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Flashcards in Aortic Disease Deck (48)
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1

What is the basic histology of the tunica intima?

Layer of endothelial cells
Subendothelial layer - collagen and elastic fibres
Separated from the tunica media by internal elastic membrane

2

What is the basic histology of the tunica media?

Smooth muscle cells
Secrete elastin in the form of sheets or lamellae

3

What is the basic histology of the tunica adventitia?

Thin connective tissue layer
Colagen fibres and elastic fibres
The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole

4

When does atherosclerosis begin?

In early childhood

5

What are the risk factors for atherosclerosis?

Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Male

6

What are the possible outcomes of atherosclerosis?

Stroke
MI (ischaemia and infarction)
Aneurysm

7

What is an aneurysm?

A localised enlargement of an artery caused by a weakening of the vessel wall

8

What are the features of a true aneurysm?

Weakness and dilatation of the wall involving all 3 layers
Associated with hypertension, atherosclerosis, smoking and collagen abnormalities
Also associated with trauma and infection

9

What are the features of a false aneurysm

Rupture of the wall of the aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue
Inflammation
Thrill
Bruit
Pulsatile mass
Ischaemia
Rupture

10

What are the signs and symptoms of thoracic aneurysms?

Asymptomatic
Based on location of the aneurysm
Dyspnoea or heart failure
Dysphagia and hoarseness
Sharp chest pain, radiating to back/between shoulder blades
Pulsatile mass felt on abdominal examination
Hypotension

11

What is an aortic dissection?

Tear in the inner wall of the aorta
Blood forces the walls apart
Acute is a medical emergency

12

What are the aetiological factors that cause aortic dissection?

Hypertension
Atherosclerosis
Trauma
Marfan syndrome

13

What is seen on histology of a patient with aortic dissection?

Cystic medial necrosis - loss of elastin and muscle fibres in the media with accumulation of mucopolysaccharides in cyst-like spaces

14

What directions can false lumens progress in?

Antegrade or retrograde

15

Where might an aortic dissection rupture?

Back into the lumen or externally into the pericardium or mediastinum

16

What might dilatation of the ascending aorta cause?

Acute aortic regurgitation

17

What is the DeBakey type I aortic dissection?

Originates in the ascending aorta and propagates at least to the aortic arch and often beyond it distally

18

What is the DeBakey type II aortic dissection?

Originates in and is confined to the ascending aorta

19

What is the DeBakey type III aortic dissection?

Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

20

What is the Stanford type A aortic dissection?

All dissections involving the ascending aorta, regardless of the site of origin

21

What is the Stanford type B aortic dissection?

All dissections not involving the ascending aorta

22

What are the symptoms and signs of aortic dissection?

Tearing, severe chest pain radiating to the back
Collapse - tamponade, acute rupture, external rupture
Inferior ST elevation

23

What is the mortality of aortic dissection pre-hospital?

Around 50%

24

What might be seen on examination of a patient with aortic dissection?

Reduced or absent peripheral pulses, BP mismatch between sides
Hypotension/hypertension
Soft early diastolic murmur
Pulmonary oedema
CXR usually shows widened mediastinum

25

What can confirm a diagnosis of aortic dissection?

Echo or CT

26

What is the investigation of aortic aneurysm and aortic dissection?

Echo
CT
CXR

27

What are the treatments of aortic aneurysm and aortic dissections?

Surgery
Meticulous blood pressure control
Sodium nitroprusside plus a beta blocker

28

What is Takayasu's arteritis?

Granulomatous vasculitis of the aorta and main branches

29

What sex is affected more by Takayasu's arteritis?

Females

30

What are the features of Takayasu's arteritis?

Stenosis
Thrombosis
Aneurysm
Renal artery stenosis
Neurological symptoms