Aortic Dissection Flashcards
Most aortic dissection occurs in older males Typically over age 60 Chronic HTN Acute Inc in BP is a risk factor Marfan syndrome Mutation in fibrillin Ehlers Danlos syndrome Collagen type 3 mutation Iatrogenic Pre existing aortic aneurysm
Seperation of the medial smooth muscle later by dissecting blood creates true(systemic bloodflow and false(dissecting bloodflow) lumen
Degeneration smooth muscle tiles; cystic medial degeneration (a process that leads to mucoid degeneration of the medial SMC)
Weakens vessel wall
30 pc occur in any portion of the aortic arch
30 pc of thoracic aortic dissection occur at the takeoff of the left subclavian artery
Type 1aortic aneurysm involving both ascending and descending aorta
Type 2 Only ascending
Type 3 descending
Stanford system Area A(2/3rd) Ascending aorta And both asc and desc Descending aorta type B
Clinical picture
Severe tearing chest pain radiating to back bw shoulder blades
20 mmHg bw arms diff
Occlusion of carotids by Dec blood flow to brain
Syncope
Hat on fire Fever Wrapped joints Arthralgias are common w systemic inflammatory diseases Thin weight loss ear Plasma viscosity Temporal arteritis Giant cell arteritis Half of patients have polymyalgia rheumatica T cells found in media and IEL Macrophages accumulate in the media and accumulate the multinucleated giant cells Patchy inflammation Fragmented IEL
Headaches Jaw claudication Vision change Ischemic neuritis Diplopia to vision loss Pain while chewing Temporal artery biopsy gold standard
Corticosteroid
Takayasu arteritis
Asian women under 40
Aortic arch and proximal branches
Inflammation affects abdominal and cerebral vessels
Involved abd aorta and renal artery in half of cases
Pulse less disease
T cell activation in intrinsic antigens in large arteries T cells Granuloma Multinucleated giant cells Intimal thickening
Narrowed prox aortic branches
Different blood pressure in and/or absent pulses in the extremities in both giant cell & takayasu arteritis
Inflammation and narrowing of large vessels
Turbulent blood flow✓✓
Bruits
Neurological symptoms headache,vertigo syncope,vision loss, limb claudication
Complications
AA, AR, HTN
Subclavian steal syndrome
Inflammation and stenosis of SA proximal to VERTEBRAL ARTERY
Retrograde flow thru the vertebral system at vertigo visual system
Corticosteroid
PAN Hep B or Hep C PAN Immune complex deposition in tissues Complex activation Inflammation Tissue damage Type 3 HTS
