Aortic disease Flashcards

1
Q

What is an aneurysm

A

Localised enlargement of artery caused by weakening of vessel wall

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2
Q

What are the different types of aneurysms

A
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3
Q

What is the difference between true and false aneurysm

A

True aneurysm:
Weakness an dilation of 3 layers
Associated with
Hypertension
Atherosclerosis
Smoking
Bicuspid aortic valve
Collagen abnormalities (Marfan’s)
Infection (mycotic/syphillis)
Trauma

False aneurysm
Rupture of wall of aorta with haematoma
Aetiology:
Trauma
Latrogenic
Inflammation

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4
Q

What do the classifications of aortic aneurysm by site look like

A
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5
Q

What are the signs and symptoms of aortic aneurysm

A

Shortness of breath (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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6
Q

WHat are the investigations for thoracic 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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7
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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8
Q

What are the classifications of aortic dissection

A

no.1 Type A
no.2 Type A
no.3 Type B

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9
Q

What are the symptoms of Aortic dissection

A

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

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10
Q

What are the signs of aortic dissection

A

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

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11
Q

What are the investigations for aortic dissection

A

ECG – might show ST elevation/ischaemia indicating coronary involvement
CXR - widened mediastinum
Transthoracic echocardiogram (TTE) – assess aortic root (limited views), aortic regurgitation? pericardial effusion ?
CT angiogram aorta - confirms diagnosis

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12
Q

WHat are the different treatment options for aortic dissection

A

Type A
Blood Pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Emergency Surgery

Type B
Blood pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Percuraneous (endo-vascular) intervention

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13
Q

What is takayasu,s arthritis

A

Granulomatous vasculitis
Females>Males
Aorta & main branches
Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx
Steroids and immunosuppressive Tx
Surgery and percutaneous intervention may be required

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14
Q

What is aortic coarctation

A

Aortic narrowing close to where Ductus arteriosus inserts
(ligamentum arteriosum)
3 types:
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

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15
Q

What are the signs of coarctation

A

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

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16
Q

What are the investigations for coarctation

A
17
Q

What are the treatments for coarctation

A

Percutaneous o surgical correction