Aortic Disease

Question 1

Where are the measurements of the aortic root taken?

Answer 1

The annulus - where the aortic valve leaflets hinge or get attached to the myocardium.
The sinus of Valsalva diameter.
The sinotubular junction diameter.

Question 2

What is a true aneurysm?

Answer 2

A weakness and dilation of the artery wall, involving all three tunica layers.
Caused by atherosclerosis, hypertension, smoking, a bicuspid aortic valve, Marfan’s syndrome, infection, or trauma.

Question 3

What is a false aneurysm?

Answer 3

A rupture of the aortic wall, with the haematoma either contained by the adventitia or by the surrounding soft tissue.
Caused by trauma, inflammation, or iatrogenic.

Question 4

What are the different types of aortic aneurysms?

Answer 4

Ascending aorta.
Aortic arch.
Descending aorta.
Abdominal aorta.

Question 5

What are the signs of a thoracic aneurysm?

Answer 5

Sharp chest pain, radiating to the back, between the shoulder blades.
Hypotension.
Pulsatile mass.

Question 6

What are the symptoms of a thoracic aneurysm?

Answer 6

SOB - associated with aortic regurgitation.
Dysphagia and hoarseness.
Back pain.
Asymptomatic.

Question 7

What are the investigations for a thoracic aneurysm?

Answer 7

CXR - widened mediastinum.
Echocardiogram - assesses aortic root size and aortic valve (limited for the distal ascending aorta and arch).
CT angiogram aorta and MRI aorta - diagnostic.

Question 8

What is an aortic dissection?

Answer 8

A tear in the inner wall of the aorta.
Blood forces the walls apart.

Question 9

What are the risk factors for aortic dissection?

Answer 9

Hypertension.
Atherosclerosis.
Marfan’s syndrome.
Bicuspid aortic valve.
Trauma.

Question 10

What is the histology of aortic dissection?

Answer 10

Cystic medial necrosis.
A false lumen can progress, in an antegrade or retrograde direction.

Question 11

What are the complications of aortic dissection?

Answer 11

Occlusion of artery branches.
Rupture - can cause cardiac tamponade.
Dilation of the ascending aorta may cause acute aortic regurgitation.

Question 12

What are the different classifications of aortic aneurysms?

Answer 12

Stanford - Type A = ascending aorta, Type B = not ascending aorta.
DeBakey - three types, depends on origin and extension.

Question 13

What are the signs of aortic dissection?

Answer 13

Collapse - tamponade, acute AR, rupture.
Stroke.
Reduced/absent peripheral pulses.
Extreme or mismatched BP.
Soft early diastolic murmur - AR.
Pulmonary oedema.

Question 14

What are the investigations for aortic dissection?

Answer 14

CXR - widened mediastinum.
ECG - ST elevation or ischaemia.
TTE - assesses aortic root (limited views).
CT angiogram aorta - diagnostic.

Question 15

What is the treatment for aortic dissection?

Answer 15

Control of blood pressure (BBs, nitrates, CCBs, IVI sodium nitroprusside).
Type A - emergency surgery.
Type B - percutaneous intervention.

Question 16

What is Takayasu’s arteritis?

Answer 16

Granulomatous vasculitis of the aorta and its main branches.

Question 17

What are the signs and treatment of Takayasu’s arteritis?

Answer 17

Signs - (renal artery) stenosis, thrombosis, aneurysms, neurological effects.
Treatment - steroids, immunosuppressive drugs, surgery, percutaneous intervention.

Question 18

What is syphilis?

Answer 18

An STD caused by T. Pallidum.
Antibiotics prevent late stages.

Question 19

What is cardiac syphilis?

Answer 19

An untreated syphilis complication.
Occurs 10-30 years post-infection.
Syphilitic aortitis can cause aneurysms and aortic regurgitation).

Question 20

What is a bicuspid aortic valve?

Answer 20

The most common congenital abnormality.
An abnormal aorta (reduced strength).
Prone to aortic valve stenosis +/- regurgitation, aneurysms, dissection.
Associated with coarctation.
Investigations - ECHO, MRI.

Question 21

What are the different types of coarctation of the aorta?

Answer 21

Pre-ductal - can be life-threatening.
Ductal.
Post-ductal (C) - most common in adults; hypertension in the upper extremities; weak lower limb pulses. Associated with rib-notching (collateral circulation).

Question 22

What are the symptoms of coarctation of the aorta?

Answer 22

Cold legs, poor leg pulses.
If before LSA - radial-radial and right radio-femoral delay.
If after LSA - no radial-radial delay, right and left radio-femoral delay.

Question 23

What are the signs and treatment of coarctation of the aorta?

Answer 23

Infancy (severe) - heart failure, failure to thrive.
Later life - hypertension, MI, CVA, aortic dissection.

Treatment - percutaneous or surgical correction.

Question 24

What is Marfan’s syndrome?

Answer 24

A CT weakness due to a mutation of Fibrillin 1.
Risk increased during pregnancy.

Question 25

What are the signs and symptoms of Marfan’s syndrome?

Answer 25

Aortic/Mitral valve prolapse (regurgitation).
Cataracts, lens dislocation, aneurysm, dissection, pneumothorax.