Aortic Disease

Question 1

The aorta exists in 3 parts…

Answer 1

Ascending aorta
Aortic Arch
Descending Aorta

Question 2

Types of aneurysms

Answer 2

Saccular (true)
Fusiform (true)
False
Dissecting

Question 3

True aneurysms involve all 3 layers of the aorta and are associated with…

Answer 3

Hypertension
Atheroscleorosis 
Smoking
Collagen abnormalities (e.g. marfans, cystic medial necrosis)
Trauma
Infection (Mycotic/syphilis)

Question 4

False aneurysms is when there is a rupture in a wall of the aorta with the haematoma either contained by the thin adventitial layer or by the soft surrounding tissue. They are caused by

Answer 4

Inflammation (e.g. endocarditis - with septic emboli)
Trauma
Iatrogenic

Question 5

Signs of False aneurysm

Answer 5

Thrill
Bruit
Pulsatile mass
Ischaemia
Rupture

Question 6

Dissecting aneurysm is not a rupture but there is a tear in the second layer but there is still a layer left.

Answer 6

YAH

Question 7

Classification of aortic aneurysm by site

Answer 7

Normal
Ascending aortic aneurysm
Aortic arch aneurysm 
Descending aortic aneurysm 
Abdominal aortic aneurysm

Question 8

Signs and symptoms of thoracic aneurysms

Answer 8

Asymptomatic
Based on location of aneurysm
- SOB or even heart failure.
- Can give AR if stretches the root
- Dysphagia and horseness (if AA, chronic)
- Sharp chest pain radiating to back = between shoulder blades, possible dissection
- Pulsatile mass
- Hypotension

Question 9

Debakey classification of aortic dissection

Answer 9

Type I = all of the aorta
Type II = ascending aorta
Type III = descending aorta

Question 10

Stanford classification of aortic dissection

Answer 10

Type A = all dissections involving ascending aorta regardless of origin
Type B = All dissections not involving the ascending aorta

Question 11

Causes of aortic dissection

Answer 11

Hypertension
Atherosclerosis
Trauma
Marfan’s Syndrome

Question 12

Symptoms of aortic dissection

Answer 12

Tearing, severe chest pain radiating to back
Collapse (tamponade, acute AR, external rupture)
Beware inferior ST elevation

Question 13

Signs of aortic dissection

Answer 13

Reduced/absent peripheral pulses (BP mismatch between sides)
Hypo/hypertension
Soft early diastolic murmur (AR)
Pulmonary oedema
CXR: usually shows a widened mediastinum
Diagnosis confirmed by ECHO or CT screening

Question 14

Treatment of aortic dissection

Answer 14

Type A = surgery
Type B = meticulous blood pressure control (try to keep systolic BP less than 100 using IV GTN) sodium nitroprusside (not unless you have to) plus beta blocker

Question 15

Inflammatory condition involved with aortic aneurysms/dissection

Answer 15

Takayasu’s Arteritis

Question 16

Infection involved with aortic dissection/aneurysm

Answer 16

Syphyllis

Question 17

Tertiary syphyllis =without treatment a 1/3rd will develop one of these:

Answer 17

Late neuro syphilis
Gummatous syphilis
Cardiac syphilis

Question 18

Congenital aortic aneurysms

Answer 18

Bicuspid aortic valve
Marfans syndrome
Coarctation

Question 19

Shunts of coarctated aortas

Answer 19

Ductus arteriosus
Foramen ovale
Ductus venosus

Question 20

3 types of aortic narrowing

Answer 20

Preductal
Ductal
Post ductal
In respect to where the ductus arteriosus insets (ligamentum arteriosum)

Question 21

Symptoms of coarctation

Answer 21

Infancy
- HF
- Failure to thrive
Later life
- Hypertension

Question 22

Signs of coarctation

Answer 22

Cold legs
Poor leg pulses
If before left subclavian artery - right-radial and right radial-femoral delay)
If after left subclavian artery - no radial-radial delay. Right and left radio-femoral delay)

Question 23

Imaging investigations for Coarctation of aorta

Answer 23

CXR

CMRI