Aortic Disease

Question 1

What is an aneurysm?

Answer 1

Localised enlargement on an artery caused by weakening of the vessel wall

Question 2

What are the different types on aneurysm?

Answer 2

Saccular + fusiform = ‘true aneurysm’

False aneurysm
Dissecting aneurysm

Question 3

What is the difference between a ‘true’ and ‘false’ aneurysm?

Answer 3

A true aneurysm involves weakness and dilation of all three layers of the arterial wall

A false aneurysm is a rupture in the wall with a contained haematoma (by adventitial or surrounding soft tissue)

Question 4

What can cause a true aneurysm?

Answer 4

Hypertension
Atherosclerosis
Smoking
Collagen abnormalities
Trauma
Infection

Question 5

What can cause a false aneurysm?

Answer 5

Inflammation
Trauma
Iatrogenic

Question 6

What are the signs and symptoms on an aneurysm?

Answer 6

Asymptomatic
Symptoms based on location

SOB or even HF and AR if in ascending aorta
- Dysphagia and hoarseness

Sharp chest pain radiating to back between shoulder blades - possible dissection

Pulsatile mass
Hypotension

Aortic dissection can be acute - medical emergency
- can also be chronic

Question 7

What can cause a dissection?

Answer 7

Hypertension
Athersclerosis
Trauma
Marfan’s

Question 8

What is a dissection?

Answer 8

False lumen
Histology of a cystic medial necrosis
May occlude branches
Can rupture back into the true lumen or externally into pericardium or mediastinum
Dilation of ascending aorta may cause acute chronic regurgitation

Question 9

What are the signs/symptoms of a dissection?

Answer 9

Tearing, severe chest pain radiating to back
Collapse (tamponade)
Acute AR
External rupture
Beware inferior ST elevation

Reduced/absent peripheral pulses
Contralateral BP mismatch
Hypo/hypertension
Soft early AR
Pulmonary oedema
CXR usually shows widened mediastinum

Question 10

What investigations might be done in suspected aneurysm/dissection?

Answer 10

CXR
Echo
CT
Ultrasound

Question 11

What is the treatment for an aneurysm?

Answer 11

Surgery
Meticulous BP control
Sodium nitroprusside + beta blocker

Question 12

What is Takayasu’s Arteritis?

Answer 12

Granulomatous vasculitis
Affects females more than males
Affects aorta and main branches
Can cause stenosis, thrombosis, aneurysms, renal artery stenosis, neurological symptoms

Treated with steroids/surgery

Question 13

What congenital problems can affect the aorta?

Answer 13

Congenital aortic aneurysm (can be caused by any of the below)

Bicuspid aortic valve

Coarctation

Marfan’s

Question 14

What effect does a bicuspid aortic valve have?

Answer 14

Prone to stenosis +/- regurgitation
Associated with coarctation
Abnormal aorta (reduced tensile strength)
Prone to aneurysm/dissection
Monitor with echo/MRI
Most common congenital abnormality

Question 15

What effect does coarctation or the aorta have?

Answer 15

Narrowing below the left subclavian artery
- narrowing can occur close to where ductus arteriosus inserts

3 types

• preductal
• ductal
• post-ductal (most common)

Signs

• cold legs
• poor pulses
• if before L subclavian then radial/radial delay and RIGHT radial/femoral delay
• if after, R and L radiofemoral delay, no radial/radial delay

Symptoms

• heart failure
• failure to thrive
• hypotension in later life