Aortic Disease: Pathophysiology, Presentation, Investigation + Therapy Flashcards
What are the 3 layers of the aorta called?
- Tunica intima
- Tunica media
- Tunica adventitia
What is the tunics intima composed of?
- Layer of endothelial cells
- Sub-endothelial layer of collagen and elastic fibres
- Separated from tunica media by IEL
What is the tunica media composed of?
- Smooth muscle cells
- Secrete elastin in the form of sheets, or lamellae
What is the tunic adventitia composed of?
- Thin connective tissue layer
- Collagen fibres and elastic fibres
What does the collagen in the tunica adventitia prevent?
Prevents elastic arteries from stretching beyond their physiological limits during systole
What is the commonest cause of death in the Western world?
Atherosclerosis
When does atherosclerosis begin?
Early childhood
What are the risk factors for atherosclerosis?
- Hypertension
- Hypercholesterolemia
- Smoking
- Diabetes
- Family history
- Male
What can atherosclerosis lead to?
- Stroke
- MI
- Aneurysm
Aneurysm
A localised enlargement of an artery cause by a weakening of the vessel wall
What are the different types of aneurysms?
- True aneurysms
- False aneurysms
- Dissecting aneurysms
What are the 2 types of true aneurysm?
- Saccular
- Fusiform
What causes a true aneurysm?
Weakness and dilation of vessel wall
Which layers does a true aneurysm affect?
All 3 layers
What are true aneurysms associated with?
- Hypertension
- Atherosclorosis
- Smoking
- Collagen abnormalities
- Trauma
- Infarction
What causes a false aneurysm?
-Rupture of wall of aorta with the haematoma either contained by the thin adventitia layer or by the surrounding soft tissue
What are false aneurysms associated with?
- Inflammation
- Trauma
- Iatrogenic
What signs does a false aneurysm present with?
- Thrill
- Bruit
- Pulsatile mass
What can occur with a false aneurysm?
- Ischaemia
- Rupture
What is an aortic dissection?
Tear within the inner wall of aorta, blood forces walls apart and the blood is redirected into a flap of the artery
How can aortic aneurysms be classified by site?
- Ascending aortic aneurysm
- Aortic arch aneurysm
- Descending aortic aneurysm
- Abdominal aortic aneurysm
What are the signs and symptoms of thoracic aneurysms based on?
Location of the aneurysm
What are the signs and symptoms of thoracic aneurysms?
- Asymptomatic
- Shortness of breath
- Heart failure
- Dysphagia
- Hoarseness
- Sharp chest pain radiating to back between shoulder blades (could be dissection)
- Pulsatile mass
- Hypotension
What is the most common classification system for thoracic aortic dissection?
Stanford and DeBakey
Stanford Type A
All dissections involving the ascending aorta, regardless of the site of origin