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CVS Pathology > Aortic Disease > Flashcards

Aortic Disease Flashcards

1
Q

Parts of the aorta

A

Ascending aorta
Aortic arch
Descending aorta

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2
Q

What level does the aorta transverse the diaphragm?

A

T12

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3
Q

What can be seen on a CT in the aortic valve?

A

Aortic annulus
Sinus Valsalva
Sino tubular junction

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4
Q

What is the sinus Valsalva?

A

Widest part of aortic route

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5
Q

When does atherosclerosis start?

A

Early child

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6
Q

Risk factors for atherosclerosis

A 
HTN
Hypercholesteraemia
Smoking
DM
FH
Male
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7
Q

What can atherosclerosis lead to?

A

Stroke
MI
Anuerysm

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8
Q

What is an aneurysm?

A

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

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9
Q

Types of aneurysms

A

Saccular
Fusiform
False
Dissecting

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10
Q

What are the true aneurysms?

A

Saccular

Fusiform

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11
Q

What is a true aneurysm?

A

Weakness and dilation of the wall

Involves all 3 layers

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12
Q

Associations of true aneurysm

A 
HTN
Atherosclerosis
Smoking
Collagen abnormalities (marfans, cystic medial necrosis)
Trauma
Infection (mycotic/syphilis)
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13
Q

What is the difference between true and false aneurysms?

A

The layers involved

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14
Q

What is a false aneurysm?

A

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

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15
Q

Causes of false aneurysm

A

Inflammation (e.g. endocarditis with septic emboli)
Trauma
Iatrogenic

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16
Q

What would be felt with a false aneurysm?

A

Thrill
Bruit
Pulsatile mass

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17
Q

What is a dissecting aneurysm?

A

Dissection / tear in first or second layer but there is still a layer left. The artery is teared and blood is going into the sac of one layer

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18
Q

Classification of aortic aneurysm by site

A

Ascending
Aortic arch
Descending
Abdominal

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19
Q

Which aneurysm site can be very dangerous and why?

A

Arch

3 main vessels come off here

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20
Q

Presentation of thoracic aneurysms

A 
Asymptomatic 
Based on location of aneurysm
- SOB 
- HF
- dysphagia and hoarseness (ascending aorta, chronic)
- Sharp chest pain radiating to back 
- pulsatile mass
- hypotension
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21
Q

What is aortic dissection?

A

Tear in the inner wall of the aorta

Blood forces the walls apart

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22
Q

Types of aortic dissection

A

Acute (medical/surgical emergency)

Chronic

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23
Q

Classification systems of aortic dissection

A

DeBakey

Stanford

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24
Q

What is in the Debakey classification of aortic dissection?

A

Type I - Originates ascending aorta, propagates at least to the aortic arch and often beyond it distally
Type II - Originates in and is confined to the ascending aorta
Type III - Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

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25
Q

What are the Stanford classifications of aortic dissection?

A

Type A - All dissections involving the ascending aorta, regardless of the site of origin
Type B - All dissections not involving the ascending aorta

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26
Q

Causes of dissection

A

HTN
Atherosclerosis
Trauma
Marfans syndrome

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27
Q

Histology of aortic dissection

A

Cystic medial necrosis
False lumen can progress in an antegrade (down into distal aorta) or retrograde direction (back into ascending aorta)
May occlude branches (e.g. mesenteric, carotid, renal, spinal)
Rupture
- back into the lumen or externally into the pericardium (tamponade) or mediastinum
If in the root then can affect coronary arteries and so can dissect these - MI symptoms

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28
Q

What may dilation of ascending aorta cause?

A

AR

29
Q

Presentation of aortic dissection

A

Tearing, severe chest pain radiating to back
Collapse
- tamponade, acute AR, external rupture

30
Q

What should you beware of in aortic dissection?

A

Inferior ST elevation

31
Q

Mortality of aortic dissection

A

50%

32
Q

Signs on examination for aortic dissection

A 
Reduced or absent peripheral pulses (BP mismatch between sides)
Hypo/HTN
Soft early diastolic murmur (AR)
Pulmonary oedema 
CXR showing widened mediastinum 
ECHO
33
Q

Diagnosis of aortic dissection is confirmed by what?

A

CT

ECHO

34
Q

Treatment for aortic dissection

A

Type A ; surgery

Type B; Meticulous BP control (BP systolic <100 using IV GTN), sodium nitroprusside (not unless have to) + BB

35
Q

What is takayasus Arteritis?

