Aortic Disease

Question 1

3 functions of the aorta

Answer 1

1. conduit function: to carry blood from heart to branch vessels without loss of energy through turbulence or resistance.
2. cushion/capacitor function: to accept the ejectd blood volume into the aorta and accommodate this volume
3. pump function: to release the potential energy stored with the walls of elastin through recoil

Question 2

Aortic dissection Definition: A cleavage (“dissection”) of the media of the aorta along its ____.

Answer 2

Definition: A cleavage (“dissection”) of the media of the aorta along its length.

Question 3

pathogenesis of aortic dissection: the initiative event is an ____ tear, which allows for blood and pulsatile forces into the ____.

Answer 3

the initiative event is an INTIMAL tear, which allows for blood and pulsatile forces into the MEDIA.

• it propagates down the media.

Question 4

For type B dissection, pain is often acute and radiates to the ____.

Answer 4

radiates to the back compared to radiating to left arm like the MI

Question 5

Spontaneous causes of aortic dissection

Answer 5

1. hypertension
2. heritable disesase of the aorta: marfans and ehlers-danlos
3. aneurysm
4. iatrogenic
5. catheter or surgical manipulation

Question 6

presentation of aortic dissection

Answer 6

Question 7

Type A vs B aortic dissection

Answer 7

type A: involves the ascending aorta

type B: does not involve the ascending aorta

Question 8

how does management change between type a and b aortic dissection?

Answer 8

type A: surgical management. mortality is higher if you just manage medically

Type B: medical management. mortality is higher if you manage surgically.

Question 9

note

Question 10

most common test to diagnose aortic dissection

Answer 10

CT scan

• echo (TTE or TEE)

Question 11

CXR isn’t specific for aortic dissection, but what are some features that might make you suspect?

Answer 11

• hilar adenopathy
• widening of mediastinum
• aorta unfolding.

also, in some cxr, note the enlarged aorta and the development of pleural effusions

Question 12

goals of treatment for aortic dissectoin

Answer 12

1. control BP/induce mild hypotension
2. decreased aortic impulse.
   - consider stent

Question 13

an aneurismal disease of the aorta is a ____ of the aorta about ____ times the expected diameter of the aorta

Answer 13

an aneurismal disease of the aorta is a DILATION OF AORTA 1.5 TIMES the expected diameter.

• Threshold to intervention
• Symptomatic aneurysms: all cases
• Asymptomatic aneurysms:
• Ascending aorta: ≥55 mm • Descending thoracic aorta:≥65 mm • Abdominal aorta:≥45 mm • If the risks to the patient are acceptable
• Intervention
• Endovascular if possible
• Surgical resection if necessary

Question 14

causes of aortitis; inflammatory diseases of the aorta.

Answer 14

• it often goes along side vasculitides.
• giant cell aortitis; >55 years of age often associated with temporal arteritis.

- takayasu’s aortitis; often seen in young females. occlusive disorder of aortic branch vessels, hence “pulseless disease”.

• need to treat it with steroids and immunomodulating applications

Question 15

note:

Question 16

how to treat atherosclerotic disease of the aorta

Answer 16

• treatment with cholesterol mediating, treating with BP mediating, treatment with diabetes.
• consider bypass of stents