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Systems: Cardiovascualar AB > Aortic Disease: Pathophysiology, Presentation, Investigation + Therapy > Flashcards

Aortic Disease: Pathophysiology, Presentation, Investigation + Therapy Flashcards

1
Q

What are the 3 layers of the aorta called?

A
  • Tunica intima
  • Tunica media
  • Tunica adventitia
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2
Q

What is the tunics intima composed of?

A
  • Layer of endothelial cells
  • Sub-endothelial layer of collagen and elastic fibres
  • Separated from tunica media by IEL
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3
Q

What is the tunica media composed of?

A
  • Smooth muscle cells

- Secrete elastin in the form of sheets, or lamellae

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4
Q

What is the tunic adventitia composed of?

A
  • Thin connective tissue layer

- Collagen fibres and elastic fibres

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5
Q

What does the collagen in the tunica adventitia prevent?

A

Prevents elastic arteries from stretching beyond their physiological limits during systole

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6
Q

What is the commonest cause of death in the Western world?

A

Atherosclerosis

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7
Q

When does atherosclerosis begin?

A

Early childhood

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8
Q

What are the risk factors for atherosclerosis?

A
  • Hypertension
  • Hypercholesterolemia
  • Smoking
  • Diabetes
  • Family history
  • Male
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9
Q

What can atherosclerosis lead to?

A
  • Stroke
  • MI
  • Aneurysm
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10
Q

Aneurysm

A

A localised enlargement of an artery cause by a weakening of the vessel wall

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11
Q

What are the different types of aneurysms?

A
  • True aneurysms
  • False aneurysms
  • Dissecting aneurysms
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12
Q

What are the 2 types of true aneurysm?

A
  • Saccular

- Fusiform

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13
Q

What causes a true aneurysm?

A

Weakness and dilation of vessel wall

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14
Q

Which layers does a true aneurysm affect?

A

All 3 layers

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15
Q

What are true aneurysms associated with?

A
  • Hypertension
  • Atherosclorosis
  • Smoking
  • Collagen abnormalities
  • Trauma
  • Infarction
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16
Q

What causes a false aneurysm?

A

-Rupture of wall of aorta with the haematoma either contained by the thin adventitia layer or by the surrounding soft tissue

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17
Q

What are false aneurysms associated with?

A
  • Inflammation
  • Trauma
  • Iatrogenic
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18
Q

What signs does a false aneurysm present with?

A
  • Thrill
  • Bruit
  • Pulsatile mass
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19
Q

What can occur with a false aneurysm?

A
  • Ischaemia

- Rupture

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20
Q

What is an aortic dissection?

A

Tear within the inner wall of aorta, blood forces walls apart and the blood is redirected into a flap of the artery

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21
Q

How can aortic aneurysms be classified by site?

A
  • Ascending aortic aneurysm
  • Aortic arch aneurysm
  • Descending aortic aneurysm
  • Abdominal aortic aneurysm
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22
Q

What are the signs and symptoms of thoracic aneurysms based on?

A

Location of the aneurysm

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23
Q

What are the signs and symptoms of thoracic aneurysms?

A
  • Asymptomatic
  • Shortness of breath
  • Heart failure
  • Dysphagia
  • Hoarseness
  • Sharp chest pain radiating to back between shoulder blades (could be dissection)
  • Pulsatile mass
  • Hypotension
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24
Q

What is the most common classification system for thoracic aortic dissection?

A

Stanford and DeBakey

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25
Stanford Type A
All dissections involving the ascending aorta, regardless of the site of origin
26
Stanford Type B
All dissections not involving the ascending aorta
27
DeBakey Type I
Originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distally
28
DeBakey Type II
Originates in and is confined to the ascending aorta
29
DeBakey Type III
Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta
30
What are the aetiological factors for dissection?
- Hypertension - Atherosclerosis - Trauma - Marfans syndrome
31
What is the histology of aortic dissection?
Cystic medial necrosis
32
How can the false lumen of a dissection progress?
In antegrade or retrograde direction
33
Give examples of branches a dissection may occlude.
- Mesenteric - Carotid - Renal - Spinal
34
How can a dissection rupture?
Back into the lumen or externally in to the pericardium (tamponade) or mediastinum
35
What can cause acute aortic regurgitation?
Dilation of ascending aorta
36
What are the symptoms of an aortic dissection?
- Tearing, sever chest pain radiating to the back - Collapse - Inferior ST elevation
37
What would be found on examination of a patient with an aortic dissection?
- Reduced or absent peripheral pulses - BP mismatch between sides - Hypotension/hypertension - Soft early diastolic murmur (AR) - Pulmonary oedema - CXR usually shows a widened mediastinum - Diagnosis can be confirmed by ECHO or CT scanning
38
What is the treatment for Type A?
Surgery
39
What is the treatment for Type B?
- Meticulous blood pressure control | - Sodium nitroprusside plus beta blocker
40
What infection can cause aortic aneurysms?
Syphilis
41
What inflammatory condition can cause aortic aneurysms?
Takayasu's arthritis
42
What is Takayasu's arthritis?
Granulomatous vasculitis
43
What sex is affected by Takayasu's arthritis more often?
Females>males
44
What does Takayasu's arthritis affect?
Aorta and main branches
45
What does Takayasu's arthritis cause?
- Stenosis - Thrombosis - Aneurysms - Renal artery stenosis - Neurological symptoms
46
What is the treatment for Takayasu's Arthritis?
-Steroids or surgery
47
What is syphilis?
STD
48
What organism causes syphilis?
Treponema pallidum
49
What treatment is there for syphilis?
Antibiotics prevent late stages
50
What happens without treatment for syphilis?
1/3 will develop 1 from below: - Late neuro syphilis - Gummatous syphilis - Cardiac syphilis
51
When does cardiac syphilis occur?
10-30 years after infection
52
What can cause congenital aortic aneurysms?
- Bicuspid aortic valve - Marfan's syndrome - Coarctation
53
What is the prevalence of bicuspid aortic valve?
1-2%
54
What are bicuspid aortic valves prone to?
- Stenosis+/- regurgitation | - Aneurysms/dissection
55
What are bicuspid aortic valves associated with?
- Coarctation | - Reduced tensile strength of aorta
56
How are bicuspid aortic valves monitored?
- ECHO | - MRI
57
What are the 3 shunts within the heart?
- Ductus arteriosus - Foramen ovale - Ductus venosus
58
What are the 3 types of coarctation?
- Pre ductual - Ductal - Post ductal
59
What are the signs of a post ductal coarctation?
- Hypertension in upper extremities - Weak pulses in lower limbs - Rib notching
60
Coarctation
Aortic narrowing close to where ductus arteriosus inserts
61
What are the signs of coarctation?
- Cold legs - Poor leg pulses - If before the LSA: radial radial and right radial femoral delay - If after LSA then no radial radial delay but right and left radio femoral delay
62
What are the symptoms of coarctation in infancy?
- Heart failure | - Failure to thrive
63
What are the symptoms of coarctation in adulthood?
Hypertension

Systems: Cardiovascualar AB (42 decks)

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