Aortic Dissection And Aneurysm

Question 1

Aortic dissection

Answer 1

Separation and layers of walls, due to high blood pressure, the Tunica intima tears up and blood starts to leak into tunica media and with each heartbeat, the blood keeps moving between the two layers, tearing them apart. Sometimes blood creator exit for itself and doesn’t continue moving further through the layers, causing a exit tear.

Question 2

True lumen and false lumen

Answer 2

True lumen is between Tunica intimas
False lumen is between Tunica intima and Tunica media.

Question 3

Causes of aortic dissection

Answer 3

Hypertension, connective tissue disease, such as Marfans syndrome and Ethan Danlo’s syndrome , weaken connective tissues and walls of aorta , aneurysm, chest trauma age 50 to 65 years

Question 4

Stanford system classification

Answer 4

Type a dissection( anywhere around origin of left subclavian artery) , Type B dissection( anywhere in descending aorta after left subclavian artery origin) ,
Type A dissection common site ( 2 cm above aortic root) and Type B dissection common site( below left subclavian artery root)
This is because a lot of blood gets hit at these locations with a high-pressure.

Question 5

Symptoms of aortic dissection

Answer 5

Sudden onset of severe central chest pain or abdomen radiating to back, sweating, nausea, shortness of breath, weakness, syncope.

Question 6

Diagnosis of aortic dissection

Answer 6

Imaging: TEE( trans esophageal echocardiogram), shows thoracic, aorta, and aorta valve.
CT scan with iodine contrast (can see entire aorta ) , MRI (100% specific).

Question 7

Thoracic aortic aneurysm

Answer 7

True aneurysm (all three layers of wall bulge out, fusiform (symmetrical/ uniform aneurysm), saccular ( symmetrical/one-sided bulging aneurysm),
False aneurysm ( pseudoaneurysm: puncture in vessels due to trauma, blood leaks through the vessel and get stuck between vessel and surrounding tissues depicting a ballooning/bulging).

Question 8

Other complications

Answer 8

Aneurysms can rupture, can develop clots inside at the bulging site because of no blood movement, these clots can piece off causing ischemia at other areas, compress surrounding structures like a vena cava, running parallel.

Question 9

Causes of aneurysm

Answer 9

Atherosclerosis (aorta wall, get weaker and hard, noncompliant(less elastic)), aortic, dissection, connective, tissue disorders, atherosclerosis.

Question 10

Risk factors of aneurysm

Answer 10

Atherosclerosis, smoking, hypertension, COPD, mail, age(due to classification and degeneration of the elastin and collagen overtime).

Question 11

Symptoms of aneurysm

Answer 11

Intact aneurysm(pain in the region), rupture aneurysm(hypotension, syncope, hemoptysis (coughing up blood), hematemesis (vomiting blood)

Question 12

Diagnosis of aneurysm

Answer 12

X-rays, CT scans, MRI

Question 13

Abdominal aortic aneurysm

Answer 13

True aneurysm, most common site right below, renal artery.
Complications and causes are same as thoracic aneurysm, aorta below renal artery, has less collagen and elastic structurally so it’s more prone to aneurysm.
Diagnosis: physical exam: pulsatile expansile mass, imaging: ultrasound, CT scan, MRI

Question 14

Aortic dissection treatment

Answer 14

Type A dissection: surgery(affected aorta gets replaced with a graft (synthetic tube), it gets stuck in aorta and sutured in), type B dissection: medication’s, but sometimes a minimally invasive technique (endovascular, stent grafting-a mash tube is inserted to affected area to support aorta in that region, done using a catheter), drugs are to lower blood pressure, decrease heart rate and contractility such as- Nitroprusside (dilates veins ), beta blockers(block B receptors on heart), calcium channel blockers(reduces contractions of arteries) altogether leading to low blood pressure.

Question 15

Aneurysm treatment

Answer 15

Watch and wait approach to avoid surgeries as much as possible (checking aneurysm in every 6 to 12 months, done for a small aneurysm), medium aneurysm (4 cm – 5.3/5.4 cm, at risk of rupturing more than smaller aneurysm, either watch and wait approach (ultrasound every 6 to 12 months) or surgery can be considered), large aneurysm (5.5 cm to 6 cm, needs surgery).
Surgeries: open abdominal surgery (incision is made and remove damaged aorta and get replaced by a graft(synthetic tube)), endovascular stenting (using a catheter a graft/stent gets placed at the damaged site of aorta to continue supporting the aorta), medications are prescribed to lower blood pressure (beta blockers, especially).