A

Inflammatory disease - granulomatous vasculitis

36
Q

Who gets takayasus arteritis?

A

F > M

Asians

37
Q

Pathology of takayasus arteritis

A

Aorta and main brances

Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological symptoms

38
Q

Treatment of takayasus arteritis

A

Steriods

Surgery

39
Q

What causes syphilis?

A

Treponema pallidum

40
Q

Without Tx of syphilis, 1/3rd of people develop 1 of 3 types of tertiary syphilis, which are….

A

Late neuro syphilis
Gummatous syphilis
Cardiac syphilis

41
Q

What is a bicuspid aortic valve?

A

Fusion of two of the cusps and so functionally becomes two cusps instead of 3

42
Q

What is the most common congenital abnormality?

A

Bicuspid aortic valve

43
Q

What are bicuspid aortic valves prone to?

A

Stenosis +/- regurgitation

44
Q

Bicuspid aortic valves effect on the abdominal aorta

A

Reduced tensile strength
Prone to
- aneurysm
- dissection

45
Q

Monitoring of bicuspid aortic valve

A

ECHO

MRI

46
Q

What is coarctation of aorta?

A

Narrowing of aorta

47
Q

What are the 3 shunts before birth?

A

Ductus arteriosus
Foramen ovale
Ductus venosus

48
Q

3 types of coarctation of aorta

A

Pre ductal
Ductal
Post ductal

49
Q

What are the locations of coarctation of aorta in relation to?

A

Where the ductus arteriosus inserts (ligamentum arteriosum)

50
Q

What is the most common coarctation in adults?

A

Post ductal

51
Q

Presentation of post ductal coarctation

A

HTN in upper extremities
Weak pulses in lower limbs
Rib notching (collateral circulation)
Asymptomatic in children

52
Q

Presentation of coarctation of aorta

A 
Cold legs 
Poor leg pulses
If before left subclavian - radial radial and RIGHT radial femoral delay 
If after left subclavian - no radial radial delay but right and left radio femoral delay
Severe infancy 
HF
FTT
HTN
53
Q

Investigations of coarctation of aorta

A

CXR

CMRI

54
Q

What genetics are associated with marfans?

A

Fibrillin 1 gene

55
Q

What is marfans?

A

A genetic condition which causes connective tissue weakness

56
Q

Effects of marfans

A 
Aortic/mitral valve prolapse/regurg
Skeletal system 
Eyes 
- cataracts
- upwards lens dislocation 
Vascular - aneurysm
Lungs - pneumontorax
Aneurysm 
Dissection
57
Q

What is Leriche syndrome?

A

Atheromatous disease involving the iliac vessels which compromises the blood flow to the pelvic viscera

58
Q

Triad of presenting symptoms in males with Leriche syndrome

A
  1. Claudication of buttocks and thighs
  2. Atrophy of musculature of the legs
  3. Impotence (due to paralysis of L1 nerve)
59
Q

Features of Takayasu arterities

A

Systemic features of vasculitis e.g. malaise, headache
Unequal blood pressure in the upper limbs
Carotid bruit
Intermittent claudication
Aortic regurg (20%)

60
Q

Assosiations of takayasus arteritis

A

Renal artery stenosis

61
Q

Management of takayasus

A

Steriods

62
Q

Over what size of aortic aneurysm must the DVLA be notified?

A

> 6cm

63
Q

Over what size of aortic aneurysm will you be banned from driving at?

A

> 6.5 cm

64
Q

Management of Type A + B aortic dissection and the pneumonic to remember

A

Type A - ASS
- Surgery and systolic management

Type B - BOOBS
- Bed rest and beta blockers

65
Q

What is coarctation of the aorta associated with?

A

Bicuspid aortic valve

66
Q

What are the diagnostic indications of carotid sinus hypersensitivity?

A

After carotid sinus massage, either;

  • Cardioinhibitory (ventricular pause > 3 seconds)
  • Vasodepressive (Fall in SBP > 50mmHg)
67
Q

How does the carotid sinus massage work to diagnose carotid sinus hypersensitivity?

A

Gently massaging carotid artery for 5 seconds
This stimulates the baroreceptors and the parasympathetic nervous system
This increases the vagal tone and affects the SA and AV node
Leading to a decrease in BP and HR
If the baroreceptor is hypersensitive, this response is exaggerated

68
Q

What is present in 70% of adults with coarctation of the aorta?

A

Notching of the inferior border of the ribs

CVS Pathology (19 decks)

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