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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
Q

Stanford Type A

A

All dissections involving the ascending aorta, regardless of the site of origin

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26
Q

Stanford Type B

A

All dissections not involving the ascending aorta

27
Q

DeBakey Type I

A

Originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distally

28
Q

DeBakey Type II

A

Originates in and is confined to the ascending aorta

29
Q

DeBakey Type III

A

Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

30
Q

What are the aetiological factors for dissection?

A
  • Hypertension
  • Atherosclerosis
  • Trauma
  • Marfans syndrome
31
Q

What is the histology of aortic dissection?

A

Cystic medial necrosis

32
Q

How can the false lumen of a dissection progress?

A

In antegrade or retrograde direction

33
Q

Give examples of branches a dissection may occlude.

A
  • Mesenteric
  • Carotid
  • Renal
  • Spinal
34
Q

How can a dissection rupture?

A

Back into the lumen or externally in to the pericardium (tamponade) or mediastinum

35
Q

What can cause acute aortic regurgitation?

A

Dilation of ascending aorta

36
Q

What are the symptoms of an aortic dissection?

A
  • Tearing, sever chest pain radiating to the back
  • Collapse
  • Inferior ST elevation
37
Q

What would be found on examination of a patient with an aortic dissection?

A
  • 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
Q

What is the treatment for Type A?

39
Q

What is the treatment for Type B?

A
  • Meticulous blood pressure control

- Sodium nitroprusside plus beta blocker

40
Q

What infection can cause aortic aneurysms?

41
Q

What inflammatory condition can cause aortic aneurysms?

A

Takayasu’s arthritis

42
Q

What is Takayasu’s arthritis?

A

Granulomatous vasculitis

43
Q

What sex is affected by Takayasu’s arthritis more often?

A

Females>males

44
Q

What does Takayasu’s arthritis affect?

A

Aorta and main branches

45
Q

What does Takayasu’s arthritis cause?

A
  • Stenosis
  • Thrombosis
  • Aneurysms
  • Renal artery stenosis
  • Neurological symptoms
46
Q

What is the treatment for Takayasu’s Arthritis?

A

-Steroids or surgery

47
Q

What is syphilis?

48
Q

What organism causes syphilis?

A

Treponema pallidum

49
Q

What treatment is there for syphilis?

A

Antibiotics prevent late stages

50
Q

What happens without treatment for syphilis?

A

1/3 will develop 1 from below:

  • Late neuro syphilis
  • Gummatous syphilis
  • Cardiac syphilis
51
Q

When does cardiac syphilis occur?

A

10-30 years after infection

52
Q

What can cause congenital aortic aneurysms?

A
  • Bicuspid aortic valve
  • Marfan’s syndrome
  • Coarctation
53
Q

What is the prevalence of bicuspid aortic valve?

54
Q

What are bicuspid aortic valves prone to?

A
  • Stenosis+/- regurgitation

- Aneurysms/dissection

55
Q

What are bicuspid aortic valves associated with?

A
  • Coarctation

- Reduced tensile strength of aorta

56
Q

How are bicuspid aortic valves monitored?

A
  • ECHO

- MRI

57
Q

What are the 3 shunts within the heart?

A
  • Ductus arteriosus
  • Foramen ovale
  • Ductus venosus
58
Q

What are the 3 types of coarctation?

A
  • Pre ductual
  • Ductal
  • Post ductal
59
Q

What are the signs of a post ductal coarctation?

A
  • Hypertension in upper extremities
  • Weak pulses in lower limbs
  • Rib notching
60
Q

Coarctation

A

Aortic narrowing close to where ductus arteriosus inserts

61
Q

What are the signs of coarctation?

A
  • 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
Q

What are the symptoms of coarctation in infancy?

A
  • Heart failure

- Failure to thrive

63
Q

What are the symptoms of coarctation in adulthood?

A

Hypertension

Systems: Cardiovascualar AB (42 decks)

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