Aortic Disease - Pathophysiology, Presentation, Flashcards
true or false:
atherosclerosis is the commonest cause of death in the west
true
when does atherosclerosis begin?
early childhood
what are the risk factors for atherosclerosis?
hypertesion hypercholesterolaemia smoking diabetes family history
what gender is more likely to develop atherosclerosis?
male
what can atherosclerosis cause?
stroke
myocardial infarction
aneurysm
what is an aneurysm?
a localised enlargement of an artery caused by a weakening of the vessel wall
true or flase:
there are true but no false aneurysms
false, there is a true, flase amd dissecting aneursym
what are the two types of true aneurysms
saccular and fusiform
what are true aneurysms?
weakness and dilation of wall and involves 3 layers
what are true aneurysms associated with?
hypertension atherosclerosis smoking collagen abnormalities trauma
what are false aneurysms?
rupture of wall aorta with the haematoma either contained by the thin adventitia layer or by the surrounding soft tissue
signs and symptoms of thoracic aneurysms
Asymptomatic
shortness of breath or even heart failure (AR)
dysphagia and hoarseness (ascending aorta, chronic)
Sharp chest pain radiating to
back –between shoulder blades –Possible dissection!
Pulsatile mass
Hypotension
what is aortic dissection?
tear inner wall of aorta
blood forces wall apart
acute-medical emergency
chronic
what is debakey type 1?
originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distally
what is debakey type 2
originates in and its confined to the ascending aorta
what is debakey type 3
originates in the descending aorta and extends distally down the aorta or rarely retrogade into the aortic arch and ascending aorta
what is stanford type A
all dissections involving the ascending aorta, regardless of the site origin
what is stanford type B
all dissections not involving the ascending aorta
what are aetiological factors of dissection?
hypertension
atherosclerosis
trauma
marfans syndrome
symptoms and signs of aortic dissection
Tearing, severe chest pain (radiating to back)
Collapse (tamponade, acute AR, external rupture)
Beware inferior ST elevation
~50% mortality pre-hospital
what would you see on examination with a patient that had 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
Diagnosis can be confirmed by echocardiogram or CT scanning
what are the two types of treatment for aortic dissection?
surgery
meticulous blood pressure control and sodium nitroprusside plus beta blocker
what is Takayasu’s Arteritis
large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing
whats the most vommon congenital abnormality?
bicuspid aortic valve
what is the prevelance of bicuspid aortic valve?
1-2%
how do you monitor bicuspid aortic valve?
echo/MRI
what is aortic coarction?
narrowing of the aorta
where are the locations of the 3 shunts?
ductus arteriosus
foramen ovale
ductus venosus
what are the thee types of coarction?
pre-ductal-can be life threatening
ductal
post ductal- most common in adults- hypertension in upper extremities
what are signs of coarction?
cold legs
poor leg pulses
if before left subclavian: radial and right radial femoral delay
if after left subclavian artery: no radial-radial delay
right and left radio femoral delay
symptoms of coarction
infancy-
heart failure
failure to thrive
later life-
hypertension
what is marfans syndrome?
connective tissue weakness
how does marfans syndrome affect the eyes
cataract, lens dislocation
how does marfans syndrome affect the vascular system?
aneurysm, dissection
how does marfams syndrome affect the lungs
pneumothorax
what are signs of marfans syndrome
Tall and slender build. Disproportionately long arms, legs and fingers. A breastbone that protrudes outward or dips inward. A high, arched palate and crowded teeth. Heart murmurs. Extreme nearsightedness. An abnormally curved spine. Flat feet.
