Aortic Disease Flashcards
What can aortic diseases affect?
Aortic root
Sinuses of Valsalva
Arch
Descending aorta
What is an aneurysm?
A localised enlargement of an artery caused by weakening of the vessel wall (dilation)
What are the layers to the T intima layer of vessel walls?
Layer of endothelial cells
Subendothelial layer: collagen and elastic fibres
Separated from T media by the Internal Elastic Membrane
What is T media of vessel wall composed of?
Smooth muscle cells
Secrete elastin as lamellae
Describe histology of T. adventitia
Thin connective tissue layer
Collagen and elastin fibres
The collagen prevents elastic arteries from stretching beyond limits during systole - prevents rupture
What there conditions can atherosclerosis cause?
Stroke
Myocardial infarction
Aneurysm
What are the two classifications of aneurysms?
True and false
Describe the true aneurysm
Weakness and dilation of wall involve all 3 layers
What are risk factors for true aneurysm?
Hypertension Atherosclerosis Smoking Collagen abnormalities (Marfan's, cystic medial necrosis) Trauma Infection
Describe the false aneurysm
Rupture of the aorta with the haematoma either contained by the thin adventitial layer or by the surrounding tissue - between the media and adventitia
What are 3 causes of false aneurysms?
Inflammation (endocarditis, septic emboli)
Trauma
Iatrogenic
What clinical signs will false aneurysms cause?
Thrills
Bruits
Pulsatile mass
What is an aortic dissection?
A rip between the two inner layer (T. intima and media) and create a false lumen
And with high BP, blood is forced into the false lumen which can occlude true lumen
What are the signs and symptoms of thoracic aneurysms?
Asymptomatic
Based on location of the aneurysm:
SOB or HF
Dysphagia and hoarseness (ascending aorta)
Sharp chest pain radiating to back (between blades)
Pulsatile mass
Hypotension
What are different classifications of aortic aneurysms by site?
Ascending
Arch
Descending
Abdominal
What are causes of dissection?
Hypertension
Atherosclerosis
Taruma
Marfan’s syndrome
What is the histological features of dissection?
Cystic medial necrosis
What directions can the false lumen progress to?
Antegrade
Retrograde
How can false lumen occlude branches?
Can stenos true lumen cutting of blood supply to branches
Where can a rupture after the dissection occur?
Back into lumen
Externally in to pericardium (tamponade)
Mediastinum
What can dilation of ascending aorta cause?
Acute regurgitation and thus can cause rapid progressive heart failure
What are the symptoms of dissection?
Tearing, severe chest pain (radiating to back)
Collapse (tamponade, acute AR, external rupture)
What are the symptoms of examination of a dissection?
Reduced or absent peripheral pulses
Hypotension/hypertension
Soft early diastolic murmur (sign of AR)
Pul. oedema
What investigations should be carried out for dissection?
CXR - widened mediastinum
Can diagnose:
Echo
CT
What is type A and type B dissections?
Type A: Involves ascending aorta
Type B: Involves descending aorta
What is the treatment for Type A dissections?
Surgery
What is the treatment for Type B dissections?
BP control
Sodium nitroprusside and beta blocker
What are 2 agents that can cause infection and inflammation in the aorta?
Infection: syphyllis
Inflammation: Takayasu’s arteritis
What is Takayasu’s Arteritis?
Granulomatous vasculitis inflammation of the aorta and its major branches
What does Takayasu’s Arteritis cause?
Stenosis Thrombosis Aneurysms Renal artery stenosis Neurological symptoms
How do you treat Takayasu’s Arteritis?
Steroids
Surgery
What is syphilis?
STD caused by treponema palladium
Give antibiotics to prevent late stages
What are causes for congenital aortic aneurysm?
Bicuspid aortic valve
Marfan’s syndrome
Coarctation
What are the 3 shunts in the embryo?
Ductus arteriosus
Foramen vale
Ductus venosus
What is coarctation?
Aortic narrowing close to where ductus arterioles inserts (becomes ligament arteriosum)
What are 3 types of coarctations?
Preductal (5% turners)
Ductal
Post-ductal
What are signs of coarctation?
Cold legs
Poor leg pulses
If before L subclavian artery: Radial-raidal and RIGHT femoral-femoral delay
If after L subclavian artery: no radial-radial delay, R and L radio-femoral delay
What are the symptoms of coarctation?
Infancy (HF and failure to thrive) Later life (hypertension)
What test can be used for coarctation?
CXR
CMRI
