first-line imaging modalities.
- CTA is most commonly used in the emergency department for hemodynamically stable patients.
- TEE is used at bedside or in the operating room for hemodynamically unstable patients, those with impaired renal function, contrast allergy, or strong suspicion of ascending dissection.
Aortic Dissection Management
- Surgical management is used for acute proximal (Stanford Type A) dissections or acute distal (Type B) dissections with complications, such as ischemia, progression, or impending rupture.
- Preoperative blood pressure control is essential, with a target systolic blood pressure of 100-120 mmHg.
- Beta-blockers, such as esmolol or labetalol, are used to decrease systolic blood pressure, heart rate, and aortic wall stress.
- Vasodilators, such as nitroprusside or nicardipine, may be added after beta-blockers to reach the target blood pressure if additional therapy is needed, but should not be used alone or before beta-blockers as they can cause reflex tachycardia.
Giant Cell (Temporal) Arteritis
- It is a large-vessel vasculitis that affects the temporal artery and other branches of the carotid artery system.
- It is more common in individuals over 50 years old, particularly in women and of Northeastern European and Caucasian descent.
- Smoking is a risk factor.
Giant Cell Arteritis Symptoms
- New onset headache or a change in baseline headache is the most common symptom, often temporal in location, with associated scalp tenderness while combing hair.
- Jaw claudication (exertional ischemia) can cause mandibular pain, monocular vision loss, diplopia, and amaurosis fugax.
- Abnormal superficial temporal artery may present with absent or decreased pulsation, local tenderness to palpation (including scalp tenderness), erythema, nodularity, or thickening.
- Constitutional Symptoms: nonspecific and include fever, fatigue, weight loss, loss of appetite, and malaise.
Giant Cell Arteritis Diagnosis
- Elevated ESR & CRP are hallmarks of GCA, along with normocytic, normochromic anemia.
- Temporal artery biopsy is the criterion standard, revealing mononuclear cell infiltration or granulomatous inflammation, or multinucleated giant cells.
- Prompt treatment with systemic glucocorticoids is crucial to prevent vision loss and suppress disease activity.
- Do not delay treatment pending biopsy results, as delays increase the risk of complications, such as vision loss.
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Description
This quiz covers the topic of atherosclerosis, including its definition, effects on arteries, and the different types of arterial hardening. Additionally, it explores the risk factors associated with the condition, such as age, gender, and lifestyle choices. Test your knowledge on this crucial health issue.
