Aortic Disease- Pathophysiology, Presentation, Investigation & Therapy Flashcards
Features of the aortic root (5)
Sinotubular junction Right coronary ostium Right sinus Valsalva Left coronary ostium Left sinus valsalva
Tunica Intima (3)
- Layer of endothelial cells
- Subendothelial layer- collagen and elastic fibres
- Separated from tunica media internal elastic membrane
Tunica media (2)
- Smooth muscle cells
2. Secrete elastin in the form of sheets or lamellae
Tunica Adentitia (3)
- Thin connective layer tissue layer
- Collagen fibres and elastic fibres (not lamellae)
- The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole
Most common cause of death in the west
Atherosclerosis
When does atherosclerosis begin
In early childhood
Risk factors for atherosclerosis (6)
- Hypertension
- Hyper cholesterolaemia
- Smoking
- Diabetes
- Family history
- Male>female
Atherosclerosis Timeline
- Foamy cells
- Fatty streak
- Intermediate lesion
- Atheroma
- Fibrous plaque
- Complicated lesion/rupture
What can atherosclerosis lead to (3)
- Stroke
- MI
- Aneurysm
Aneurysm
a localised enlargement of an artery caused by a weakening to the vessel wall
True aneurysm (3)
Saccular
Fusiform
Involves all 3 layers
False aneurysm (2)
- A break in the vessel wall
* Dissecting aneurysm
True aneurysms are associated with (6)
- Hypertension
- Atherosclerosis
- Smoking
- Collagen abnormalities (Marfan’s, cystic medial necrosis)
- Trauma
- Infection (mycotic/syphilis)
False aneurysm
Rupture of wall of aorta with haematoma that is either contained in the thin adventitial layer or by the surrounding soft tissue
Classification of Aortic Aneurysm by site (5)
- Normal
- Ascending aorta aneurysm
- Aortic arch aneurysm
- Descending aorta aneurysm
- Abdominal aorta aneurysm
Signs and Symptoms of Thoracic Aneurysms (5)
SOB or even HF Dysphagia and hoarseness Sharp chest pain radiating to back (between shoulder blades) Pulsatile mass Hypotension
Aortic Dissection
Tear in the inner wall of the aorta caused
What is the classification system of thoracic aortic dissection
Stanford and Debakey
Debakey Type I
Originates in the ascending, propagates at least to the aortic arch
Debakey Type II
Originates in and is confined to ascending aorta
Debakey Type III
Originates in the descending aorta and extends distally down the aorta- rarely into arch or ascending aorta
Stanford Type A
All dissections involving ascending aorta
Stanford Type B
All dissections not involving the ascending aorta
Causes of aortic dissection (4)
- Hypertension
- Atherosclerosis
- Trauma
- Marfan’s syndrome
Histology of aortic dissection
• Cystic medial necrosis
Dilation of ascending aorta may cause ___
Acute aortic regurgitation
Symptoms (3)
- Tearing, severe chest pain (radiating to back)
- Collapse (tamponade, acute AR, external rupture)
- Inferior ST elevation
Treatment (2)
Type A- Surgery
Type B- Meticulous BP control and sodium nitroprusside pls beta blocker
What does Takayasu’s Arteritis cause
Inflammation
Granulomatous vasculitis
Takayasu’s Arteritis infection more common in
Women
Main area that Takayasu’s Arteritis effects
Aorta and main branches
Takayasu’s Arteritis can lead to (5)
Stenosis Thrombosis Aneurysm Renal artery stenosis Neurological
Treatment for Takayasu’s Arteritis
Surgery or steroids
Syphilis causes
Infection
Treponema pallidum
Tertiary Syphilis (3)
Late neuro-syphillis
Gummatous syphillis
Cardiac syphilis- aneurysm, AR
Congenital Aortic Aneurysms (3)
Bicuspid
Marfan’s Syndrome
Coarctation
Whats the most common congenital aortic aneurysm cause
Bicuspid aortic valve
What are the consequences of bicuspid aortic aneurysm
Associated coarctation
Regurgitation
Stenosis
Coarctation (3)
- Preductal (5% turner’s)
- Ductal
- Post ductal (most common in adults- hypertension in upper extremities, weak pulses in low limbs)
Signs of Coarctation (2)
- Cold legs
* Poor leg pulses
Coarctation before left subclavian artery
radial and RIGHT radial-femoral delay
Coarctation after left sublavian artery
No radial-radial delay
Right and left radial-femoral delay
Symptoms of coarctation in infancy (2)
HF
Failure to thrive
Symptoms of Coarctation in adults
Hypertension
Marfan’s syndrome inheritance
Autosomal dominant
Gene involved in Marfan’s syndrome
Fibrillin 1 gene leading to connective tissue weakness
Consequences of Marfan’s Syndrome (5)
- Aortic/mitral valve prolapse- regurgitation
- Skeletal system
- Eyes (cataracts, lens dislocation)
- Vascular- aneurysm/dissection
- Lungs (pneumothorax)
