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2. Cardiovascular System > 37. Aortic Disease > Flashcards

37. Aortic Disease Flashcards

1
Q

What are the 3 branches of the aorta?

A
  1. brachiocephalic artery (splits into right common carotid artery and right subclavian artery)
  2. left common carotid artery
  3. left subclavian artery
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2
Q

What is found within the aortic root?

A
  1. sinotubular junction
  2. right and left coronary ostrium
  3. right and left sinus of valsalva (give rise to coronary arteries; there are 3: one anterior (gives rise to right coronary artery) and two posterior; left posterior gives rise to left coronary artery and right posterior doesn’t give rise to any vessels)
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3
Q

What are 3 layers of the aorta?

A
  1. tunica intima
  2. tunica media
  3. tunica adventitia
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4
Q

What makes up tunica intima?

A
  • layer of endothelial cells
  • subendothelial layer made of collages and elastic fibres
  • internal elastic membrane separates it from tunica media
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5
Q

What makes up tunica media?

A
  • smooth muscle cells

- secrete elastin in the form of sheets or lameliae

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6
Q

What makes up tunica adventitia?

A
  • thin connective tissue layer
  • collagen fibres and elastic fibres
  • the collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole
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7
Q

When does atherosclerosis begin?

A

in early childhood

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8
Q

What are risk factors for atherosclerosis?

A
  1. hypertension
  2. hypercholesterolaemia
  3. smoking
  4. diabetes (and its control)
  5. family history
  6. male>female (relative protection in females until menopause)
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9
Q

Describe the stages of atherosclerotic plaque. (6)

A
  1. foam cells
  2. fatty streak
  3. intermediate lesion
  4. atheroma
  5. fibrous plaque
  6. complication lesion/ rupture
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10
Q

What is atherosclerosis the leading cause of? (3)

A
  1. stroke
  2. MI
  3. aneurysm
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11
Q

Define aneursm.

A

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

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12
Q

What are 4 different types of aneurysms?

A
  1. Saccular (true aneurysm)
  2. fusiform (true aneurysm)
  3. false aneurysm
  4. dissecting aneurysm
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13
Q

What does a saccular aneurysm look like?

A
  • have a characteristic rounded shape

- true aneurysm involves the formation of the aneurysm sac from the arterial wall with at least one unbroken layer

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14
Q

What does a fusiform aneurysm look like?

A
  • spindle shaped aneurysm

- true aneurysm involves the formation of the aneurysm sac from the arterial wall with at least one unbroken layer

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15
Q

What does a false aneurysm look like?

A
  • usually caused by trauma
  • the wall of the blood vessel is ruptured and blood escapes into surrounding tissues and forms a clot.
  • because of pressure within the clot arising from the heart’s contractions, the clot often pulsates against the examiner’s hand as does a true aneurysm.
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16
Q

What does a dissecting aneurysm look like?

A

one resulting from hemorrhage that causes lengthwise splitting of the arterial wall, producing a tear in the inner wall (intima) and establishing communication with the lumen of the vessel. It usually affects the thoracic aorta but can also occur in other large arteries

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17
Q

What determines whether an aneurysm is true or false?

A

the layers involved

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18
Q

What is a true aneurysm? What is it associated with? (7)

A
  • weakness and dilation of wall in ALL 3 layers
  • associated with: hypertension, atherosclerosis, smoking, colagen abnormalities, Marfan’s cystic medal necrosis, trauma or infection (mycocic/ syphillis)
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19
Q

What infection is the most common to cause an aneurysm?

A

syphillis

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20
Q

What is a false aneurysm? What is it associated with?

A
  • rupture of aortic wall with the haemorrhage either contained in the adventitial layers or by surrounding tissue
  • third layer is still intact
  • associated with:
  • inflammation (e.g. endocarditis with septic emboli)
  • trauma
  • iatrogenic (caused by illness)
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21
Q

What can be felt/ examined with false aneurysms? (3)

A
  • thrills
  • bruits
  • pulsatile mass
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22
Q

What does false aneurysm put the body at risk of? (2)

A
  1. ischaemia

2. rupture

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23
Q

What are the common aortic aneurysm sites? (4)

A
  1. in ascending aorta
  2. aortic arch aneurysm
  3. descending aorta aneurysm
  4. abdominal aorta aneurysm
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24
Q

What are signs and symptoms of aortic aneurysm based on?

A

based on location of the aneurysm

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25
Q

Are most aneurysms symptomatic?

