thoracic aorta disease

Question 1

how does blood get into the coronary arteries

Answer 1

through the right and left coronary ostium

Question 2

where are the coronary ostium’s located

Answer 2

in the right and left sinus of Valsalva (behind the aortic valve)

Question 3

what are the parts of the aorta

Answer 3

the ascending

the arch

descending

thoracic

abdominal

Question 4

what are the 3 layers of the aorta

Answer 4

tunica intima
tunica media
tunica adventitia

Question 5

what is in the tunica intima

Answer 5

layer of endothelia cells

subendothelial collagen and elastic fibres

Question 6

what is in the tunica media

Answer 6

smooth muscle cells

create elastin sheets - called lamellae

Question 7

what is in tunica adventitia

Answer 7

thin connective tissue

collagen and elastin fibres (that are not lamellae)

Question 8

what does the collagen in elastic arteries do

Answer 8

prevents them from stretching beyond their physiological limits during systole

Question 9

what is an aneurysm

Answer 9

a localised enlargement of an artery caused by a weakness of the vessel wall

Question 10

what is a false aneurysm

Answer 10

when there is a tear in the inner layers (intima, media) leading to collection of blood and stretching of the tunica adventitia

Question 11

what is a saccular aneurysm

Answer 11

when there is a bulge in only one side (true aneurism)

Question 12

what is fusiform aneurysm

Answer 12

where the budge is on both sides

Question 13

what can a false aneurysm be caused by

Answer 13

dissection of the two inner layers

Question 14

what are the sings and symptoms of a thoracic aneurisms

Answer 14

asymptomatic

location dependents 
SOB
heart failure 
pulsate mass
hypotension 
pain

Question 15

how would pain suggest a aortic dissection

Answer 15

sharp chest pain

radiating to back

Question 16

what can aortic dissections be - what happens

Answer 16

acute - surgical emergency

chronic

blood forces walls apart

Question 17

what can lead to aortic dissection

Answer 17

turbulent flow
hypertension
atherosclerosis

vessel wall weakness/damage
trauma
marfans syndrome

Question 18

what are the symptoms of aortic dissection

Answer 18

tearing, severe chest pain - radiation to back

collapse (tamponade, acute AR (aortic regurgitation)

Question 19

what is the prognosis for a aortic dissection

Answer 19

bad 50% mortality rates pre-hospital

Question 20

what would you find on examination of a aortic dissection

Answer 20

reduced or absent peripheral pulsed

hypotension

pulmonary oedema

Question 21

hiw can a diagnosis of a aortic dissection be confirmed

Answer 21

chest x ray - wider mediastinum

echo - CT for confirmation

Question 22

what is the treatment for a aortic dissection

Answer 22

most - surgery

mild cases
meticulous BP control

NA nitroprusside
beta blocker

Question 23

what are the congenital aortic aneurisms

Answer 23

bicuspid aortic valve

marfans syndrome

coarctation

Question 24

what is the infection that can cause aortic problems

Answer 24

syphilis

aortic regurgitation - late stage

treat with antibiotics

Question 25

what is the inflammation disease that causes problems with the aorta

Answer 25

Takayasu’s arteritis

Question 26

what dose the inflammation do to the aorta and the main branches (Takayasu’s arteritis)

Answer 26

stenosis, thrombosis
aneurysms

steroids

and surgery

Question 27

what are sings of aortic coarctation

Answer 27

cold legs
poor leg pulses

infancy - heart failure, failure to thrive

later in life - hyper tension

Question 28

what can marfans syndrome cause

Answer 28

aneurysm, aortic dissection

pneumothorax in the lungs

Question 29

how do you monitor a bicuspid aortic valve

Answer 29

monitor with echo/ MRI

Question 30

what is the most common congenital abnormality

Answer 30

bicuspid aortic valve 1-2%

Question 31

what does having a bicuspid aortic valve possibly lead to

Answer 31

coarctation

prone to stenosis/ regurgitation

aneurysm/ dissection

Question 32

where does coarctation occur around

Answer 32

the ductus arteriosa which becomes the ligamentum arteriosum

Question 33

what are the 3 types of coarctation

Answer 33

pre-ductal
ductal
post ductal

Question 34

what is important about preductal

Answer 34

can be life threatening if there is sever stenosis of the aorta

linked to turners syndrome

Question 35

what is the most common coarctation in adults - symptoms

Answer 35

post ductal

hypertension upper limb extremities areas, weak lower limb pulses

Question 36

what is coarctation

Answer 36

aortic narrowing close to where the ligamentum artriosum attaches to the aorta (end of the aortic arch)

Question 37

how can you image a coarctation

Answer 37

lateral CXR

contrast MRI