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Chapter 2
•
Cardiovascular Care
PICTURING
PATHO
Treatment
•
Small fusiform aneurysms, less
than 4.0 cm maximum diameter,
are at low risk of rupture and
should be monitored
•
Fusiform aneurysms greater than
5.4 cm in maximum diameter
should be repaired in a healthy
patient.
•
Elective repair is also reasonable
for patients that present with a
saccular aneurysm
Clinical Manifestations
•
Most AAAs do not produce any
symptoms.
•
Only 30% to 40% of aneurysms
are noted on physical examination
with detection dependent on
aneurysm size.
•
Detection is limited by truncal
obesity.
ANEURYSMS WITH GENETIC
PREDISPOSITION
Thoracic aneurysms are usually
asymptomatic and detected
incidentally of chest radiograph.
Determining the Types of Aortic Aneurysms
Aortic arch
aneurysm
Fusiform
aneurysm
Pulsatile
hematoma
Aortic
arch
Blood
entering
wall of
artery
Direction
of normal
blood
flow
Blood
entering
wall of
artery
Blood
in artery
Clinical Manifestations
•
Deep, aching back pain
Compression of respiratory structures
and of the recurrent laryngeal nerve
can cause:
•
Dyspnea
•
Hoarseness
•
Coughing
TIP:
Thoracic aneurysms that pres-
ent as rupture as the initial manifes-
tation is usually fatal.
Genetically mediated thoracic
aortic aneurysm and dissection
(TAAD) are part of a syndrome such
as Marfan syndrome, Loeys–Dietz
syndrome, vascular Ehlers–Danlos
syndrome, Turner syndrome, or
nonsyndromic, as with familial TAAD
and bicuspid aortic valve. These
TAAs tend to rupture at smaller
aortic diameters. Decision making
in patients with genetically mediated
TAAD, especially in patients younger
than 60 years old must consider the
diameter of the ascending aorta/
proximal arch but also the diameter
of the aortic root and aortic valve
function.
Ehlers–Danlos
syndrome is an
inherited connective tissue disorder
known for hyperextensibility of skin,
hypermobility of joints, easy bruising,
and arterial aneurysms. The most
common cause of death in patients
with Ehlers–Danlos syndrome is
arterial rupture.
Marfan syndrome
is an autosomal
dominant inherited disorder
affecting connective tissue. Although
the majority of patients with Marfan
syndrome have a family history of
the disease, approximately 25%
of patients represent sporadic
mutations. Characteristics of Marfan
syndrome involve the cardiovascular,
ocular, and skeletal systems. Common
presentation includes aortic
aneurysms and dissection, mitral valve
prolapse and regurgitation, ectopia
lentis, myopia, chest-wall deformities,
joint laxity, and long arms and
fingers.