Aortic Disease Flashcards
What are the complications of atherosclerosis?
4
MI
ACS
Stroke
aneurysm
What are the classifications of aneurysms by type?
4
- True:
- saccular
- fusiform - False
- Dissecting
What is an aneurysm?
A localised enlargement of an artery caused by a weakening of the vessel wall.
What is a true aneurysm?
1
- involves all 3 layers of artery wall.
What is a saccular aortic aneurysm?
One area of the vessel wall is weakened and causes a sac like shape to form in the artery wall.
What is a fusiform abdominal aortic aneurysm?
Widening of the complete diameter of the artery to create a swollen like artery.
What are true aneurysms associated with?
6
Hypertension Atherosclerosis Smoking Collagen abnormalities (e.g. Marfan’s, cystic medial necrosis) Trauma Infection (mycotic/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?
8
- Inflammation (e.g. endocarditis with septic emboli)
- Trauma
- Iatrogenic
- Thrill
- Bruit
- Pulsatile mass
- Ischaemia
- Rupture
What are the signs and symptoms of thoracic aneurysms (note what each might indicate)?
6
- asymptomatic!
- dysphagia/hoarseness (ascending aorta)
- SOB
- pulsatile mass (false)
- hypotension
- sharp chest pain, radiating to back - possible dissection.
What is an aortic dissection?
4
- Tear in the inner wall of aorta
- Blood forces walls apart
- Acute –medical/surgical emergency
- Chronic
According to DeBakey classifications, what is a Type 1 thoracic aortic dissection?
- originates in the ascending aorta
- propagates at least to the aortic arch, and usually beyond it distally.
According to DeBakey classifications, what is a Type 2 thoracic aortic dissection?
- originates and confined to the ascending aorta
According to DeBakey classifications, what is a Type 3 thoracic aortic dissection?
- originates in the descending thoracic aorta
- usually propagates distally downward.
According to Stanford classifications, what is a Type A thoracic aortic dissection?
- involving the ascending aorta
According to Stanford classifications, what is a Type B thoracic aortic dissection?
- all dissections NOT involving the ascending aorta.
What are some of the causes of aortic dissections?
4
- hypertension
- atherosclerosis
- Marfan’s syndrome (collagen defect syndrome)
- Trauma
What are the complications of a ruptured aortic dissection?
2
- in pericardium = cardiac tamponade
- in ascending aorta = acute AR
What are the symptoms of aortic dissection?
2
- severe chest pain, radiating to back
- collapse (acute AR, tamponade, external rupture)
What are the signs of an aortic dissection?
5
- absent peripheral pulses
- hypotension/hypertension
- soft early diastolic murmur (AR)
- CXR (widened mediastinum)
- pulmonary oedema
What investigations might aid in reaching a diagnosis?
- CXR
- ECG
- Echo
- Exam
What would be the treatment for a type A (ascending aorta) dissection?
- acute emergency
- surgery
What would be the treatment for a type B (non-ascending aorta) dissection?
3
- meticulous BP control
- sodium nitroprusside plus beta blocker
Give an example of an infection which might lead to aortic dissection?
syphillis
What is the causative agent of syphillis?
Treponema pallidum
What are the different stages of syphillis?
primary
secondary
tertiary
Without treatment, what might patients develop in the tertiary stage of syphillis?
3
late neuro-syphillis
gummatous syphillis
cardiac syphillis
What can cardiac syphillis result in?
2
Syphilitic aortitis – aneurysm
Aortic regurgitation
What are some congenital causes of aortic aneurysm/abnormality?
3
- bicuspid aortic valve
- Marfan’s syndrome
- Coarctation
What is aortic coarctation?
Narrowing of the aorta below the left subclavian artery.
Where does the narrowing of the aorta take place in coarctation?
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.
What are the signs of coarctation?
- 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
Describe the characteristics of Marfan’s syndrome.
________ gene.
Fibrillin 1
Describe the characteristics of Marfan’s syndrome.
_______ ______ weakness
connective tissue
Describe the characteristics of Marfan’s syndrome.
cardiac issues?
3
- aortic/mitral valve prolapse (regurgitation)
- aortic dissection
- aneurysm
Describe the characteristics of Marfan’s syndrome.
lung issues?
pnemothorax
