Aortic disease Flashcards
What is an aneurysm
Localised enlargement of artery caused by weakening of vessel wall
What are the different types of aneurysms
What is the difference between true and false aneurysm
True aneurysm:
Weakness an dilation of 3 layers
Associated with
Hypertension
Atherosclerosis
Smoking
Bicuspid aortic valve
Collagen abnormalities (Marfan’s)
Infection (mycotic/syphillis)
Trauma
False aneurysm
Rupture of wall of aorta with haematoma
Aetiology:
Trauma
Latrogenic
Inflammation
What do the classifications of aortic aneurysm by site look like
What are the signs and symptoms of aortic aneurysm
Shortness of breath (associated aortic regurgitation)
Dysphagia and hoarseness
Back pain
Symptoms of dissection - sharp chest pain radiating to back (between shoulder blades), hypotension
Pulsatile mass
WHat are the investigations for thoracic aneurysms
CXR – widened mediastinum
Echocardiogram – assess aortic root size and aortic valve (limited views of distal ascending aorta and arch)
CT angiogram aorta – diagnostic
MRI aorta – diagnostic and follow-up
Other tests: TOE and invasive aortogram – rarely done
What is an aortic dissection
Tear in the inner wall of aorta
Blood forces walls apart
Acute –medical/surgical emergency
Chronic
What are the classifications of aortic dissection
no.1 Type A
no.2 Type A
no.3 Type B
What are the symptoms of Aortic dissection
Chest pain – severe, sharp, radiating to back (inter-scapular)
Collapse (tamponade, acute AR, external rupture)
Stroke (involvement of carotid arteries)
What are the signs of aortic dissection
Reduced or absent peripheral pulses
Hypertension or hypotension
BP mismatch between sides
Soft early diastolic murmur (aortic regurgitation)
Pulmonary oedema
Signs of CVA
What are the investigations for aortic dissection
ECG – might show ST elevation/ischaemia indicating coronary involvement
CXR - widened mediastinum
Transthoracic echocardiogram (TTE) – assess aortic root (limited views), aortic regurgitation? pericardial effusion ?
CT angiogram aorta - confirms diagnosis
WHat are the different treatment options for aortic dissection
Type A
Blood Pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Emergency Surgery
Type B
Blood pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Percuraneous (endo-vascular) intervention
What is takayasu,s arthritis
Granulomatous vasculitis
Females>Males
Aorta & main branches
Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx
Steroids and immunosuppressive Tx
Surgery and percutaneous intervention may be required
What is aortic coarctation
Aortic narrowing close to where Ductus arteriosus inserts
(ligamentum arteriosum)
3 types:
Pre-ductal (5% turner’s) can be life-threatening if severe narrowing (B)
Ductal (A)
Post-ductal (C) –most common in adults – hypertension in upper extremities, weak pulses in lower limbs
What are the signs of coarctation
Cold legs
Poor leg pulses
If before left subclavian artery:
Radial – radial and RIGHT radial-femoral delay
If after left subclavian artery:
No radial- radial delay
Right and left radio-femoral delay
What are the investigations for coarctation
