Aortic Disease - Pathophysiology, Presentation, Investigation & Therapy Flashcards
What are examples of aortic diseases?
Atherosclerosis
Aneurysm
Coarctation
What are risk factors for atherosclerosis?
Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Males more than females (until menopause)
Are males or females more at risk of atherosclerosis?
Males, until females undergo menopause
What can atherosclerosis lead to?
Stroke
Myocardial infarction
Aneurysm
What is an aneurysm?
Localised enlargement of an artery caused by a weakening of the vessel wall
What is a localised enlargement of an artery caused by a weakening of the vessel wall called?
Aneurysm
How can aneurysms be classified?
By being true or false, and by the site
What are examples of true aneurysms?
Saccular and fusiform
What is A?
True aneurysm
What is B?
Succular aneurysm
What is C?
Fusiform aneurysm
What is D?
False aneurysm
What is E?
Dissecting aneurysm
What is a true aneurysm?
Weakness and dilation of the wall, involving 3 layers
What are true aneurysms associated with?
Hypertension
Atherosclerosis
Smoking
Collagen abnormalities (such as Marfan’s)
Trauma
Infection
What is a false aneurysm?
Rupture of the wall of the aorta with the haematoma either contained by the thin adventitial layer or the surrounding soft tissue
What is a false aneurysm associated with?
Inflammation (such as endocarditis)
Trauma
Iatrogenic
Thrill
Bruit
Pulsatile mass
Ischaemia
What are different classifications of aortic aneurysms by site?
Normal
Ascending aorta
Aortic arch
Descending aorta
Abdominal aorta
What are signs and symptoms of thoracic aneurysms?
Asymptomatic
Based on location:
Shortness of breath or even heart failure
Dysphagia and hoarseness (ascending aorta, chronic)
Sharp chest pain radiating to back (dissection)
Pulsatile mass
Hypotension
What is aortic dissection?
Tear in the inner wall of the aorta
What forces the walls apart in an aortic dissection?
Blood
What could an aortic dissection occlude?
Branches (such as mesenteric, carotid, renal or spinal)
What are the classifications of aortic dissection?
Type A (all dissections involving the ascending aorta, regardless of site of origin)
Type B (all dissections not involving the ascending aorta)
What are type A aortic dissections?
All dissections involving the ascending aorta regardless of site of origin
What are type B aortic dissections?
All dissections not involving the ascending aorta
What are aetiological factors for aortic dissection?
Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome
What are symptoms of aortic dissection?
Tearing, severe chest pain (radiating to back)
Collapse
Inferior ST elevation
What can be seen on the examination of aortic dissection?
Reduced or absent peripheral pulses
Hypo/hypertension
Soft early diastolic murmur
Pulmonary oedema
What investigations are done for aortic dissection?
Chest X-ray
Diagnosis can be confirmed by echocardiogram or CT
What can confirm the diagnosis of aortic dissection?
Echocardiogram or CT
What does the treatment of aortic dissection depend on?
Whether is is type A or B
What is the treatment for type A aortic dissection?
Surgery
What is the treatment for type B aortic dessection?
Meticulous blood pressure control
Sodium nitroprusside plus beta blocker
What could cause aortic dissection?
Infections and inflammation
What is an example of an infection that could cause aortic dissection?
Syphillis
What is an example of inflammation that could cause aortic dissection?
Takayasu’s arteritis
What is Takayasu’s arteritis?
Granulomatous vasculitis that affects aorta and main branches
Does Takayasu’s arteritis affect more males or females?
Females
What are some causes of Takayasu’s arteritis?
Stenosis
Thrombosis
Aneurysm
Renal artery stenosis
What is the treatment of Takayasu’s arteritis?
Steroids
Surgery
What is syphilis?
STD caused by treponema pallidum
What is syphilis caused by?
Treponema pallidum
What are the different kinds of syphilis?
Primary and secondary
What can prevent the late stages of syphilis?
Antibiotics
What can congenital aortic aneurysm be caused by?
Bicuspid aortic valve
Marfan’s syndrome
Coarctation
What are the problems of a bicuspid aortic valve?
Prone to stenosis and regurgitation
Associated with coarctation
What is the prevalence of bicuspid aortic valve?
1-2%
What is aortic coarctation?
Narrowing of the aorta
What is narrowing of the aorta called?
Aortic coarctation
What are the 3 associated shunts due to aortic coarctation?
Ductus arteriosus
Foramen ovale
Ductus venosus
Where does aortic coarctation occur?
Close to where the ductus arteriosus insets (ligamentum arteriosum)
What are the 3 types of aortic coarctation?
Pre-ductal
Ductal
Post-ductal
What are signs of coarctation?
Cold legs
Poor leg pulses
If before subclavian artery (radial-radial and righ radial-femoral delay)
If after subclavian artery (no radial-radial delay, right and left radio-femoral delay)
What are symptoms of coarctation?
Heart failure and failure to thrive in infancy
Hypertension in later life
What imaging is used to diagnosis aortic coarctation?
Chest X-ray
Chest MRI
What is Marfan’s syndrome?
Genetic disorder that causes connective tissue weakness
What gene causes Marfan’s syndrome?
Fibrillin 1 gene
What does Marfan’s syndrome lead to?
Aortic/mitral valve prolapse or regurgitation
Skeletal system problems
Eye problems
Aneurysm, dissection (vascular problems)
Lung problems
