Aortic Disease- Pathophysiology, Presentation, Investigation & Therapy

Question 1

Features of the aortic root (5)

Answer 1

Sinotubular junction
Right coronary ostium
Right sinus Valsalva
Left coronary ostium
Left sinus valsalva

Question 2

Tunica Intima (3)

Answer 2

1. Layer of endothelial cells
2. Subendothelial layer- collagen and elastic fibres
3. Separated from tunica media internal elastic membrane

Question 3

Tunica media (2)

Answer 3

1. Smooth muscle cells

2. Secrete elastin in the form of sheets or lamellae

Question 4

Tunica Adentitia (3)

Answer 4

1. Thin connective layer tissue layer
2. Collagen fibres and elastic fibres (not lamellae)
3. The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole

Question 5

Most common cause of death in the west

Answer 5

Atherosclerosis

Question 6

When does atherosclerosis begin

Answer 6

In early childhood

Question 7

Risk factors for atherosclerosis (6)

Answer 7

1. Hypertension
2. Hyper cholesterolaemia
3. Smoking
4. Diabetes
5. Family history
6. Male>female

Question 8

Atherosclerosis Timeline

Answer 8

1. Foamy cells
2. Fatty streak
3. Intermediate lesion
4. Atheroma
5. Fibrous plaque
6. Complicated lesion/rupture

Question 9

What can atherosclerosis lead to (3)

Answer 9

• Stroke
• MI
• Aneurysm

Question 10

Aneurysm

Answer 10

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

Question 11

True aneurysm (3)

Answer 11

Saccular
Fusiform
Involves all 3 layers

Question 12

False aneurysm (2)

Answer 12

• A break in the vessel wall

* Dissecting aneurysm

Question 13

True aneurysms are associated with (6)

Answer 13

• Hypertension
• Atherosclerosis
• Smoking
• Collagen abnormalities (Marfan’s, cystic medial necrosis)
• Trauma
• Infection (mycotic/syphilis)

Question 14

False aneurysm

Answer 14

Rupture of wall of aorta with haematoma that is either contained in the thin adventitial layer or by the surrounding soft tissue

Question 15

Classification of Aortic Aneurysm by site (5)

Answer 15

1. Normal
2. Ascending aorta aneurysm
3. Aortic arch aneurysm
4. Descending aorta aneurysm
5. Abdominal aorta aneurysm

Question 16

Signs and Symptoms of Thoracic Aneurysms (5)

Answer 16

	SOB or even HF 
	Dysphagia and hoarseness 
	Sharp chest pain radiating to back (between shoulder blades)
	Pulsatile mass
	Hypotension

Question 17

Aortic Dissection

Answer 17

Tear in the inner wall of the aorta caused

Question 18

What is the classification system of thoracic aortic dissection

Answer 18

Stanford and Debakey

Question 19

Debakey Type I

Answer 19

Originates in the ascending, propagates at least to the aortic arch

Question 20

Debakey Type II

Answer 20

Originates in and is confined to ascending aorta

Question 21

Debakey Type III

Answer 21

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

Question 22

Stanford Type A

Answer 22

All dissections involving ascending aorta

Question 23

Stanford Type B

Answer 23

All dissections not involving the ascending aorta

Question 24

Causes of aortic dissection (4)

Answer 24

• Hypertension
• Atherosclerosis
• Trauma
• Marfan’s syndrome

Question 25

Histology of aortic dissection

Answer 25

• Cystic medial necrosis

Question 26

Dilation of ascending aorta may cause ___

Answer 26

Acute aortic regurgitation

Question 27

Symptoms (3)

Answer 27

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

Question 28

Treatment (2)

Answer 28

Type A- Surgery | Type B- Meticulous BP control and sodium nitroprusside pls beta blocker

Question 29

What does Takayasu’s Arteritis cause

Answer 29

Inflammation | Granulomatous vasculitis

Question 30

Takayasu’s Arteritis infection more common in

Answer 30

Women

Question 31

Main area that Takayasu’s Arteritis effects

Answer 31

Aorta and main branches

Question 32

Takayasu’s Arteritis can lead to (5)

Answer 32

``` Stenosis Thrombosis Aneurysm Renal artery stenosis Neurological ```

Question 33

Treatment for Takayasu’s Arteritis

Answer 33

Surgery or steroids

Question 34

Syphilis causes

Answer 34

Infection | Treponema pallidum

Question 35

Tertiary Syphilis (3)

Answer 35

 Late neuro-syphillis  Gummatous syphillis  Cardiac syphilis- aneurysm, AR

Question 36

Congenital Aortic Aneurysms (3)

Answer 36

Bicuspid Marfan's Syndrome Coarctation

Question 37

Whats the most common congenital aortic aneurysm cause

Answer 37

Bicuspid aortic valve

Question 38

What are the consequences of bicuspid aortic aneurysm

Answer 38

Associated coarctation Regurgitation Stenosis

Question 39

Coarctation (3)

Answer 39

1. Preductal (5% turner’s) 2. Ductal 3. Post ductal (most common in adults- hypertension in upper extremities, weak pulses in low limbs)

Question 40

Signs of Coarctation (2)

Answer 40

* Cold legs | * Poor leg pulses

Question 41

Coarctation before left subclavian artery

Answer 41

radial and RIGHT radial-femoral delay

Question 42

Coarctation after left sublavian artery

Answer 42

No radial-radial delay | Right and left radial-femoral delay

Question 43

Symptoms of coarctation in infancy (2)

Answer 43

HF | Failure to thrive

Question 44

Symptoms of Coarctation in adults

Answer 44

Hypertension

Question 45

Marfan's syndrome inheritance

Answer 45

Autosomal dominant

Question 46

Gene involved in Marfan's syndrome

Answer 46

Fibrillin 1 gene leading to connective tissue weakness

Question 47

Consequences of Marfan's Syndrome (5)

Answer 47

* Aortic/mitral valve prolapse- regurgitation * Skeletal system * Eyes (cataracts, lens dislocation) * Vascular- aneurysm/dissection * Lungs (pneumothorax)