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aortic atheroma
Pathology:
- intimal thickening
- calcification may actually confer stability to atheroma
- sometimes ulceration, destablization, development of mobile projections & embolization
Special laboratory:
- transesophageal echocardiogram
- identify atheromas in the ascending aorta or aortic arch with a mobile component (see Complications belowz0
- no definitive medical or surgical management that has been shown to reduce incidence of aortic complications or thromboembolic events due to aortic atheromas [1]
Radiology:
- CT of abdomen & thorax
Complications:
1) aortic atheromas >= 4 mm in thickness in the ascending aorta or aortic arch increase the risk of recurrent embolic stroke
- atheromas with a mobile component are more likely to be associated with thromboembolism [1]
2) atheromas in the descending aorta are markers of atherosclerosis & cardiovascular risk, but do not seem to be associated with pathologic embolism
Management:
1) life style modification, risk factor reduction*
a) smoking cessation
b) heart-healthy diet
c) aerobic exercise
2) antiplatelet agent: aspirin or clopidogrel
- warfarin may be superior to aspirin for prevention of stroke
3) statin
4) control blood pressure [1]
* MKSAP dismisses diet & lifetyle modification; advocates aggressive treatment with anti-platelet agent & statin [1]
Specific
penetrating aortic atherosclerotic ulcer
General
atherosclerosis
atheroma (atherosclerotic plaque)
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16. 17, 19.
American College of Physicians, Philadelphia 2009, 2012, 2014, 2022
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Isselbacher EM, Preventza O, Hamilton Black III J, et al; Writing Committee Members.
2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report
of the American Heart Association/American College of Cardiology Joint Committee on
Clinical Practice Guidelines.
J Am Coll Cardiol. 2022;80:e223-e393.
PMID: 36334952