Disease of the Aorta

Question 1

What comes from the

1. Left coronary sinus
2. Right coronary sinus
3. Posterior coronary sinus?

Answer 1

The left aortic sinus gives rise to the left coronary artery.

The right aortic sinus gives rise to the right coronary artery.

Usually, no vessels arise from the posterior aortic sinus, which is therefore known as the non-coronary sinus.

Each aortic sinus can also be referred to as the sinus of Valsalva

Question 2

What is the definition of an aneurysm?

Answer 2

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

Question 3

What are the different types of aneurysm?

Answer 3

True aneurysms - Saccular and Fusiform

False Aneurysm

Question 4

Which layers of the aorta does a true aneurysm involve?

Answer 4

All three layers

Question 5

What are the risk factors for true aneurysm?

Answer 5

Hypertension

Atherosclerosis

Smoking

Collagen abnormalities (Marfan’s)

Trauma

Infection (mycotic / syphilis)

Question 6

What are the features of a false aneurysm?

Answer 6

A rupture of the wall of the aorta with the haemotoma either contained by the thin adventitial layer or by the surrounding soft tissue

Question 7

What are the clinical features of a false aneurysm?

Answer 7

Thrill

Bruit

Pulsatile mass

Question 8

What is the difference between a false aneurysm (pseudo aneurysm) and a dissecting aneurysm?

Answer 8

Pseudoaneurysm: Collection of blood that forms between the two outer layers of an artery, the muscularis and the adventitia.

Dissecting aneurysm: When blood from the vessel lumen tracks between the two inner layers, the intima and the muscularis.

Question 9

What are the different classifications of aortic aneurysms?

Answer 9

Question 10

What are potential signs and symptoms of aneurysms?

Answer 10

Dependant on location:

SOB

Heart Failure

SHarp Chest Pain radiating to the back - between shoulder blades (possible sign of dissection)

Pulsatile mass

Hypotension - due to compliance of the aorta

Question 11

What is the Stanford classification of aortic dissection?

Answer 11

Type A - involves ascending aorta

Type B - Doesn’t

Question 12

What are the potential risk factors for dissection?

Answer 12

Hypertension

Atherosclerosis

Trauma

Marfan’s Syndrome

Question 13

What direction can the dissection progress in?

Answer 13

Antegrade or Retrograde Direction

Antegrade – arch to distal aorta

Retrogade – back to ascending aorta

Question 14

What are the potential branches that an aortic dissection may occlude?

Answer 14

Mesenteric, carotid, renal or spinal

Carotid - Aortic dissection can present with neurological symptoms as a result of carotid blood occlusion

Question 15

What are the potential complications of a ruptured dissection?

Answer 15

•Rupture - back into the lumen or externally in to pericardium (tamponade) or mediastinum

Question 16

What is the effect of dissection on the ascending aorta?

Answer 16

May cause dilation and therefore aortic regurgitation

Question 17

What are the symptoms of aortic dissection?

Answer 17

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

Question 18

What are the features of aortic dissection on examination?

Answer 18

Reduced / absent peripheral pulses (BP mismatch between sides)

Hypotension / hypertension

Soft early diastolic murmur (AR)

Pulmonary oedema

Widened mediastinum on X - Ray

Diagnosis can be confirmed by echocardiogram or CT scanning

Question 19

What is the treatment of dissection?

Answer 19

Question 20

What is the pathology of takayasu’s arteritis?

Answer 20

Stenosis due to fibrosis - scarring of the blood vessels due to repeated inflammation (bracocephalic, left common carotid, left subclavean)

Granulomas present in artery wallls

Question 21

What are the common signs and symptoms of Takayasu’s arteritis?

Answer 21

Weak / absent peripheral pulses, difference in blood pressure between arms is possible

Bad/blurry/double vision

Reduced cognition

Bruit and thrill in carotid if stenosed

Question 22

What is the treatment for takayasu’s arteritis?

Answer 22

Steroids

Surgery

Question 23

What is cardiac syphilis?

Answer 23

Infection of the heart and related blood vessels by the syphilis bacteria

Question 24

What are the conditions associated with cardiac syphilis?

Answer 24

Narrowing of the blood vessels that supply blood to the heart, which may lead to heart attack and possibly death.

Damage to heart valves that may lead to heart failure. (aortic regurgitation)

Aortic aneurysm. If a vessel becomes weak enough, it can rupture and cause death.

Question 25

What are the types of congenital aortic aneurysm?

Answer 25

• Bicuspid Aortic Valve
• Marfan’s Syndrome
• Coarctation

Question 26

What causes the formation of a bicuspid valve?

Answer 26

The fusion of two cusps, so only two functional cusps

Question 27

What are the complications of bicuspid aortic valve?

Answer 27

Prone to stenosis and regurgitation

Associated with coarctation

Abnormal aorta, meaning reduced tensile strength

Prone to aneurysm / dissection

Question 28

How do you monitor a bicuspid valve?

Answer 28

Echo / MRI

Question 29

Where does coarctation occur?

Answer 29

Close to where the ductus arteriosus inserts (ligamentum arteriosum)

Question 30

What are the three types of coarctation?

Answer 30

Question 31

What are the signs of coractation?

Answer 31

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, but right and left radio - femoral delay

Question 32

What are the symptoms of coarctation?

Answer 32

Question 33

What is one of the signs of coarctation on an X - ray?

Answer 33

Rib notching (colalteral circulation)

Question 34

What are the pathologies associated with marfan’s syndrome?

Answer 34