Aortic disease - pathophysiology, presentation, investigation and therapy

Question 1

What are the main sections of the thoracic aorta?

Answer 1

1️⃣ Ascending aorta → From aortic valve to aortic arch
2️⃣ Aortic arch → Gives off brachiocephalic, left common carotid, left subclavian arteries
3️⃣ Descending thoracic aorta → Continues from arch down to diaphragm

Question 2

What are the layers of the aortic wall?

Answer 2

🩸 Tunica intima – Inner endothelial layer
🧱 Tunica media – Elastic & muscular layer
🛡 Tunica adventitia – Outer connective tissue layer

Question 3

What is an aortic aneurysm?

Answer 3

A permanent, localized dilation of the aorta, >50% its normal diameter.

Question 4

What are the broad classifications of aortic aneurysms?

Answer 4

True aneurysm → Involves all 3 layers of the aortic wall

False aneurysm (pseudoaneurysm) → Blood collects between layers due to rupture

Question 5

What is an aortic dissection?

Answer 5

A tear in the intima allowing blood to enter the media, creating a false lumen.

Question 6

What are the classification systems for aortic dissections?

Answer 6

📌 Stanford classification:

Type A → Involves the ascending aorta (more severe, needs surgery)
Type B → Only involves the descending aorta (medical management possible)

📌 DeBakey classification:

Type I → Originates in ascending, extends to descending
Type II → Confined to ascending aorta
Type III → Originates in descending aorta

Question 7

What is the clinical presentation of an acute thoracic aneurysm?

Answer 7

Chest pain (can radiate to back)

Cough, hoarseness (compression of recurrent laryngeal nerve)

Dysphagia (compression of esophagus)

Dyspnea (tracheal compression)

Hypotension & shock if ruptured

Question 8

What are the signs & symptoms of acute aortic dissection?

Answer 8

Sudden, severe, tearing chest pain → Radiates to back

Pulse deficit (different BP in arms)

Neurological symptoms (stroke, syncope)

Hypotension/shock (if rupture occurs)

Question 9

What is coarctation of the aorta?

Answer 9

A narrowing of the aortic lumen, usually near the ductus arteriosus.

Question 10

What are the pulse findings in coarctation of the aorta?

Answer 10

Weak/delayed femoral pulse (radio-femoral delay)

Higher BP in arms than legs

Question 11

What is Marfan’s syndrome?

Answer 11

A connective tissue disorder caused by FBN1 gene mutation, affecting fibrillin-1.

Question 12

What are the aortic manifestations of Marfan’s syndrome?

Answer 12

Aortic root dilation

Thoracic aortic aneurysm

Aortic dissection (especially Type A)