Aortic diseas

Question 1

How many sinus of valsalva are there?

Answer 1

3, one right and one left (leading to the corornary arteries) and one non coronary sinus

Question 2

What is the sinotubular junction?

Answer 2

Just above the sinuses of vasalva (junction between ascending aorta and sinuses of valsalva)

Question 3

What 3 levels is the aortic route measured?

Answer 3

Level of the sinuses, level of the snotubular junction and the annulets (hinge points of aortic valve leaflets)

Question 4

What is in the intima/media/adventitial?

Answer 4

Intima = endothelial cells and subendothelial layer - collagen and elastic fibres  
Media = elastic/smooth muscle fibres
Adventitia = thin Rough n tough - collagen and elastic fibres (but not lamellae), prevents elastic arteries expanding beyond where they are supposed to expand.

Question 5

What are the risk factors for atherosclerosis?

Answer 5

Hypertension, 
Smoking
Family history
Diabetes
Hypercholesterolaemia
Males>Females

Question 6

Which gender more affeted/?

Answer 6

Males - females have more protection until the menopause

Question 7

What is an aneurysm? True/False (pseudo)/disecting?

Answer 7

An expansion of an artery vessels due to weakness of vessel wall.

True = all 3 layers of vessel expand together, false = rupture of wall leading to haematoma within adventitial layer or surrounding tisseu.

Disecting is when it starts to peel apart (split) the layers within the artery wall)

Question 8

Conditions linked with true aneurysms?

Answer 8

Hypertension
Atherosclerosis
Smoking
Bicuspid aortic valve
Collagen abnormalities (eg marfans)
Infection (eg Mycotic/syphillis)
Trauma

Question 9

True/pseudoanyerusm more likely to rupture?

Answer 9

Pseudo as the layer the blood is going into isn’t the full thickness of the evssle wall and an be very thin.

Question 9

False causes

Answer 9

Iatogenic (nknown)
trauma
Inflammation (eg endocarditis)

Question 10

Signs and symptoms, when found?

Answer 10

Often asymptomatic and will be picked up on another scan/investigation for something else.

back pain,
Shortness of breath (related to aortic regurgitation)
Dysphagia and hoaseness
Dissection = sharp pain radiating to the back , hypotension
Potentially pulsatile mass if abdominal aorta (hard to feel otherwise as other structures in the way

Question 11

Investigations? What show?

Answer 11

CXR – widened mediastinum
Echocardiogram – assess aortic root size and aortic valve (limited views of distal ascending aorta and arch)

Main ones are:
CT angiogram aorta – diagnostic
MRI aorta – diagnostic and follow-up

Other tests: TOE and invasive aortogram – rarely done

Question 12

Diagnostic tests?

Answer 12

CT angiogram aorta

Question 13

Why is MRI used for follow ups?

Answer 13

To reduce radiation from CTs

Question 14

What is an aortic disection? What can it be caused by? What does it look like histologically? What can it cause?

Answer 14

When the blood starts peeling apart eh t media and adventitia.

Can be caused by:
Hypertension
Atherosclerosis
Marfan's syndrome 
Bicuspid aortic valve
Trauma

Histologically looks like Cystic medial necrosis (easily cracked and broken.

Can rupture - could cause tamponade if in pericardium, occlude branches eg coronary artery, dilatation of ascending aorta could lead to aortic regurgitation.

Question 15

What do Type A or Type B refer to in STanford classification?

Answer 15

Type A involves ascending aorta, Type B doesn’t involve ascending aorta

Question 16

Presentation of Aortic disection?

Answer 16

Chest pain - severe and could radiate to back
Collapse (tamponade, acute AR, external rupture)
Stroke (involvement of carotid arteries)

Reduced or absent peripheral pulses
Hypertension or hypotension - mainly hypertension unless it has ruptured in which case hypotension
BP mismatch between sides
Soft early diastolic murmur (aortic regurgitation)
Pulmonary oedema
Signs of CVA

Question 17

Limitations of Transthoracic echocardiogram (TTE)

Answer 17

Lots of other structures in ht eway and so can’t see everything. Only see aortic root and proximal part of ascending aorta.

Question 18

Investigation of choice for Aortic Dissection

Answer 18

CT angiogram aorta

Question 19

Mortality rate of Aortic Dissection

Answer 19

50%

Question 20

Treatment for aortic disections

Answer 20

Type A - more of a medical emaergency, so controlling the blood pressure and then emergency surgery

Type B main concern is controlling the Blood pressure and then also considering Percuraneous (endo-vascular) intervention

Question 21

What drugs are used to control the Blood pressure?

Answer 21

beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside- mst be v careful with this last one as easy to over do ut.

Question 22

What is Takayasu Arteritis?

Answer 22

A granulomatus disease (Granulomatous vasculitis) leading to Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx and treated with Steroids and immunosuppressive Tx.

Affects females more than males

Question 23

Syphilis cause and cardiac issues relating to it?

Answer 23

Caused by bacteria - Treponema pallidum
Is a STD. Cardiac issues relating to it include:
Syphilitic aortitis – aneurysm
Aortic regurgitation

Question 24

Name 3 congenital cardiac abnormality

Answer 24

Bicuspid Aortic Valve (main one)

Coarctation

Marfan’s Syndrome

Question 25

What is aortic coarctation? Pre, post and ductal meaning what?

Answer 25

Caused by the ligamentum arteriosum (ductus arteriosis), tugging on the aorta and causing aortic narrowing.

3 places it can occur:

Pre-ductal (above ductus arteriosis)
Ductal
Post ductal (most common - causes hypertension in upper limbs and hypotention/weak pulse in lower limbs)

Question 26

Signs and presentations of coarctations

Answer 26

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

In infancy = heart failure/failure to thrive

In adults= Hypertension, CV complications

Question 27

Treatments of coarctations

Answer 27

Surgery or precutaneous(stent) correction

Question 28

What is Marfan’s? Main problems and especially when?

Answer 28

Congenital disease of fibrillin 1 gene. Can lead to annyueurisms and regurgitations amongst other things, especially when pregnant.