A

No, most are asymptomatic and are discovered by chance on echo or chest x ray where dilated aorta will be seen

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26
Q

What are the signs and symptoms of thoracic aortic aneurysms? (8)

A
  1. shortness of breath (dyspnoea)
  2. heart failure
  3. dysphagia (difficulty swallowing) and hoarseness (ascending aorta, chronic)
  4. sharp, sudden chest pain radiating to the back (between should blades; possible dissection)
  5. pulsatile mass
  6. hypotension (compliance of aorta isn’t good)
  7. unequal arm pulses
  8. acute limb ischaemia
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27
Q

What is an aortic dissection?

A
  • tear in the INNER wall of aorta
  • blood forces walls apart (at high pressure from l.ventricle)
  • acute (medical/surgical emergency) or chronic
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28
Q

What is a Debakey Type 1 thoracic aortic dissection?

A

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

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29
Q

What is a Debakey Type 2 thoracic aortic dissection?

A

Original in and is confined to the ascending aorta

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30
Q

What is a Debakey Type 3 thoracic aortic dissection?

A

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

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31
Q

What is Stanford Type A thoracic aortic dissection?

A

All dissections involving the ascending aorta regardless of site of origin

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32
Q

What is Stanford Type B thoracic aortic dissection?

A

All dissections NOT involving the ascending aorta

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33
Q

What is the aetiology for aortic dissection? (4)

A
  1. hypertension
  2. atherosclerosis (weakens layers of aorta)
  3. trauma
  4. Marfan’s
34
Q

What is seen on histology in aortic dissection?

A

cystic medial necrosis

35
Q

Describe the pathophysiology of aortic dissection.

A
  • false lumen is created by first layer which is teared and second layer creates the aneurysm
  • false lumen can progress in an antegrade or retrograde direction
36
Q

What branches can aortic dissection occlude? (4)

A

Branches such as mesenteric, carotid, renal, spinal etc and more!

37
Q

What can a dissection rupture cause?

A

Blood backs into the lumen or externally in to the pericardium which causes a temponade or mediastinum

38
Q

What cardiac condition can be caused as a result of a dilated ascending aorta?

A

acute aortic regurgitation (which can be present as heart failure)

39
Q

What are symptoms and signs of aortic dissection?

A
  1. tearing, severe chest pain radiating to the back; interscapular or anterior chest
  2. Collapse (due to temponade, acute aortic regurgitation, external rupture)
  3. inferior ST elevation
  4. nausea
  5. sweating and vomiting
  6. syncope
40
Q

What does an aortic dissection involving a coronary artery cause?

A

myocardial ischaemia (and eventually death)

41
Q

What does an aortic dissection involving a rupture into a pericardium cause?

A

acute temponade ( and eventually death)

42
Q

What is found on examination in aortic dissection patients? (5)

A
  1. reduced or absent peripheral pulses (BP mismatch between sides)
  2. hypotension/ hypertension
  3. soft early diastolic murmur (aortic regurgitation)
  4. pulmonary oedema
  5. chest x ray shows widened mediastinum
43
Q

What investigations should be done to diagnose an aortic dissection? (4)

A
  1. chest x ray
  2. echo (transthoracic (TTE) or tranoesophageal (TOE)
  3. cardiac CT
  4. MRI
44
Q

What is the treatment for Type A aortic aneurysm? (ascending aorta involved)

A

Surgery

45
Q

What is the treatment for Type B aortic aneurysm (not ascending aorta involved)? (3)

A
  • meticulous BP control
  • sodium nitroprusside plus beta blocker
  • tend to be managed medically through drugs for BP control
46
Q

What 2 infective and inflammatory infections can lead to aneurysms?

A

1 infective: syphyllis

2. inflammation: Takayasu’s arteritis

47
Q

What medication is best avoided in aortic dissection patients?

A

ACEIs (until involvement of renal arteries has been excluded)

48
Q

What antihypertensive drug therapy can be used at treatment for type B aneurysms? (3)

A
  • beta blockers
  • vasodilators e.g. hydralazine, nitrates and Ca antagonists (nifedipine or amlodipine)
  • labetalol (combined alpha and beta blocker)
49
Q

What type of disease is Takayasu’s arteritis?

A

Granulomatous vasculitis (inflammation of the aorta and pulmonary arteries)

50
Q

Is Takayasu’s arteritis more common in males or females?

A

females

51
Q

What structures does Takayasu’s arteritis affect?

A

aorta and its main branches

52
Q

What does Takayasu’s arteritis cause? (5)

A
  1. stenosis/ narrowing
  2. thrombosis
  3. aneurysms
  4. renal artery stenosis
  5. neurological symptoms
53
Q

What is the main treatment for Takayasu’s arteritis? (2)

A
  1. steroids

2. surgery

54
Q

What bacteria causes syphilis that can lead to aneurysms?

