Rapid Review·Cardiovascular
Select any text to highlight it or add a note.
HY Approach
T1Must knowApproach to Aortic Syndromes
Focus on
Four aortic catastrophes with four first tests: dissection (tearing pain to the back, pulse differential — CT angiography or TEE), ruptured AAA (pain, shock, pulsatile mass — bedside ultrasound or straight to the OR), traumatic aortic injury (deceleration, widened mediastinum — CT angiography), and acute aortic occlusion (bilateral cold legs — embolectomy). Plus the numbers that decide elective repair.
Key takeaways
How the aorta fails
It dilates
an aneurysm involves all three layers at 1.5 times normal; ascending over 5 cm, descending over 4 cm, abdominal 3 cm or more.It tears
a dissection is an intimal tear that splits the media.It is blocked
an embolic saddle occlusion.Trauma
ruptures it at the isthmus.| Condition | Who | Presentation | First test | Treatment | Page |
|---|---|---|---|---|---|
| Aortic dissection | Hypertensive man in his 60s; Marfan, bicuspid valve, cocaine in the young | Tearing chest or back pain, pulse or pressure asymmetry, syncope, new regurgitation murmur, neurologic deficit | Electrocardiogram and chest film; CT angiography if stable, transesophageal echo if unstable | Intravenous beta blocker, then nitroprusside; type A surgery, type B medical | Aortic Dissection |
| Ruptured abdominal aneurysm | Male smoker over 60 with a known aneurysm | Abdominal, flank or back pain, shock, pulsatile mass | Known aneurysm and unstable: operating room directly; unknown and unstable: bedside ultrasound; stable: CT angiography | Emergency endovascular or open repair | Abdominal Aortic Aneurysm |
| Traumatic aortic injury | High-energy deceleration (motor vehicle crash, fall over 3 m) | Often deceptively stable; widened mediastinum | Chest film, then CT angiography; transesophageal echo if unstable | Keep systolic under 100, then repair | Traumatic Aortic Injury |
| Acute aortic occlusion | Atrial fibrillation, recent infarction | Sudden bilateral leg pain, pallor, pulselessness, paralysis | CT angiography; electrocardiogram and echo for the source | Heparin, transfemoral embolectomy or aortobifemoral bypass, thrombolysis | Acute Limb Ischemia |
| Thoracic aortic aneurysm | Marfan, bicuspid valve, hypertension, syphilis, giant-cell arteritis | Usually silent; chest or back pain, hoarseness, dysphagia, regurgitation, superior vena cava syndrome | Chest film, then CT angiography | Repair over 5.5 cm or growth over 0.5 cm in 6 months | Thoracic Aortic Aneurysm |
Dissections and aneurysms by location
| Artery | Clinical features | Etiology | Management |
|---|---|---|---|
| Aorta (Stanford A ascending, B descending) | Sudden tearing pain in the chest, back, neck or abdomen; syncope; asymmetric pulses and pressures | Hypertension, trauma, Marfan and Ehlers-Danlos, vasculitis, stimulants | Control the pressure (type B is conservative); immediate surgery for type A |
| Internal carotid | Ipsilateral headache, pulse-synchronous tinnitus, partial Horner, stroke | Trauma, connective-tissue disease, fibromuscular dysplasia, hypertension | Anticoagulation or antiplatelets; stenting or surgery if needed (Carotid Artery Dissection) |
| Vertebral | Occipital headache, stroke resembling Wallenberg syndrome | Same as carotid | Same as carotid |
| Aneurysm | Location and cause | Presentation |
|---|---|---|
| Popliteal | The most common peripheral aneurysm; bilateral in 50 percent | Usually an asymptomatic popliteal mass; knee pain; acute limb ischemia (the six P's) |
| Femoral | Atherosclerotic (the second most common peripheral aneurysm); pseudoaneurysm after femoral cannulation | Palpable pulsatile mass, compressive or thromboembolic features; pseudoaneurysm is painful with a bruit or thrill (Femoral Artery Disease) |
| Iliac | Atherosclerotic | Acute limb ischemia from thromboembolism; compression of bowel, ureter or nerves |
| Extracranial carotid | Atherosclerosis, mostly the internal carotid | Pulsatile neck mass, bruit, transient ischemic attacks or stroke |
| Coronary | Kawasaki disease, polyarteritis nodosa; right coronary most often | Angina, abdominal pain, vomiting |
| Cerebral | Circle of Willis | Usually asymptomatic; mass effect; subarachnoid hemorrhage on rupture |
| Ventricular true aneurysm | Anterior or apical left ventricle after myocardial infarction (MI) | Enlarged heart, S3 and S4, systolic murmur (Post MI Complications) |
| Ventricular pseudoaneurysm | Lateral or posterior wall after infarction | Same findings; ruptures |
Screening and prevention
Screening
a one-time ultrasound for abdominal aneurysm in men 65 to 75 who have ever smoked.Prevention for all aortic disease
blood pressure control, smoking cessation and statins.A 72-year-old smoker with a known 6 cm abdominal aneurysm arrives with back pain and a blood pressure of 70/40. What is the next step, and what would change if the aneurysm were not known?
Ruptured abdominal aortic aneurysm in an unstable patient with a known aneurysm: straight to the operating room, no imaging. Without a known aneurysm, a bedside ultrasound first; a stable patient gets CT angiography.
How it's tested
Tearing chest pain radiating to the back with a 30 mm Hg pressure difference between the arms: aortic dissection — CT angiography (TEE if unstable); esmolol before any vasodilator.
A 70-year-old smoker with a known 6-cm AAA arrives hypotensive with abdominal pain: ruptured aneurysm — the operating room, no imaging.
Unrestrained driver, chest wall bruising, widened mediastinum on the film, BP 140/90: blunt aortic injury — CT angiography, beta blockade to SBP < 100, endovascular repair.
Sudden pain and pulselessness in both legs in a patient with atrial fibrillation: saddle embolus — heparin and embolectomy.
What screening does a 68-year-old former smoker need for his aorta: a one-time abdominal ultrasound.
Go deeper
Guidelines: 2022 ACC/AHA Aortic Disease Guideline
Related Step 2 pages: Aortic Dissection, Abdominal Aortic Aneurysm, Thoracic Aortic Aneurysm, Traumatic Aortic Injury, Acute Limb Ischemia, Carotid Artery Dissection, Approach to Leg Pain & Ulcers
You just read one page of 236
The rest of Step 2 CK, written exactly like this.
Rapid Review is the reading layer of a full Step 1 platform: a schedule fitted to your exam date, flashcards for every page, and a mentor a message away.
Every Step 1 system
Written the same way: what to know, how it’s tested, where to go deeper.
A plan built to your exam date
Tell us when you sit, and the schedule fits the whole library and your question bank to it.
Flashcards for every page
Ready-made spaced-repetition decks linked to each topic, so nothing you read gets forgotten.
