Positive predictive value of clinical suspicion of abdominal aortic aneurysm

Article Abstract:

An abdominal aortic aneurysm (AAA) is an abnormal dilatation of the abdominal aorta, a large blood vessel that supplies blood to the abdominal organs, pelvic region, and lower extremities. Clinical screening for AAA may be carried out by abdominal palpation, a physical examination in which the hands and fingers are applied to the external abdominal surface to detect any changes in position or characteristics of abdominal organs. If AAA is suspected after abdominal palpation, the patient is commonly referred for abdominal ultrasonography, the use of sound waves to provide images of internal abdominal organs. The ability of abdominal palpation to classify patients appropriately as to the presence of AAA was assessed. Out of 116 patients suspected of having AAA on abdominal palpation and referred for abdominal ultrasonography, 17 had a 3.5 centimeter (cm) or greater AAA. The presence of AAA was associated with higher body mass, older age, and presence of other macrovascular disease, which involves the large blood vessels. A 3.5 cm or greater AAA was detected in only 1 of 17 patients, aged 70 years or younger, with low body mass and without macrovascular disease, and in 10 of 20 patients, aged 70 years or older, with a large body mass and macrovascular disease. These findings suggest that abdominal palpation is a relatively inaccurate method of screening for AAA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Demographic aspects, Diagnosis, Ultrasonic, Diagnostic ultrasonography, Palpation

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Clinical follow-up after percutaneous aortic balloon valvuloplasty

Article Abstract:

Aortic balloon valvuloplasty is being used to treat patients with severe symptomatic calcific aortic stenosis, which is a narrowing of the aortic valve due to calcium deposits on it, obstructing blood flow from the heart to the body and thereby causing the heart to work harder. In valvuloplasty, a tube is inserted through blood vessels into the aorta, the body's main artery, and a balloon attached to the tube is inflated to widen the opening of the aortic valve. In 90 patients, with an average age 80 years, who had aortic balloon valvuloplasty, the aortic valve area increased an average of 50 percent. At six months after the procedure, 75 percent of the patients were alive, and at 12 months 63 percent were alive. Factors which were found to be associated with death included: more severe heart disease prior to the procedure, a smaller aortic valve area before and after balloon valvuloplasty, and poor heart output of blood to the body. Among the patients who survived, 50 percent had no heart symptoms and 85 percent had improved symptoms from congestive heart failure, a condition in which the heart functions poorly in pumping blood to the body. The procedure reduces symptoms in patients who are severely ill and at high risk for aortic valve replacement or at risk of a limited life-span due to other medical problems. It is not indicated for patients who are at a low risk for complications with aortic valve replacement.

Care and treatment, Research, Physiological aspects, Congestive heart failure, Aortic valve insufficiency, Aortic valve stenosis, Balloon dilatation

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Bilateral brachial artery emboli presenting as aortic dissection

Article Abstract:

Loss of pulse in the arm of a patient with chest pain usually suggests aortic dissection, a condition in which the aortic artery which carries oxygenated blood from the heart to the body has separated from its surrounding, supportive connective tissue. An 80-year-old woman presenting with chest pain and no pulse in wither arm was initially treated as per a diagnosis of aortic dissection. Physical examination and heart ultrasound, however, indicated mitral stenosis, a narrowing of the valve between the left upper and lower chambers of the heart. Moreover, angiography (x-ray of blood vessels after injecting radiopaque dye) revealed emboli, or fragments of clotted blood, in the brachial arteries of both upper arms. This case represents the first report of bilateral brachial artery emboli in association with mitral stenosis.

Case studies, Embolism, Angiography, Brachial artery

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