Aortic disease Flashcards
3 layers of aorta (elastic artery)
tunica intima
tunica media
tunica adventitia
risk factors of atherosclerosis
Hypertension Hypercholesterolaemia Smoking Diabetes Family history Male>female (relative protection in females until menopause)
when does atherosclerosis begin?
early childhood
define aneurysm
A localised enlargement of an artery caused by a weakening of the vessel wall
what is a true aneurysm
Weakness & dilation of wall
Involves all 3 layers
what are true aneurysms associated with?
Hypertension
Atherosclerosis
Smoking
Collagen abnormalities (Marfan’s, cystic medial necrosis)
trauma
infection (mycotic - vessel wall/syphillis)
what is a false aneurysm?
Rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue
what are false aneurysms associated with?
inflammation ( eg endocarditis with septic emboli)
Trauma
Iatrogenic - caused by medical examination or treatment
what might you expect to hear/feel on examination of false anuerysm?
thrill
bruit - turbulent blood flow
pulsatile mass
in a false aneurysm the blood that leaks out pools between which 2 layers of the artery?
the 2 outer layers - adevntitia and media
in a dissection aneurysm the blood that leaks out pools between which 2 layers of the artery?
intima and media
2 inner ones
what different names are given to aortic aneurysms at different sites on the aorta? (4)
ascending aorta aneurysm
aortic arch aneurysm
descending aorta aneurysm
abdominal aorta aneurysm
signs and symptoms of thoracic aortic aneurysms (6)
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
Info about aortic dissection
tear in the inner wall of the aorta
blood forces the walls apart
can be acute and chronic
(acute is a medical/surgical emergency)
causes for dissection aneursym
Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome
if a dissection aneurysm was to rupture what would happen?
it would rupture back into the lumen or externally into pericardium or mediastinum
dilation of ascending aorta may cause what?
acute aortic regurgitation
symptoms of aortic dissection
Tearing, severe chest pain (radiating to back)
Collapse (tamponade-fluid in pericardium, acute AR, external rupture)
Beware inferior ST elevation
what might you find on examination of patient with aortic dissection?
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
treatment options for aortic dissection
type A - surgery
type B - meticulous blood pressure control
sodium nitroprusside and beta blocker
what is Takayasu’s arteritis? - aortic arch syndrome
a form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing
Females > Males
stenosis, thrombosis, aneuryms, renal artery stenosis, neurological
treatment options for Takayasu’s arteritis
steroids
surgery
what is syphilis? which bacteria is it caused by? treatment?
STD
treponema pallidum
antibiotics prevent late stages
give 3 congenital conditions causing aortic anuerysms
Bicuspid Aortic Valve
Marfan’s Syndrome
Coarctation - narrowing of aorta
Discuss:- Bicuspid Aortic Valve (6)
Most common congenital abnormality
prone to stenosis +/- regurgitation
Associated with coarctation
Abnormal aorta (reduced tensile strength)
Prone to aneurysm/ dissection
Monitor with echo/ MR
3 types of coarctation?
pre-ductal
ductal
post-ductal
pre-ductal coarctation
can be life-threatening if severe narrowing
often infantile
post-ductal coarctation
most common in adults – hypertension in upper extremities, weak pulses in lower limbs
adult type
signs of coarctation
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
symptoms of coarctation in infancy
heart failure
failure to thrive
symptoms of coarctation in later life
hypertension
imaging options for coarctation
CXR
CMRI
Marfan’s syndrome
Fibrillin 1 gene
Connective tissue weakness
Associated with:-
Aortic/ Mitral valve prolapse – regurgitation
Skeletal system
Eyes (cataract, lens dislocation)
Vascular – aneurysm, dissection
Lungs (pneumothorax)
