Aortic disease

Question 1

Name the parts of the aortic root.

Answer 1

sinus of valsalvar (aortic root)
left and right coronary osmium
sinotubular junction

Question 2

in the aorta, what is the role of collagen in the tunica adventitia?

Answer 2

prevents the elastic arteries (aorta) from stretching beyond their physiological limits during systole

Question 3

what are the risk factors for atherosclerosis?

Answer 3

sex (male)
age
smoking
hypertension
hypercholesterolaemia
diabetes
family history

Question 4

describe the timeline for the development of atherosclerosis.

Answer 4

from first decade;
- foamy cells
- fatty streak
from third decade;
- intermediate lesion
- atheroma
from fourth decade;
- fibrous plaque
- complicated/ ruptured plaque

Question 5

what are the different types aneurysm?

Answer 5

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)

Question 6

what is the aetiology of aneurysms?

Answer 6

degenerate i.e. atheroscleroma
connective tissue disorder i.e. marfans syndrome
infection i.e. mycotic aneurysm or syphillis
trauma

Question 7

what are causes of false aneurysms?

Answer 7

inflammation i.e. endocarditis with septic emboli
trauma
iatrogenic

Question 8

what signs would you find on examination suggestive of a false aneurysms?

Answer 8

thrill
bruit
pulsatile mass

Question 9

what are the different types of aortic aneurysms?

Answer 9

ascending aortic aneurysms
aortic arch aortic aneurysms
descending aortic aneurysm
abdominal aorta aneurysm

Question 10

what are the signs and symptoms of a thoracic aneurysm?

Answer 10

Aysmptomatic
Symtpoms depend on loacation:
SOB
May have HF
Dysphagia and hoarseness (ascending aorta)
Sharp pain radiating to back (possible direction)
Pulsatile mass
Hypotension

Question 11

What is aortic dissection?

Answer 11

a tear in the inner wall of the aorta

the pressure of blood flow forces the wall apart

Question 12

what is the stand ford classification of dissecting aneurysms?

Answer 12

type A involves the ascending aorta

type B involves the descending aorta

Question 13

what are the aetiological factors for aortic dissection?

Answer 13

hypotension
atherosclerosis
trauma
marfans syndrome

Question 14

what is the histology like in aortic dissection?

Answer 14

cystic medial necrosis

Question 15

what can a the false lumen , in an aortic dissection, progress to?

Answer 15

may progress in an integrate or retrograde direction

may occlude branches such as mesenteric, carotid, renal and spinal

Question 16

what are the consequences of a ruptured thoracic aortic aneurysms?

Answer 16

may rupture back into the lumen or externally in to the pericardium = tamponade or the mediastinum

Question 17

regarding aortic disease, what can cause acute mitral regurgitation?

Answer 17

dilatation of the ascending aorta

Question 18

what is the treatment for type B Thoracic aortic aneurysm?

Answer 18

blood pressure control
beta blocker main drug
but if BB doesn’t work then CCB, ACEI ect

Question 19

what is the desired bp for treatment of type B aneurysm?

Answer 19

< 110 systolic

Question 20

what can takayasu’s arteritis cause?

Answer 20

stenosis, thrombosis, aneurysms, renal artery stenosis, neurological diseases

Question 21

what drug is used to treat takayasu’s arteritis?

Answer 21

steroids

Question 22

what microorganism is responsible for syphillis infection?

Answer 22

treponema pallidum

Question 23

what are the 3 congenital causes for an aortic aneurysm?

Answer 23

bicupsid valve
marfans syndrome
coarctation

Question 24

what are people with bicuspid aortic valves prone to?

Answer 24

stenosis/regurgitation
associated with coarctation
abnormal aorta (reduced tensile strength)
prone to aneurysm/dissection

Question 25

what are the3 types of coarctation?

Answer 25

pre ductal ductal post ductal

Question 26

what type of coarctation is most common in adults?

Answer 26

post ductal | the other 2 are picked up in childhood

Question 27

what is the sign of coarctation if it occurs before the left subclavian artery?

Answer 27

radial-radial and right radio-femoral delay

Question 28

what is the sign of coarctation if it occurs below the left subclavian artery?

Answer 28

no radial-radial delay | right and left radio-femoral delay

Question 29

what cardio problems are people with marfans syndrome prone to?

Answer 29

aortic/mitral valave prolapse/regurgitation aneurysms dissection pneumothorax

Question 30

describe the DeBakey classification of aortic dissection.

Answer 30

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

Question 31

what are the complications which Takayasus arteritis can cause?

Answer 31

``` stenosis thrombosis aneurysms renal artery stenosis neurological complications ```

Question 32

what are the causes of false aneurysms?

Answer 32

inflammation i.e. endocarditis with septic emboli trauma iatrogenic

Question 33

what are the signs of aortic dissection?

Answer 33

``` poor peripheral pulses hypo or hypertension BP mismatch between sides soft early diastolic mumur (AR) widened mediastinum on CXR pulmonary oedema inferior ST elevation ```