Aortic Disease

Question 1

What can aortic diseases affect?

Answer 1

Aortic root
Sinuses of Valsalva
Arch
Descending aorta

Question 2

What is an aneurysm?

Answer 2

A localised enlargement of an artery caused by weakening of the vessel wall (dilation)

Question 3

What are the layers to the T intima layer of vessel walls?

Answer 3

Layer of endothelial cells
Subendothelial layer: collagen and elastic fibres
Separated from T media by the Internal Elastic Membrane

Question 4

What is T media of vessel wall composed of?

Answer 4

Smooth muscle cells

Secrete elastin as lamellae

Question 5

Describe histology of T. adventitia

Answer 5

Thin connective tissue layer
Collagen and elastin fibres
The collagen prevents elastic arteries from stretching beyond limits during systole - prevents rupture

Question 6

What there conditions can atherosclerosis cause?

Answer 6

Stroke
Myocardial infarction
Aneurysm

Question 7

What are the two classifications of aneurysms?

Answer 7

True and false

Question 8

Describe the true aneurysm

Answer 8

Weakness and dilation of wall involve all 3 layers

Question 9

What are risk factors for true aneurysm?

Answer 9

Hypertension 
Atherosclerosis 
Smoking 
Collagen abnormalities (Marfan's, cystic medial necrosis)
Trauma 
Infection

Question 10

Describe the false aneurysm

Answer 10

Rupture of the aorta with the haematoma either contained by the thin adventitial layer or by the surrounding tissue - between the media and adventitia

Question 11

What are 3 causes of false aneurysms?

Answer 11

Inflammation (endocarditis, septic emboli)
Trauma
Iatrogenic

Question 12

What clinical signs will false aneurysms cause?

Answer 12

Thrills
Bruits
Pulsatile mass

Question 13

What is an aortic dissection?

Answer 13

A rip between the two inner layer (T. intima and media) and create a false lumen

And with high BP, blood is forced into the false lumen which can occlude true lumen

Question 14

What are the signs and symptoms of thoracic aneurysms?

Answer 14

Asymptomatic
Based on location of the aneurysm:
SOB or HF
Dysphagia and hoarseness (ascending aorta)
Sharp chest pain radiating to back (between blades)
Pulsatile mass
Hypotension

Question 15

What are different classifications of aortic aneurysms by site?

Answer 15

Ascending
Arch
Descending
Abdominal

Question 16

What are causes of dissection?

Answer 16

Hypertension
Atherosclerosis
Taruma
Marfan’s syndrome

Question 17

What is the histological features of dissection?

Answer 17

Cystic medial necrosis

Question 18

What directions can the false lumen progress to?

Answer 18

Antegrade

Retrograde

Question 19

How can false lumen occlude branches?

Answer 19

Can stenos true lumen cutting of blood supply to branches

Question 20

Where can a rupture after the dissection occur?

Answer 20

Back into lumen
Externally in to pericardium (tamponade)
Mediastinum

Question 21

What can dilation of ascending aorta cause?

Answer 21

Acute regurgitation and thus can cause rapid progressive heart failure

Question 22

What are the symptoms of dissection?

Answer 22

Tearing, severe chest pain (radiating to back)

Collapse (tamponade, acute AR, external rupture)

Question 23

What are the symptoms of examination of a dissection?

Answer 23

Reduced or absent peripheral pulses
Hypotension/hypertension
Soft early diastolic murmur (sign of AR)
Pul. oedema

Question 24

What investigations should be carried out for dissection?

Answer 24

CXR - widened mediastinum

Can diagnose:
Echo
CT

Question 25

What is type A and type B dissections?

Answer 25

Type A: Involves ascending aorta | Type B: Involves descending aorta

Question 26

What is the treatment for Type A dissections?

Answer 26

Surgery

Question 27

What is the treatment for Type B dissections?

Answer 27

BP control | Sodium nitroprusside and beta blocker

Question 28

What are 2 agents that can cause infection and inflammation in the aorta?

Answer 28

Infection: syphyllis Inflammation: Takayasu's arteritis

Question 29

What is Takayasu's Arteritis?

Answer 29

Granulomatous vasculitis inflammation of the aorta and its major branches

Question 30

What does Takayasu's Arteritis cause?

Answer 30

``` Stenosis Thrombosis Aneurysms Renal artery stenosis Neurological symptoms ```

Question 31

How do you treat Takayasu's Arteritis?

Answer 31

Steroids | Surgery

Question 32

What is syphilis?

Answer 32

STD caused by treponema palladium Give antibiotics to prevent late stages

Question 33

What are causes for congenital aortic aneurysm?

Answer 33

Bicuspid aortic valve Marfan's syndrome Coarctation

Question 34

What are the 3 shunts in the embryo?

Answer 34

Ductus arteriosus Foramen vale Ductus venosus

Question 35

What is coarctation?

Answer 35

Aortic narrowing close to where ductus arterioles inserts (becomes ligament arteriosum)

Question 36

What are 3 types of coarctations?

Answer 36

Preductal (5% turners) Ductal Post-ductal

Question 37

What are signs of coarctation?

Answer 37

Cold legs Poor leg pulses If before L subclavian artery: Radial-raidal and RIGHT femoral-femoral delay If after L subclavian artery: no radial-radial delay, R and L radio-femoral delay

Question 38

What are the symptoms of coarctation?

Answer 38

``` Infancy (HF and failure to thrive) Later life (hypertension) ```

Question 39

What test can be used for coarctation?

Answer 39

CXR | CMRI