Aortic disease Flashcards
Name the parts of the aortic root.
sinus of valsalvar (aortic root)
left and right coronary osmium
sinotubular junction
in the aorta, what is the role of collagen in the tunica adventitia?
prevents the elastic arteries (aorta) from stretching beyond their physiological limits during systole
what are the risk factors for atherosclerosis?
sex (male) age smoking hypertension hypercholesterolaemia diabetes family history
describe the timeline for the development of atherosclerosis.
from first decade; - foamy cells - fatty streak from third decade; - intermediate lesion - atheroma from fourth decade; - fibrous plaque - complicated/ ruptured plaque
what are the different types aneurysm?
saccular (forms a pouch at one side of the vessel)
fusiform (equal dilatation of both sides of the vessel)
false aneurysm (dilatation of 1 layer of the vessel)
what is the aetiology of aneurysms?
degenerate i.e. atheroscleroma
connective tissue disorder i.e. marfans syndrome
infection i.e. mycotic aneurysm or syphillis
trauma
what are causes of false aneurysms?
inflammation i.e. endocarditis with septic emboli
trauma
iatrogenic
what signs would you find on examination suggestive of a false aneurysms?
thrill
bruit
pulsatile mass
what are the different types of aortic aneurysms?
ascending aortic aneurysms
aortic arch aortic aneurysms
descending aortic aneurysm
abdominal aorta aneurysm
what are the signs and symptoms of a thoracic aneurysm?
Aysmptomatic Symtpoms depend on loacation: SOB May have HF Dysphagia and hoarseness (ascending aorta) Sharp pain radiating to back (possible direction) Pulsatile mass Hypotension
What is aortic dissection?
a tear in the inner wall of the aorta
the pressure of blood flow forces the wall apart
what is the stand ford classification of dissecting aneurysms?
type A involves the ascending aorta
type B involves the descending aorta
what are the aetiological factors for aortic dissection?
hypotension
atherosclerosis
trauma
marfans syndrome
what is the histology like in aortic dissection?
cystic medial necrosis
what can a the false lumen , in an aortic dissection, progress to?
may progress in an integrate or retrograde direction
may occlude branches such as mesenteric, carotid, renal and spinal
what are the consequences of a ruptured thoracic aortic aneurysms?
may rupture back into the lumen or externally in to the pericardium = tamponade or the mediastinum
regarding aortic disease, what can cause acute mitral regurgitation?
dilatation of the ascending aorta
what is the treatment for type B Thoracic aortic aneurysm?
blood pressure control
beta blocker main drug
but if BB doesn’t work then CCB, ACEI ect
what is the desired bp for treatment of type B aneurysm?
< 110 systolic
what can takayasu’s arteritis cause?
stenosis, thrombosis, aneurysms, renal artery stenosis, neurological diseases
what drug is used to treat takayasu’s arteritis?
steroids
what microorganism is responsible for syphillis infection?
treponema pallidum
what are the 3 congenital causes for an aortic aneurysm?
bicupsid valve
marfans syndrome
coarctation
what are people with bicuspid aortic valves prone to?
stenosis/regurgitation
associated with coarctation
abnormal aorta (reduced tensile strength)
prone to aneurysm/dissection
what are the3 types of coarctation?
pre ductal
ductal
post ductal
what type of coarctation is most common in adults?
post ductal
the other 2 are picked up in childhood
what is the sign of coarctation if it occurs before the left subclavian artery?
radial-radial and right radio-femoral delay
what is the sign of coarctation if it occurs below the left subclavian artery?
no radial-radial delay
right and left radio-femoral delay
what cardio problems are people with marfans syndrome prone to?
aortic/mitral valave prolapse/regurgitation
aneurysms
dissection
pneumothorax
describe the DeBakey classification of aortic dissection.
I - involving ascending aorta and aortic arch. usually continues distally down the descending as well
II - involving only the ascending aorta
III - involving only the descending aorta
what are the complications which Takayasus arteritis can cause?
stenosis thrombosis aneurysms renal artery stenosis neurological complications
what are the causes of false aneurysms?
inflammation i.e. endocarditis with septic emboli
trauma
iatrogenic
what are the signs of aortic dissection?
poor peripheral pulses hypo or hypertension BP mismatch between sides soft early diastolic mumur (AR) widened mediastinum on CXR pulmonary oedema inferior ST elevation
