Aortic disease

Question 1

How is the aorta structured?

Answer 1

Tunica Intima
-Endothelium
_ Collagen and elastic fibres beneath that
- internal elastic membrane

Tunica media
- smooth muscle
-secrete elastin

Tunica adventitia
- Thin ct
- Collagen and elastic fibres
- the collagen prevents elastic arteries from over stretching in systole

Question 2

What is a true aneurysm?

Answer 2

Weakness and dilatation of wall involving all three layers.

Question 3

What is associated with a true aneurysm?

Answer 3

Hypertension
atherosclerosis
smoking
bicuspid aortic valve
Collagen abnormalities (Marfan’s)
Infection (mycotic/syphillis)
Trauma

Question 4

What is a false aneurysm?

Answer 4

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

Question 5

What causes a false aneurysm?

Answer 5

Trauma
Iatrogenic
Inflammation

Question 6

Investigations of thoracic aneurysms?

Answer 6

CT angiogram aorta and MRI aorta

sometimes cxr and echo

Question 7

What is an aortic dissection?

Answer 7

Tear in inner aortic wall
-similar aetiology to aneurysm

Question 8

Potential consequences of aortic dissection?

Answer 8

-Dilation of ascending aorta may cause acute aortic regurgitation
- Rupture
- Aortic branch occlusion
- False lumen can progress

Question 9

What are the classifications for aortic dissections?

Answer 9

Stanford type A: dissections involving ascending aorta
Type B: dissections not involving the ascending aorta

DeBakey:
- Type 1: Starts in ascending aorta, continues to aortic arch and often beyond it distally
- Type 2: Confined to ascending aorta
- Type 3: Starts in descending aorta and extends distally down the aorta

Question 10

Symptoms of dissection?

Answer 10

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

Question 11

Examination findings of dissection?

Answer 11

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

Question 12

Treatment for dissection?

Answer 12

BP control for both types A, B

surgery for type A and percutaneous intervention for B

Question 13

What is Takayasu’s Arteritis?

Answer 13

Granulomatous vasculitis of Aorta and branches
F>M
Treated with steroids and immunosuppressives
Surgery and PCI maybe

Question 14

What can cardiovascular conditions can untreated syphillis cause?

Answer 14

Aortitis (aneurysm)
Aortic regurgitation
Cardiac syphillis (10-30 yrs post infection)

Question 15

What clinical problems can a bicuspid aortic valve cause?

Answer 15

Coarctation
Aneurysm/dissection
Aortic valve stenosis +/- regurgitation
Weaker aorta

Question 16

Signs of aortic coarctation?

Answer 16

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 17

Symptoms of coarctation?

Answer 17

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

Question 18

Marfans syndrome?

Answer 18

Fibrillin 1 gene
Connective tissue weakness
Aortic/ Mitral valve prolapse – regurgitation
Skeletal system
Eyes (cataract, lens dislocation)
Vascular – aneurysm, dissection
Lungs (pneumothorax)
Aneurysm