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Cardiovascular system SA > Aortic disease - pathophysiology, presentation, investigation and therapy > Flashcards

Aortic disease - pathophysiology, presentation, investigation and therapy Flashcards

1
Q

Define Atherosclerosis

A

disease of the arteries characterised by deposition of fatty material on the inner wall

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2
Q

what is the risk factors of Atherosclerosis

A 
Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Male>female (relative protection in females until menopause)
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3
Q

What is the potential progressional outcome of Atherosclerosis

A

Stroke
Myocardial infarction
Aneurysm

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4
Q

Define aneurysm

A

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

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5
Q

What is the different classification of aneurysm

A

True aneurysm: Saccular + fusiform

false aneurysm

dissecting aneurysm

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6
Q

How do you define true aneurysm

A

Weakness & dilation of wall

Involves all 3 layers

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7
Q

What is a true aneurysm associated with

A 
Hypertension
Atherosclerosis
Smoking
Collagen abnormalities 	(Marfan’s, cystic medial necrosis)
Trauma
Infection 	(mycotic/syphillis)
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8
Q

How do you define false aneurysm

A

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

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9
Q

What is a false aneurysm associated with

A

Inflammation ( eg endocarditis with septic emboli)
Trauma
Iatrogenic

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10
Q

What is the signs of a false aneurysm

A

Thrill
Bruit
Pulsatile mass

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11
Q

What is the progressional outcome of a false aneurysm

A

Ischaemia

Rupture

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12
Q

What is the aetiology of dissecting aneurysm

A

An aneurysm in which the inner wall of an artery rips longitudinally, the blood forces the wall apart creating two lumen passages

either acute or chronic

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13
Q

What also of the classifciation of an aortic aneurysm dependant on

A

site:

asending/aortic arch/descending/abdominal aorta aneurysm

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14
Q

Signs and symptoms of the thoracic aneurysm is dependant on

A

Location

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15
Q

What is the signs and symptoms of a thoracic dissecting aneurysm

A

SOB
Heart Failure - Pulmonary oedema
Hypotension
Pulsatile mass

Sharp chest pain radiating to back and between shoulder blades

Collapse - due to rupture or dilation

In the Ascending
Dysphagia (difficult swallowing)
Hoarseness

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16
Q

What is the common classification of thoracic aortic dissection dependant upon

A

Type A: confined to ascending aorta

Type B: originates in descending aorta and moves downwars (no ascending aorta)

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17
Q

What is the aetiology of thoracic aortic dissection

A

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome

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18
Q

What is in the histology of thoracic aortic dissection

A

Cystic medial necrosis

19
Q

What is the detrimental affect of the false lumen caused in thoracic aortic dissection

A

false lumen can progress in an antegrade or retrograde direction and can potentially

occlude branches
(eg mesenteric, carotid, renal, spinal)

Rupture

Dilation

20
Q

What happens when the dissecting thoracic aorta ruptures

A

ruptures back into the lumen or externally into the mediastinum or externally in to pericardium - compressing the heart due to accumulation of fluid (tamponade)

21
Q

What can dilation of the ascending aorta cause in aortic dissection

A

may cause acute aortic regurgitation

22
Q

What can be found on examination of a patient with aortic dissection

A

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

ST elevation

23
Q

What can cause you to collapse in aortic dissection

A

due to tamponade, acute AR, external rupture

24
Q

How can diagnosis of aortic dissection be confirmed

A

Diagnosis can be confirmed by echocardiogram or CT scanning

25
Q

How do you treat type A aortic dissection

A

surgery

26
Q

How do you treat type B aortic dissection

A

Meticulous blood pressure control

Sodium nitroprusside plus beta blocker

27
Q

What is Takayasu’s Arteritis

A

granulomatous vasculitis inflammation of the aorta and its major branches

28
Q

What is the result of Takayasu’s Arteritis

A

Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx

29
Q

What is the treatment for takayasus arteritis

A

Steroids

Surgery

30
Q

What prevents late stages of syphilis -Cardiac syphillis

A

antibiotics

31
Q

What is the outcome of cardiac syphilis

A

syphilitic aortitis = aneurysm

aortic regurgitation

32
Q

What is the three congenital aortic aneurysms

A

Bicuspid Aortic Valve
(should be tricuspid)

Marfan’s Syndrome

Coarctation

33
Q

What is the possible outcomes of biscupid aortic valve

A 
stenosis
regurgitation 
aneurysm 
dissection 
abnormal aorta
34
Q

What is bicupid aorta associated with

A

Coarctation

35
Q

What is the management of bicuspid aorta

A

Monitor with echo/MRI

36
Q

What are the 3 shunts of aorta coarctation

A

Ductus arteriosus
Foramen ovale
Ductus venosus

37
Q

What are the 3 types of aortic narrowing in the ductus arteriosus

A

Pre-ductal - can be life-threatening if severe narrowing

Ductal

Post-ductal –most common in adults

38
Q

What is aortic coarctation

A

narrowing below the left subclavian artery

39
Q

What is the signs of coarctation

A 
Cold legs
Poor leg pulses
If before left subclavian artery:
Radial – radial and RIGHT radial-femoral delay
If after left subclavian artery:
No radial- radial delay
Right and left radio-femoral delay
40
Q

What is the symptoms of coarctation in infancy

A

Heart failure

Failure to thrive

41
Q

What is the symptoms of coa rcataion in later life

A

Hypertension

42
Q

What is marfan syndrome

A

A connective tissue weakness due to fibrillin 1 gene

43
Q

What is the possible outcomes of marinas syndrome

A 
Eyes (cataract, lens dislocation)
Vascular – aneurysm, dissection
Lungs (pneumothorax)
Aneurysm
Dissection

Cardiovascular system SA (43 decks)

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