Aortic disease

Question 1

aneurysm

Answer 1

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

Question 2

true aneurysm

Answer 2

weakness and dilation of wall. involves 3 layers

Question 3

true aneurysms are associated with

Answer 3

hypertension, atherosclerosis, smoking, bicuspid aortic valve, collagen abnormalities, infection, trauma

Question 4

false aneurysm

Answer 4

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

Question 5

false aneurysm caused by

Answer 5

trauma, iatrogenic, inflammation eg endocarditis with septic emboli

Question 6

sites of aortic aneurysm

Answer 6

ascending, aortic arch, descending, abdominal

Question 7

signs and symptoms of thoracic aneurysm

Answer 7

asymptomatic, based on location- SOB (aortic regurgitation), dysphasia, hoarseness, sac pain, symptoms of dissection- sharp chest pain radiating to back between shoulder blades and hypotension, pulsatile mass

Question 8

investigations for thoracic aneurysms

Answer 8

CXR- widened mediastinum, Echocardiogram- asses aortic root size and aortic valve, CT angiogram aorta- diagnostic, MRI aorta- diagnostic and follow up, TOE and invasive aortogram (rare)

Question 9

aortic dissection

Answer 9

tear in the inner wall of the aorta, blood forces walls apart, acute is a medical and surgical emergency, can be chronic. may occlude branches, false lumen can progress in integrate or retrograde direction

Question 10

risk factors of dissection

Answer 10

hypertension, atherosclerosis, marfans syndrome, bicuspid aortic valve, trauma

Question 11

you will find what in histology if dissection

Answer 11

cystic medial necrosis

Question 12

dilation of ascending aorta may cause

Answer 12

acute aortic regurgitation

Question 13

rupture can occur where

Answer 13

back into lumen, externally in to pericardium, or mediastinum

Question 14

stanford and debakey classification

Answer 14

classification for type of aortic dissection. stanford type A and B, debakey type 1, 11 and 111

Question 15

Stanford type A and B

Answer 15

A includes ascending aorta B does not

Question 16

debakey type 1, 11,111

Answer 16

1 originates in ascending aorta and propagates at least to aortic arch and often beyond II originates in and is confined to ascending aorta, III originates in the descending aorta and extends distally down the aorta or rarely retrograde into aortic arch and ascending

Question 17

symptoms of aortic dissection

Answer 17

chest pain severe sharp radiates to back, collapse if tamponade, acute AR, external rupture, and stroke if involved in carotid arteries

Question 18

examination of aortic dissection

Answer 18

reduced or absent peripheral pulses, hyper or hypotension, BP mismatch, soft early diastolic murmur (aortic regurgitation), pulmonary oedema, signs of CVA

Question 19

investigations of aortic dissection

Answer 19

ECG- might show ST elevation/ischaemia indicating coronary involvement
CXR- widened mediastinum
transthoracic echocardiogram- assess aortic root, aortic regurgitation?, pericardial effusion?
CT angiogram aorta- confrims diagnosis

Question 20

mortality rate pre hospital

Answer 20

approx 50%

Question 21

treatment for type A

Answer 21

blood pressure control eg beta blocker, calcium channel blocker etc, emergency surgery

Question 22

treatment type B

Answer 22

blood pressure control eg beta blocker, calcium channel blocker etc, percuraneous (endo-vascular) intervention if necessary

Question 23

infections and inflammatory conditions that can predispose a patient to aortic disease

Answer 23

takayasu’s arteritis, syphilus

Question 24

takayasu’s arteritis what is and treatment

Answer 24

granulomatous vasculitis, females more, affects aorta and main branches
stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx
steroids and immunosuppressive Tx
surgery and percutaneous intervention may be required

Question 25

syphilus what is and treatment

Answer 25

STD, treponema pallidum, antibiotics prevent late stages, tertiary syphilus can become cardiac syphilus- can occur up to 30 years post infection causing aneurysm and aortic regurgitation

Question 26

congenita aortic aneurysms

Answer 26

bicuspid aortic valve, coarctation, marfans syndrom

Question 27

bicuspid aortic valve

Answer 27

valve only has 2 instead of 3 valves, most common congenital abnormality, associated with coarctation, abnormal aorta and reduced tensile strength, prone to aneurysm, monitor with echo/MRI

Question 28

coarctation

Answer 28

narrowing of aorta close to where ductus arteriosus inserts. 3 types- pre ductal, ductal, post ductal

Question 29

pre ductal coarctation

Answer 29

5% turners, can be life threatening if severe narrowing

Question 30

post ductal coarctation

Answer 30

most common in adults- hypertension in upper extremities, weak pulses in lower limbs

Question 31

signs of coarctation

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, right and left radio-femoral delay

Question 32

symptoms of coarctation

Answer 32

infancy- heart failure or failure to thrive, later life- hypertension, CV complications eg mi, heart failure, aortic dissection

Question 33

imaging signs of coarctation

Answer 33

notching of ribs

Question 34

treatment of coarctation

Answer 34

percutaneous or surgical correction

Question 35

marfans syndrome

Answer 35

fibrillar 1 gene, connective tissue weakness, aortic/mitral valve regurgitation, cataracts or lens dislocation, aneurysm, dissection, pneumothorax, risk increased during pregnancy