Aortic disease Flashcards
What is the tunica intima ?
Layer of endothelial cells
Subendothelial layer- collagen and elastic fibres
Separated from tunica media internal elastic membrane
What is the tunica media ?
Smooth muscle cells
Secrete elastin in the form of sheets or lamellae
What is the tunica adventitia ?
Thin collective tissue layer
Collagen fibres and elastic fibres (not lamellae)
The collagen in the adventitia prevents elastic fibres from stretching beyond their limits during systole
What is the risk factors for atheroscleorsis ?
Hypertension Hypercholesterolaemia Smoking Diabetes Family history Male > female
What is the pathophysiology of atheroscleorsis ?
MI
Stroke
Peripheral vascular disease
Aneurysm
What is an aneurysm ?
A localised enlargement of an artery caused by a weakening of the vessel wall
What is a true aneurysm ?
Weakness and dilation of wall
Involves all 3 layers
What are true aneurysms associated with ?
Hypertension Smoking Atherosclerosis Bicuspid aortic valve Collagen abnormalities (marfans) Infection Trauma
What is a false anuerysm ?
Rupture of wall of aorta with the haematoma either contained by the thin adventitia layer or by the surrounding soft tissue
What is the aetiology of a false aneurysm ?
Trauma
Iatrogenic
Inflammation
What are the signs and symptoms of thoracic anuerysm ?
Asymptomatic Based on location SOB Dysphagia and hoarseness Back pain Symptoms of dissection- sharp chest pain radiating to back Pulsatile mass
What is the investigations of anuerysm ?
CXR- widened mediastinum ECHO- assess aortic root valve size and aortic valve CT angiogram aorta- diagnostic MRI aorta- diagnostic and follow up TOE and invasive aortogram
What is an aortic dissection ?
Tear in the inner wall of aorta
Blood forces walls apart
What type of aortic dissection is a medical emergency ?
Acute
What are the aetiological factors of dissection ?
Hypertension Atherosclerosis Marfans syndrome Bicuspid aortic valve Trauma
What is the Stanford classification of aortic dissection ?
Type A- all dissections involving the ascending aorta, regardless of site of origin
Type B- all dissections not involving ascending aorta
What is the symptoms of an aortic dissection ?
Chest pain- severe, sharp, radiating to back (inter-scapular)
Collapse (tamponade, acute AR, external rupture)
Stroke
What is the examination findings of an aortic dissection ?
Reduced or absent peripheral pulses Hypertension o hypotension BP mismatch between sides Soft early diastolic murmur Pulmonary oedema Signs of CVA
What are the investigations of aortic dissection ?
ECG- might show ST elevation/ ischaemia indicating coronary involvement CXR- widened mediastinum Transthoracic ECHO- assess aortic root CT angiogram aorta- confirms diagnosis ~50% mortality pre-hospital
What is the treatment for type A dissection ?
BP control:
- Beta-blocker
- IVI nitrate
- Ca channel blocker
- IVI sodium nitroprusside
Emergency surgeryWhat is the treatment of Type B dissection ?
BP control:
- Beta-blocker
- IVI nitrate
- Ca channel blocker
- IVI sodium nitroprusside
Emergency surgeryWhat is the presentation of Takayasu’s arteritis ?
Inflammation
Granulomatous vasculitis
F>M
Aorta and main branches
Stenosis, thrombosis, aneurysm, renal artery stenosis, neurological
Steroids and immunosuppressive
Surgery and percutaneous intervention may be needed
What is syphilis ?
STD
Treponema pallidum
Antibiotics prevents late stage
What is the presentation of bicuspid aortic valve ?
Most common congenital abnormality 1-2% prevalance Prone to aortic valve stenosis +/- regurgitation Associated with coarctation Abnormal aorta Prone to aneurysm/ dissection Monitor with ECHO/MRI
What is coarctation of aorta ?
Narrowing close to where ductus arteriosus inserts (ligamentum arteriosum)
What are the 3 types of coarctation ?
Pre-ductal 5%- can be life-threatening if severe narrowing
Ductal
Post-ductal- most common in adults- hypertension in upper extremities
What are the signs of coarctation ?
Cold legs
Poor leg pulses
If before left subclavian- radial-radial right radial-femoral delay
If after left subclavian- no radial-radial delay
Right and left radio-femoral delay
What are the symptoms of coarctation ?
Heart failure
Failure to thrive
Hypertension
CV complications
What is the treatment of coarctation ?
Percutaneous or surgical correction
