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Cardiovascular System > Aortic Disease > Flashcards

Aortic Disease Flashcards

1
Q

What is the basic histology of the tunica intima?

A

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

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2
Q

What is the basic histology of the tunica media?

A

Smooth muscle cells

Secrete elastin in the form of sheets or lamellae

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3
Q

What is the basic histology of the tunica adventitia?

A

Thin connective tissue layer
Colagen fibres and elastic fibres
The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole

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4
Q

When does atherosclerosis begin?

A

In early childhood

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5
Q

What are the risk factors for atherosclerosis?

A 
Hypertension
Hypercholesterolaemia
Smoking 
Diabetes
Family history 
Male
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6
Q

What are the possible outcomes of atherosclerosis?

A

Stroke
MI (ischaemia and infarction)
Aneurysm

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7
Q

What is an aneurysm?

A

A localised enlargement of an artery caused by a weakening of the vessel wall

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8
Q

What are the features of a true aneurysm?

A

Weakness and dilatation of the wall involving all 3 layers
Associated with hypertension, atherosclerosis, smoking and collagen abnormalities
Also associated with trauma and infection

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9
Q

What are the features of a false aneurysm

A 
Rupture of the wall of the aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue 
Inflammation
Thrill
Bruit
Pulsatile mass
Ischaemia 
Rupture
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10
Q

What are the signs and symptoms of thoracic aneurysms?

A

Asymptomatic
Based on location of the aneurysm
Dyspnoea or heart failure
Dysphagia and hoarseness
Sharp chest pain, radiating to back/between shoulder blades
Pulsatile mass felt on abdominal examination
Hypotension

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11
Q

What is an aortic dissection?

A

Tear in the inner wall of the aorta
Blood forces the walls apart
Acute is a medical emergency

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12
Q

What are the aetiological factors that cause aortic dissection?

A

Hypertension
Atherosclerosis
Trauma
Marfan syndrome

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13
Q

What is seen on histology of a patient with aortic dissection?

A

Cystic medial necrosis - loss of elastin and muscle fibres in the media with accumulation of mucopolysaccharides in cyst-like spaces

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14
Q

What directions can false lumens progress in?

A

Antegrade or retrograde

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15
Q

Where might an aortic dissection rupture?

A

Back into the lumen or externally into the pericardium or mediastinum

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16
Q

What might dilatation of the ascending aorta cause?

A

Acute aortic regurgitation

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17
Q

What is the DeBakey type I aortic dissection?

A

Originates in the ascending aorta and propagates at least to the aortic arch and often beyond it distally

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18
Q

What is the DeBakey type II aortic dissection?

A

Originates in and is confined to the ascending aorta

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19
Q

What is the DeBakey type III aortic dissection?

A

Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

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20
Q

What is the Stanford type A aortic dissection?

A

All dissections involving the ascending aorta, regardless of the site of origin

21
Q

What is the Stanford type B aortic dissection?

A

All dissections not involving the ascending aorta

22
Q

What are the symptoms and signs of aortic dissection?

A

Tearing, severe chest pain radiating to the back
Collapse - tamponade, acute rupture, external rupture
Inferior ST elevation

23
Q

What is the mortality of aortic dissection pre-hospital?

A

Around 50%

24
Q

What might be seen on examination of a patient with aortic dissection?

A 
Reduced or absent peripheral pulses, BP mismatch between sides
Hypotension/hypertension
Soft early diastolic murmur
Pulmonary oedema
CXR usually shows widened mediastinum
25
Q

What can confirm a diagnosis of aortic dissection?

A

Echo or CT

26
Q

What is the investigation of aortic aneurysm and aortic dissection?

A

Echo
CT
CXR

27
Q

What are the treatments of aortic aneurysm and aortic dissections?

A

Surgery
Meticulous blood pressure control
Sodium nitroprusside plus a beta blocker

28
Q

What is Takayasu’s arteritis?

A

Granulomatous vasculitis of the aorta and main branches

29
Q

What sex is affected more by Takayasu’s arteritis?

A

Females

30
Q

What are the features of Takayasu’s arteritis?

A 
Stenosis
Thrombosis
Aneurysm
Renal artery stenosis
Neurological symptoms
31
Q

What are the treatment options for Takayasu’s arteritis?

A

Steroids

Surgery

32
Q

What is the causative organism of syphilis?

A

Treponema pallidum

33
Q

What is the presentation of a primary syphilis infection?

A

Chancre

34
Q

Without treatment of a primary syphilis infection, what types of tertiary syphilis can develop?

A

Late neuro-syphilis
Gummatous syphilis
Cardiac syphilis

35
Q

When does cardiac syphilis present?

A

10-30 years post-infection

36
Q

What cardiovascular conditions can tertiary syphilis result in?

A

Syphilitic aortitis - aneurysm

Aortic regurgitation

37
Q

What are the causes of congenital aortic aneurysm?

A

Bicuspid aortic valve
Marfan syndrome
Coarctation

38
Q

What is the prevalence of bicuspid aortic valve?

A

1-2%

39
Q

What are patients with a bicuspid aortic valve prone to?

A

Stenosis
Regurgitation
Aneurysm
Dissection

40
Q

What is biscupid aortic valve associated with?

A

Coarctation

41
Q

What is the effect of a bicuspid aortic valve on the abdominal aorta?

A

Reduced tensile strength

42
Q

How can a bicuspid aortic valve be monitored?

A

Echo

MRI

43
Q

Where are the 3 shunts involved in coarctation of the aorta?

A

Ductus arteriosus
Foramen ovale
Ductus venosus

44
Q

What are the types of coarctation?

A

Pre-ductal
Ductal
Post-ductal

45
Q

What are the features of post-ductal coarctation?

A

Most common in adults
Hypertension in upper extremities
Weak pulses in lower limbs
Associated with rib notching

46
Q

What are the signs and symptoms 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 radial-femoral delay
Heart failure
Failure to thrive in infancy
Hypertension in later life

47
Q

What imaging can be done to diagnose coarctation?

A

CXR

CMRI

48
Q

What are the features of Marfan syndrome?

A

Mutation of fibrillin 1 gene
Connective tissue disorder
Aortic or mitral valve prolapse, regurgitation
Skeletal system involvement
Eye involvement - cataract, lens dislocation
Vascular - aneurysm, dissection
Lungs - pneumothorax

Cardiovascular System (40 decks)

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