Aortic diseas Flashcards
How many sinus of valsalva are there?
3, one right and one left (leading to the corornary arteries) and one non coronary sinus
What is the sinotubular junction?
Just above the sinuses of vasalva (junction between ascending aorta and sinuses of valsalva)
What 3 levels is the aortic route measured?
Level of the sinuses, level of the snotubular junction and the annulets (hinge points of aortic valve leaflets)
What is in the intima/media/adventitial?
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.
What are the risk factors for atherosclerosis?
Hypertension, Smoking Family history Diabetes Hypercholesterolaemia Males>Females
Which gender more affeted/?
Males - females have more protection until the menopause
What is an aneurysm? True/False (pseudo)/disecting?
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)
Conditions linked with true aneurysms?
Hypertension Atherosclerosis Smoking Bicuspid aortic valve Collagen abnormalities (eg marfans) Infection (eg Mycotic/syphillis) Trauma
True/pseudoanyerusm more likely to rupture?
Pseudo as the layer the blood is going into isn’t the full thickness of the evssle wall and an be very thin.
False causes
Iatogenic (nknown)
trauma
Inflammation (eg endocarditis)
Signs and symptoms, when found?
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
Investigations? What show?
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
Diagnostic tests?
CT angiogram aorta
Why is MRI used for follow ups?
To reduce radiation from CTs
What is an aortic disection? What can it be caused by? What does it look like histologically? What can it cause?
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.
What do Type A or Type B refer to in STanford classification?
Type A involves ascending aorta, Type B doesn’t involve ascending aorta
Presentation of Aortic disection?
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
Limitations of Transthoracic echocardiogram (TTE)
Lots of other structures in ht eway and so can’t see everything. Only see aortic root and proximal part of ascending aorta.
Investigation of choice for Aortic Dissection
CT angiogram aorta
Mortality rate of Aortic Dissection
50%
Treatment for aortic disections
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
What drugs are used to control the Blood pressure?
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside- mst be v careful with this last one as easy to over do ut.
What is Takayasu Arteritis?
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
Syphilis cause and cardiac issues relating to it?
Caused by bacteria - Treponema pallidum
Is a STD. Cardiac issues relating to it include:
Syphilitic aortitis – aneurysm
Aortic regurgitation
Name 3 congenital cardiac abnormality
Bicuspid Aortic Valve (main one)
Coarctation
Marfan’s Syndrome
What is aortic coarctation? Pre, post and ductal meaning what?
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)
Signs and presentations of coarctations
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
Treatments of coarctations
Surgery or precutaneous(stent) correction
What is Marfan’s? Main problems and especially when?
Congenital disease of fibrillin 1 gene. Can lead to annyueurisms and regurgitations amongst other things, especially when pregnant.
