Aortic Disease

Question 1

What are the complications of atherosclerosis?

4

Answer 1

MI
ACS
Stroke
aneurysm

Question 2

What are the classifications of aneurysms by type?

4

Answer 2

1. True:
   - saccular
   - fusiform
2. False
3. Dissecting

Question 3

What is an aneurysm?

Answer 3

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

Question 4

What is a true aneurysm?

1

Answer 4

• involves all 3 layers of artery wall.

Question 5

What is a saccular aortic aneurysm?

Answer 5

One area of the vessel wall is weakened and causes a sac like shape to form in the artery wall.

Question 6

What is a fusiform abdominal aortic aneurysm?

Answer 6

Widening of the complete diameter of the artery to create a swollen like artery.

Question 7

What are true aneurysms associated with?

6

Answer 7

Hypertension
Atherosclerosis
Smoking
Collagen abnormalities 	(e.g. Marfan’s, cystic medial necrosis)
Trauma
Infection (mycotic/syphillis)

Question 8

What is a false aneurysm?

Answer 8

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

Question 9

What are false aneurysms associated with?

8

Answer 9

• Inflammation (e.g. endocarditis with septic emboli)
• Trauma
• Iatrogenic
• Thrill
• Bruit
• Pulsatile mass
• Ischaemia
• Rupture

Question 10

What are the signs and symptoms of thoracic aneurysms (note what each might indicate)?

6

Answer 10

• asymptomatic!
• dysphagia/hoarseness (ascending aorta)
• SOB
• pulsatile mass (false)
• hypotension
• sharp chest pain, radiating to back - possible dissection.

Question 11

What is an aortic dissection?

4

Answer 11

• Tear in the inner wall of aorta
• Blood forces walls apart
• Acute –medical/surgical emergency
• Chronic

Question 12

According to DeBakey classifications, what is a Type 1 thoracic aortic dissection?

Answer 12

• originates in the ascending aorta

- propagates at least to the aortic arch, and usually beyond it distally.

Question 13

According to DeBakey classifications, what is a Type 2 thoracic aortic dissection?

Answer 13

• originates and confined to the ascending aorta

Question 14

According to DeBakey classifications, what is a Type 3 thoracic aortic dissection?

Answer 14

• originates in the descending thoracic aorta

- usually propagates distally downward.

Question 15

According to Stanford classifications, what is a Type A thoracic aortic dissection?

Answer 15

• involving the ascending aorta

Question 16

According to Stanford classifications, what is a Type B thoracic aortic dissection?

Answer 16

• all dissections NOT involving the ascending aorta.

Question 17

What are some of the causes of aortic dissections?

4

Answer 17

• hypertension
• atherosclerosis
• Marfan’s syndrome (collagen defect syndrome)
• Trauma

Question 18

What are the complications of a ruptured aortic dissection?

2

Answer 18

• in pericardium = cardiac tamponade

- in ascending aorta = acute AR

Question 19

What are the symptoms of aortic dissection?

2

Answer 19

• severe chest pain, radiating to back

- collapse (acute AR, tamponade, external rupture)

Question 20

What are the signs of an aortic dissection?

5

Answer 20

• absent peripheral pulses
• hypotension/hypertension
• soft early diastolic murmur (AR)
• CXR (widened mediastinum)
• pulmonary oedema

Question 21

What investigations might aid in reaching a diagnosis?

Answer 21

• CXR
• ECG
• Echo
• Exam

Question 22

What would be the treatment for a type A (ascending aorta) dissection?

Answer 22

• acute emergency

- surgery

Question 23

What would be the treatment for a type B (non-ascending aorta) dissection?

3

Answer 23

• meticulous BP control

- sodium nitroprusside plus beta blocker

Question 24

Give an example of an infection which might lead to aortic dissection?

Answer 24

syphillis

Question 25

What is the causative agent of syphillis?

Answer 25

Treponema pallidum

Question 26

What are the different stages of syphillis?

Answer 26

primary secondary tertiary

Question 27

Without treatment, what might patients develop in the tertiary stage of syphillis? 3

Answer 27

late neuro-syphillis gummatous syphillis cardiac syphillis

Question 28

What can cardiac syphillis result in? 2

Answer 28

Syphilitic aortitis – aneurysm | Aortic regurgitation

Question 29

What are some congenital causes of aortic aneurysm/abnormality? 3

Answer 29

- bicuspid aortic valve - Marfan's syndrome - Coarctation

Question 30

What is aortic coarctation?

Answer 30

Narrowing of the aorta below the left subclavian artery.

Question 31

Where does the narrowing of the aorta take place in coarctation?

Answer 31

Aortic narrowing close to where Ductus arteriosus inserts (ligamentum arteriosum): 3 types: - Pre-ductal (5% turner’s) can be life-threatening if severe narrowing - Ductal - Post-ductal –most common in adults – hypertension in upper extremities, weak pulses in lower limbs.

Question 32

What are the signs of coarctation?

Answer 32

- Cold legs - Poor leg pulses - If before left subclavian artery: * * radial–radial and RIGHT radial-femoral delay - If after left subclavian artery: * * No radial-radial delay * * Right and left radio-femoral delay

Question 33

Describe the characteristics of Marfan's syndrome. ________ gene.

Answer 33

Fibrillin 1

Question 34

Describe the characteristics of Marfan's syndrome. _______ ______ weakness

Answer 34

connective tissue

Question 35

Describe the characteristics of Marfan's syndrome. cardiac issues? 3

Answer 35

- aortic/mitral valve prolapse (regurgitation) - aortic dissection - aneurysm

Question 36

Describe the characteristics of Marfan's syndrome. lung issues?

Answer 36

pnemothorax