Aortic disease

Question 1

3 layers of aorta (elastic artery)

Answer 1

tunica intima
tunica media
tunica adventitia

Question 2

risk factors of atherosclerosis

Answer 2

Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Male>female (relative protection in females until menopause)

Question 3

when does atherosclerosis begin?

Answer 3

early childhood

Question 4

define aneurysm

Answer 4

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

Question 5

what is a true aneurysm

Answer 5

Weakness & dilation of wall

Involves all 3 layers

Question 6

what are true aneurysms associated with?

Answer 6

Hypertension
Atherosclerosis
Smoking
Collagen abnormalities (Marfan’s, cystic medial necrosis)
trauma
infection (mycotic - vessel wall/syphillis)

Question 7

what is a false aneurysm?

Answer 7

Rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue

Question 8

what are false aneurysms associated with?

Answer 8

inflammation ( eg endocarditis with septic emboli)
Trauma
Iatrogenic - caused by medical examination or treatment

Question 9

what might you expect to hear/feel on examination of false anuerysm?

Answer 9

thrill
bruit - turbulent blood flow
pulsatile mass

Question 10

in a false aneurysm the blood that leaks out pools between which 2 layers of the artery?

Answer 10

the 2 outer layers - adevntitia and media

Question 11

in a dissection aneurysm the blood that leaks out pools between which 2 layers of the artery?

Answer 11

intima and media

2 inner ones

Question 12

what different names are given to aortic aneurysms at different sites on the aorta? (4)

Answer 12

ascending aorta aneurysm

aortic arch aneurysm

descending aorta aneurysm

abdominal aorta aneurysm

Question 13

signs and symptoms of thoracic aortic aneurysms (6)

Answer 13

can be Asymptomatic
or…
Based on the location of the aneurysm.

• shortness of breath or even heart failure (AR)
• dysphagia and hoarseness (ascending aorta, chronic)
• Sharp chest pain radiating to back –between shoulder blades –Possible dissection!

Pulsatile mass

Hypotension

Question 14

Info about aortic dissection

Answer 14

tear in the inner wall of the aorta
blood forces the walls apart
can be acute and chronic

(acute is a medical/surgical emergency)

Question 15

causes for dissection aneursym

Answer 15

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome

Question 16

if a dissection aneurysm was to rupture what would happen?

Answer 16

it would rupture back into the lumen or externally into pericardium or mediastinum

Question 17

dilation of ascending aorta may cause what?

Answer 17

acute aortic regurgitation

Question 18

symptoms of aortic dissection

Answer 18

Tearing, severe chest pain (radiating to back)

Collapse (tamponade-fluid in pericardium, acute AR, external rupture)

Beware inferior ST elevation

Question 19

what might you find on examination of patient with aortic dissection?

Answer 19

Reduced or absent peripheral pulses (BP mismatch between sides)

Hypotension/ hypertension

Soft early diastolic murmur (AR)

Pulmonary oedema

Chest x-ray usually shows a widened mediastinum

Diagnosis can be confirmed by echocardiogram or CT scanning

Question 20

treatment options for aortic dissection

Answer 20

type A - surgery

type B - meticulous blood pressure control
sodium nitroprusside and beta blocker

Question 21

what is Takayasu’s arteritis? - aortic arch syndrome

Answer 21

a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing

Females > Males

stenosis, thrombosis, aneuryms, renal artery stenosis, neurological

Question 22

treatment options for Takayasu’s arteritis

Answer 22

steroids

surgery

Question 23

what is syphilis? which bacteria is it caused by? treatment?

Answer 23

STD
treponema pallidum
antibiotics prevent late stages

Question 24

give 3 congenital conditions causing aortic anuerysms

Answer 24

Bicuspid Aortic Valve

Marfan’s Syndrome

Coarctation - narrowing of aorta

Question 25

Discuss:- Bicuspid Aortic Valve (6)

Answer 25

Most common congenital abnormality

prone to stenosis +/- regurgitation

Associated with coarctation

Abnormal aorta (reduced tensile strength)

Prone to aneurysm/ dissection

Monitor with echo/ MR

Question 26

3 types of coarctation?

Answer 26

pre-ductal
ductal
post-ductal

Question 27

pre-ductal coarctation

Answer 27

can be life-threatening if severe narrowing

often infantile

Question 28

post-ductal coarctation

Answer 28

most common in adults – hypertension in upper extremities, weak pulses in lower limbs
adult type

Question 29

signs of coarctation

Answer 29

Cold legs
Poor leg pulses

If before left subclavian artery (3rd of the small chimney-like artery projections on arch of the aorta) :
Radial – radial and RIGHT radial-femoral delay

If after left subclavian artery:
No radial- radial delay
Right and left radio-femoral delay

Question 30

symptoms of coarctation in infancy

Answer 30

heart failure

failure to thrive

Question 31

symptoms of coarctation in later life

Answer 31

hypertension

Question 32

imaging options for coarctation

Answer 32

CXR

CMRI

Question 33

Marfan’s syndrome

Answer 33

Fibrillin 1 gene
Connective tissue weakness

Associated with:-

Aortic/ Mitral valve prolapse – regurgitation

Skeletal system
Eyes (cataract, lens dislocation)
Vascular – aneurysm, dissection
Lungs (pneumothorax)