A

treponema pallidum

55
Q

What type of infective disease is syphilis?

A

an STD

56
Q

What prevents later stages of syphilis?

A

antibiotics

57
Q

What does primary syphilis cause the formation of on the skin?

A

chancre: painless ulcers (sores) forming approx. 21 days after syphilis exposure

58
Q

Without treatment, what 3 types of syphilis do 1/3 of patients develop?

A
  1. late neuro-syphillis
  2. gummatous syphilis
  3. cardiac syphilis
59
Q

When does cardiac syphilis present itself?

A

10-30 years post infection

60
Q

What 2 conditions can cardiac syphilis cause?

A
  1. syphilitic aortitis (causing aortic aneurysms)

2. aortic regurgitation

61
Q

What can cause a congenital aortic aneurysm? (3)

A
  1. biscuspid aortic valve
  2. coarctation of aorta
  3. Marfan’s syndrome
62
Q

Why is bicuspid aortic valve so dangerous?

A
  • presents fine at young age and at later stages in life can cause problems
  • prone to stenosis and regurgitation
  • 1-2% prevalence
63
Q

What can a bicuspid valve be often associated with?

A

coarctation of the aorta (but not always)

64
Q

What does a bicuspid aortic valve lead to?

A
  • abnormal aorta with reduced tensile strength

- aorta more prone to aneurysm or dissection

65
Q

What are bicuspid aortic valves monitored with? (2)

A
  • echo

- MRI

66
Q

Where does the tear in aortic dissection occur?

A

In the intima layer (inner layer) of the aorta

67
Q

In which two types of aorta can aortic dissection usually happen?

A

usually in thoracic aorta or abdominal aorta

68
Q

What happens when a tear occurs in the aorta during a dissection?

A
  • tear forms 2 channels; one where blood continues to travel and one where blood stays still
  • If the channel with non-traveling blood gets bigger, it can push on other branches of the aorta. This can narrow the other branches and reduce blood flow through them.
  • aortic dissection can also cause abnormal widening and ballooning of the aorta leading to an aneurysm
69
Q

What 3 shunts exist in a coarctation of aorta?

A
  1. ductus arteriosus
  2. foramen ovale
  3. ductus venosus
70
Q

Where does aortic narrowing usually occur in coarctation of the aorta?

A

Close to where the ductus arteriosus inserts (ligamentum arteriosum; remnant of ductus arteriosis)

71
Q

What are 3 types of coarctation of aorta?

A
  1. pre-ductal
  2. ductal
  3. post-ductal
72
Q

What can pre-ductal coarctation cause? What can it be related to?

A
  • 5% can be related to Turner’s

- can be life threatening of severe narrowing

73
Q

What does post-ductal coarctation cause?

A
  • most common in adults
  • causes hypertension in upper extremities
  • weak pulses in lower limbs
  • associated with rib-notching (collateral circulation)
74
Q

What are signs of aortic coarctation? (6)

A
  1. cold legs
  2. poor leg pulses
  3. hypertension
  4. headaches
  5. chest pain
  6. muscle weakness or leg cramps
75
Q

If there is coarctation of aorta before l. subclavian artery, what does this cause? (2)

A
  • Radial-radial delay

- right radial -femoral delay only

76
Q

If there is coarctation of aorta after l.subclavian artery, what does this cause? (2)

A
  • no radial-radial delay

- right AND left radio-femoral delay

77
Q

What are symptoms of coarctation of aorta in infancy? (4)

A

More severe

  • heart failure
  • failure to thrive
  • acidosis
  • poor perfusion to lower limbs
78
Q

What are symptoms of coarctation of aorta in later life? (5)

A
  • hypertension
  • muscle cramps/ weakness
  • nosebleeds and headaches
  • possible neurological changes
  • cold legs
79
Q

What gene is associated with Marfan’s? What does it cause

A

Fibrillin 1 gene; causes muscle weakness

80
Q

What cardiac symptoms can Marfan’s cause? (3)

A
  1. aneurysm
  2. dissection
  3. aortic/ mitral valve prolapse or regurgitation
81
Q

What other symptoms does Marfan’s cause in the eyes, skeletal system and lungs?

A
  • eyes: cataract (clouding in the lens leading to decreased vision) and lens discolouration
  • lungs: pneumothorax
  • skeletal problems; stature

2. Cardiovascular System (42 decks)

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