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Aortic aneurysm and dissection for NP

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Aortic aneurysm and aortic dissection for the Nurse Practitioner Licensing Exam
Aortic Aneurysm
  • Definition:
    • An aortic aneurysm is an abnormal dilation of the aorta, classified by location as thoracic aortic aneurysm (TAA) or abdominal aortic aneurysm (AAA).
    • AAA, located below the renal arteries, is the most common form.
  • Risk Factors:
    • Advanced age, male gender, smoking (strongest modifiable risk factor), and hypertension.
    • Genetic conditions, such as Marfan syndrome and Ehlers-Danlos syndrome, increase risk, especially for TAA.
  • Clinical Presentation:
    • Asymptomatic: Many AAAs are found incidentally.
    • Symptoms (if present): Back or abdominal pain; a pulsatile abdominal mass may indicate AAA.
  • Diagnosis:
    • Ultrasound: First-line for AAA screening and diagnosis.
    • CT Angiography (CTA): Used for preoperative planning or assessing suspected rupture.
  • Management:
    • Surveillance: Regular imaging for smaller aneurysms.
    • Surgical Repair: Indicated for AAA >5.5 cm or rapid growth (>0.5 cm/year).
    • Medical: Smoking cessation, blood pressure control, often with beta-blockers.
Aortic Dissection
  • Definition:
    • Aortic dissection involves a tear in the aortic intima, allowing blood to create a false lumen between vessel layers.
  • Classification:
    • Stanford Type A: Involves the ascending aorta; requires surgery.
    • Stanford Type B: Involves only the descending aorta; usually managed medically unless complications arise.
Types of aortic dissection
  • Clinical Presentation:
    • Classic Symptom: Sudden, severe, “tearing” chest or back pain.
    • Type A Complications: Risk of cardiac tamponade, aortic regurgitation.
    • Type B Complications: Possible malperfusion affecting organs or limbs.
  • Diagnosis:
    • CT Angiography (CTA): Preferred for acute settings.
    • Transesophageal Echocardiography (TEE): Used in hemodynamically unstable patients.
  • Management:
    • Type A Dissection: Immediate surgery to prevent fatal complications.
    • Type B Dissection: Blood pressure control with beta-blockers; endovascular repair if complications develop.
Key Points
  • Aortic Aneurysm:
    • Commonly found in the abdominal aorta (AAA), with risk factors including smoking, hypertension, and age.
    • Surveillance for small aneurysms; surgery for those >5.5 cm or rapidly expanding.
  • Aortic Dissection:
    • Life-threatening emergency with sudden chest or back pain, classified as Type A (ascending aorta) or Type B (descending aorta).
    • CTA is the preferred diagnostic tool; Type A requires surgery, while Type B is often managed medically.

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