Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

42  Chapter 2 • Cardiovascular Care

Determining the Types of Aortic Aneurysms

Fusiform aneurysm

Aortic arch aneurysm

PICTURING PATHO

Direction of normal blood flow

Aortic arch

Pulsatile hematoma

Blood entering wall of artery

Blood entering wall of artery

Blood in artery

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.

Clinical Manifestations • Deep, aching back pain

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.

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