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CVS > Aortic Disease > Flashcards

Aortic Disease Flashcards

1
Q

What are the component parts of the aortic root

A
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2
Q

What are the layers of the aortic wall

A

Tunica intima
Tunica media
Tunica adventitia

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3
Q

Describe the tunica intima

A

Layer of endothelial cells
Subendothelial layer – collagen and elastic fibres
Separated from tunica media internal elastic membrane

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4
Q

Describe the tunica media

A

smooth muscle cells
secrete elastin in the form of sheets, or lamellae

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5
Q

Describe the tunica adventita

A

Thin CT layer
Collagen and elastic fibres (not lamellae)
Collagen prevents elastic arteries from stretching beyond their physiological limits during systole

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6
Q

What is an aneurysm

A

localised enlargement of an artery caused by weakening of vessel wall

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7
Q

What are the different types of aneurysm

A

True aneurysm - saccular, fusiform
False aneurysm, Dissecting aneurysm

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8
Q

What is a true aneurysm

A

Weakness & dilation of wall
Involves all 3 layers

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9
Q

What is a true aneurysm associated with

A
  • Hypertension
  • Atherosclerosis
  • Smoking
  • Bicuspid aortic valve
  • Collagen abnormalities (Marfan’s)
  • Infection (mycotic/syphillis)
  • Trauma
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10
Q

What is a false aneurysm

A

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

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11
Q

What is the aetiology of false aneurysm

A
  • Trauma
  • Iatrogenic
  • Inflammation ( eg endocarditis with septic emboli)
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12
Q

What are the different sites of aneurysms

A

Normal
Asceding aortic aneurysm
Aortic arch aneurysm
Descending aortic aneurysm
Abdominal aortic aneurysm

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13
Q

What are the signs and symptoms of aneurysms

A

Asymptomatic
Based on location of aneurysm.
* SOB (associated aortic regurgitation)
* Dysphagia and hoarseness
* Back pain
* Symptoms of dissection - sharp chest pain radiating to back (between shoulder blades), hypotension
* Pulsatile mass

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14
Q

What are the investigations for thoracic aortic aneurysms

A

CXR – widened mediastinum
Echocardiogram – assess aortic root size and aortic valve (limited views of distal ascending aorta and arch)
CT angiogram aorta – diagnostic
MRI aorta – diagnostic and follow-up

Other tests: TOE and invasive aortogram – rarely done

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15
Q

What is an aortic dissection

A

Tear in the inner wall of aorta
Blood forces walls apart
Acute –medical/surgical emergency
Chronic

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16
Q

What is the aetiology of dissections

A

Hypertension
Atherosclerosis
Marfan’s syndrome
Bicuspid aortic valve
Trauma

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17
Q

What is the histology of a dissection

A

cystic medial necrosis
False lumen can progress in antegrade or retrograde direction

18
Q

What is the consequnces of dissections

A

May occulde branches
Rupture - back into lumen, externally into mediastinum or pericardium (temponade)
Dilation of acsending aorta may cause acute aortic regurgitation

19
Q

What is the Stanford classification of dissections

A

Type A
Type B

20
Q

What is type A dissection

A

All dissections involve acsending aorta, regardless of site of origin

21
Q

What is type B dissection

A

All disections not involving acsending aorta

22
Q

What are the symtpoms of dissection

A

Chest pain – severe, sharp, radiating to back (inter-scapular)
Collapse (tamponade, acute AR, external rupture)
Stroke (involvement of carotid arteries)

23
Q

What is the examination (signs) for dissection

A

Reduced/absent peripheral pulses
Hyper or hypotension
BP mismatch between sides
Soft early diastolic murmur (aortic regurgitation)
Pulmonary oedema
Signs of CVA

24
Q

What are the investigations for dissection

A

ECG
CXR
Transthoracic echogardiogram (TTE)
CT angiogram aorta

25
Q

What will an ECG show

A

Might show ST elevation/ischaemia indicating coronary involvement

26
Q

What will a CXR show

A

Widened mediastinum

27
Q

What will a TTE show

A

Assess aortic root (limited views), aortic regurgitation, pericardial effusion

28
Q

What will a CT angiogram aorta tell us

A

Confirms diagnosis

29
Q

What is the treatment for type A dissection

A

Blood Pressure control
* beta blocker
* IVI nitrate
* calcium channel blocker
* IVI Sodium nitroprusside
Emergency Surgery

30
Q

What is the treatment for type B dissection

A

Blood pressure control
* beta blocker
* IVI nitrate
* calcium channel blocker
* IVI Sodium nitroprusside
Percutaneous (endo-vascular) intervention

31
Q

What can cause congenital aortic aneurysm

A

Bicuspid Aortic Valve
Coarctation
Marfan’s Syndrome

32
Q

Describe bicuspid aortic valve

A

2 cusps instead of 3
Most common congenital abnormality
1-2% prevalence
Abnormal aorta (reduced tensile strength)
Monitor with echo/MRI

33
Q

What is the risk of bicuspid aortic valve

A

Prone to aortic valve stenosis +/- regurgitation
Associated with coarctation
Prone to aneurysm/ dissection

34
Q

What is coarctation

A

Aortic narrowing close to where
Ductus arteriosus inserts

35
Q

What are the 3 types of coarctation

A

Pre-ductal - (5% turner’s) can be life-threatening if severe narrowing (B)
Ductal (A)
Post-ductal (C) –most common in adults – hypertension in upper extremities, weak pulses in lower limbs

36
Q

What are the signs of coarctation

A

Cold legs
Poor leg pulses
If before left subclavian artery:
*Palpate radial and RIGHT femoral, shows delay
If after left subclavian artery:
* No radial-radial delay
* Right and left radio-femoral delay

37
Q

What are the symptoms or coarctation

A

Infancy (severe)
* Heart failure
* Failure to thrive
Later life
* Hypertension
* CV complications (heart failure, MI, CVA, aortic dissection)

38
Q

What is the treatment of coarctation

A

Percutaneous or surgical correction

39
Q

What is marfans syndrome

A

Disorder that affects Fibrillin 1 gene

40
Q

What can marfans syndrome cause

A

CT weakness
Aortic/ Mitral valve prolapse – regurgitation
Aneurysm and dissection

41
Q

What else can marfans syndrome effect

A

Skeletal system
Eyes (cataract, lens dislocation)
Lungs (pneumothorax)
Risk increased during pregnancy

CVS (26 decks)

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