Aortic Disease - Pathophysiology, Presentation,

Question 1

true or false:

atherosclerosis is the commonest cause of death in the west

Answer 1

true

Question 2

when does atherosclerosis begin?

Answer 2

early childhood

Question 3

what are the risk factors for atherosclerosis?

Answer 3

hypertesion
hypercholesterolaemia
smoking
diabetes
family history

Question 4

what gender is more likely to develop atherosclerosis?

Answer 4

male

Question 5

what can atherosclerosis cause?

Answer 5

stroke
myocardial infarction
aneurysm

Question 6

what is an aneurysm?

Answer 6

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

Question 7

true or flase:

there are true but no false aneurysms

Answer 7

false, there is a true, flase amd dissecting aneursym

Question 8

what are the two types of true aneurysms

Answer 8

saccular and fusiform

Question 9

what are true aneurysms?

Answer 9

weakness and dilation of wall and involves 3 layers

Question 10

what are true aneurysms associated with?

Answer 10

hypertension
atherosclerosis
smoking
collagen abnormalities
trauma

Question 11

what are false aneurysms?

Answer 11

rupture of wall aorta with the haematoma either contained by the thin adventitia layer or by the surrounding soft tissue

Question 12

signs and symptoms of thoracic aneurysms

Answer 12

Asymptomatic

shortness of breath or even 
heart failure (AR)

dysphagia and hoarseness (ascending aorta, chronic)

Sharp chest pain radiating to
back –between shoulder blades –Possible dissection!

Pulsatile mass

Hypotension

Question 13

what is aortic dissection?

Answer 13

tear inner wall of aorta
blood forces wall apart
acute-medical emergency
chronic

Question 14

what is debakey type 1?

Answer 14

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

Question 15

what is debakey type 2

Answer 15

originates in and its confined to the ascending aorta

Question 16

what is debakey type 3

Answer 16

originates in the descending aorta and extends distally down the aorta or rarely retrogade into the aortic arch and ascending aorta

Question 17

what is stanford type A

Answer 17

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

Question 18

what is stanford type B

Answer 18

all dissections not involving the ascending aorta

Question 19

what are aetiological factors of dissection?

Answer 19

hypertension
atherosclerosis
trauma
marfans syndrome

Question 20

symptoms and signs of aortic dissection

Answer 20

Tearing, severe chest pain (radiating to back)
Collapse (tamponade, acute AR, external rupture)
Beware inferior ST elevation
~50% mortality pre-hospital

Question 21

what would you see on examination with a patient that had aortic dissection?

Answer 21

Reduced or absent peripheral pulses (BP mismatch between sides)
Hypotension/ hypertension
Soft early diastolic murmur (AR)
Pulmonary oedema
Chest x-ray usually shows a widened mediastinum
Diagnosis can be confirmed by echocardiogram or CT scanning

Question 22

what are the two types of treatment for aortic dissection?

Answer 22

surgery

meticulous blood pressure control and sodium nitroprusside plus beta blocker

Question 23

what is Takayasu’s Arteritis

Answer 23

large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing

Question 24

whats the most vommon congenital abnormality?

Answer 24

bicuspid aortic valve

Question 25

what is the prevelance of bicuspid aortic valve?

Answer 25

1-2%

Question 26

how do you monitor bicuspid aortic valve?

Answer 26

echo/MRI

Question 27

what is aortic coarction?

Answer 27

narrowing of the aorta

Question 28

where are the locations of the 3 shunts?

Answer 28

ductus arteriosus
foramen ovale
ductus venosus

Question 29

what are the thee types of coarction?

Answer 29

pre-ductal-can be life threatening

ductal

post ductal- most common in adults- hypertension in upper extremities

Question 30

what are signs of coarction?

Answer 30

cold legs
poor leg pulses

if before left subclavian: radial and right radial femoral delay

if after left subclavian artery: no radial-radial delay
right and left radio femoral delay

Question 31

symptoms of coarction

Answer 31

infancy-
heart failure
failure to thrive

later life-
hypertension

Question 32

what is marfans syndrome?

Answer 32

connective tissue weakness

Question 33

how does marfans syndrome affect the eyes

Answer 33

cataract, lens dislocation

Question 34

how does marfans syndrome affect the vascular system?

Answer 34

aneurysm, dissection

Question 35

how does marfams syndrome affect the lungs

Answer 35

pneumothorax

Question 36

what are signs of marfans syndrome

Answer 36

Tall and slender build.
Disproportionately long arms, legs and fingers.
A breastbone that protrudes outward or dips inward.
A high, arched palate and crowded teeth.
Heart murmurs.
Extreme nearsightedness.
An abnormally curved spine.
Flat feet.