Aortic disease - pathophysiology, presentation, investigation and therapy Flashcards
Define Atherosclerosis
disease of the arteries characterised by deposition of fatty material on the inner wall
what is the risk factors of Atherosclerosis
Hypertension Hypercholesterolaemia Smoking Diabetes Family history Male>female (relative protection in females until menopause)
What is the potential progressional outcome of Atherosclerosis
Stroke
Myocardial infarction
Aneurysm
Define aneurysm
A localised enlargement of an artery caused by a weakening of the vessel wall
What is the different classification of aneurysm
True aneurysm: Saccular + fusiform
false aneurysm
dissecting aneurysm
How do you define true aneurysm
Weakness & dilation of wall
Involves all 3 layers
What is a true aneurysm associated with
Hypertension Atherosclerosis Smoking Collagen abnormalities (Marfan’s, cystic medial necrosis) Trauma Infection (mycotic/syphillis)
How do you define false aneurysm
Rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue
What is a false aneurysm associated with
Inflammation ( eg endocarditis with septic emboli)
Trauma
Iatrogenic
What is the signs of a false aneurysm
Thrill
Bruit
Pulsatile mass
What is the progressional outcome of a false aneurysm
Ischaemia
Rupture
What is the aetiology of dissecting aneurysm
An aneurysm in which the inner wall of an artery rips longitudinally, the blood forces the wall apart creating two lumen passages
either acute or chronic
What also of the classifciation of an aortic aneurysm dependant on
site:
asending/aortic arch/descending/abdominal aorta aneurysm
Signs and symptoms of the thoracic aneurysm is dependant on
Location
What is the signs and symptoms of a thoracic dissecting aneurysm
SOB
Heart Failure - Pulmonary oedema
Hypotension
Pulsatile mass
Sharp chest pain radiating to back and between shoulder blades
Collapse - due to rupture or dilation
In the Ascending
Dysphagia (difficult swallowing)
Hoarseness
What is the common classification of thoracic aortic dissection dependant upon
Type A: confined to ascending aorta
Type B: originates in descending aorta and moves downwars (no ascending aorta)
What is the aetiology of thoracic aortic dissection
Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome
What is in the histology of thoracic aortic dissection
Cystic medial necrosis
What is the detrimental affect of the false lumen caused in thoracic aortic dissection
false lumen can progress in an antegrade or retrograde direction and can potentially
occlude branches
(eg mesenteric, carotid, renal, spinal)
Rupture
Dilation
What happens when the dissecting thoracic aorta ruptures
ruptures back into the lumen or externally into the mediastinum or externally in to pericardium - compressing the heart due to accumulation of fluid (tamponade)
What can dilation of the ascending aorta cause in aortic dissection
may cause acute aortic regurgitation
What can be found on examination of a patient with aortic dissection
Reduced or absent peripheral pulses (BP mismatch between sides)
Hypotension/ hypertension
Soft early diastolic murmur (AR)
Pulmonary oedema
Chest x-ray usually shows a widened mediastinum
ST elevation
What can cause you to collapse in aortic dissection
due to tamponade, acute AR, external rupture
How can diagnosis of aortic dissection be confirmed
Diagnosis can be confirmed by echocardiogram or CT scanning
How do you treat type A aortic dissection
surgery
How do you treat type B aortic dissection
Meticulous blood pressure control
Sodium nitroprusside plus beta blocker
What is Takayasu’s Arteritis
granulomatous vasculitis inflammation of the aorta and its major branches
What is the result of Takayasu’s Arteritis
Stenosis, thrombosis, aneurysms, renal artery stenosis, neurological sx
What is the treatment for takayasus arteritis
Steroids
Surgery
What prevents late stages of syphilis -Cardiac syphillis
antibiotics
What is the outcome of cardiac syphilis
syphilitic aortitis = aneurysm
aortic regurgitation
What is the three congenital aortic aneurysms
Bicuspid Aortic Valve
(should be tricuspid)
Marfan’s Syndrome
Coarctation
What is the possible outcomes of biscupid aortic valve
stenosis regurgitation aneurysm dissection abnormal aorta
What is bicupid aorta associated with
Coarctation
What is the management of bicuspid aorta
Monitor with echo/MRI
What are the 3 shunts of aorta coarctation
Ductus arteriosus
Foramen ovale
Ductus venosus
What are the 3 types of aortic narrowing in the ductus arteriosus
Pre-ductal - can be life-threatening if severe narrowing
Ductal
Post-ductal –most common in adults
What is aortic coarctation
narrowing below the left subclavian artery
What is 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
What is the symptoms of coarctation in infancy
Heart failure
Failure to thrive
What is the symptoms of coa rcataion in later life
Hypertension
What is marfan syndrome
A connective tissue weakness due to fibrillin 1 gene
What is the possible outcomes of marinas syndrome
Eyes (cataract, lens dislocation) Vascular – aneurysm, dissection Lungs (pneumothorax) Aneurysm Dissection
