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Cardio > Aortic Pathology > Flashcards

Aortic Pathology Flashcards

1
Q

What is an aneurysm?

A

It is defined if there is permanent dilation of the artery to twice its normal diameter.

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2
Q

What is the normal diameter of the aorta?

A

2cm

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3
Q

What are the two classifications of an aneurym?

A

True or false

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4
Q

What is a true aneurysm?

A

It is an abnormal dilation that involves all layers of the arterial wall

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5
Q

What arteries are most commonly involved in a true aneurysm?

A
  • Abdominal aorta (most common)
  • Iliac
  • Popliteal and femoral arteries
  • Thoracic aorta
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6
Q

What is a false aneurysm?

A

Involves the collection of blood in the outer layer only (adventia) which communicates with the lumen

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7
Q

What is the commonest site for a false aneurysm?

A

Infrarenal abdominal artery

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8
Q

What causes an abdominal aortic aneurysm?

A

Degradation of the elastic lamellae resulting in leukocyte infiltrate causing enhanced proteolysis and smooth muscle cell loss.

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9
Q

Where do abdominal aortic aneurysms most commonly occur?

A

In the renal arteries

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10
Q

What are the risk factors for abdominal aortic aneurysms?

A
  • Severe atherosclerotic damage - most common
  • Family history
  • Smoking
  • Male
  • Increasing age
  • Hypertension
  • COPD
  • Trauma
  • Hyperlipidaemia
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11
Q

What is the presentation of an unruptured aortic aneurysm?

A

Often asymptomatic. Pain in loin, groin and back, pulsatile abdominal swelling

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12
Q

What would make an aortic aneurysm more likely?

A

If the patient has increased blood pressure, if they’re a smoker, if they’re female or if they have a family history.

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13
Q

How would a ruptured abdominal aortic aneurysm present?

A
  • Intermittent or continuous abdominal pain (radiates to the back, iliac fossa’s or groin)
  • Pulsatile abdominal swelling (more pronounced)
  • Collapse
  • Hypotension
  • Tachycardia
  • Profound anaemia
  • Sudden death
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14
Q

What investigations would you do if you suspected an aortic aneurysm?

A

Abdominal ultrasound, CT and MRI

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15
Q

What is the non pharmacological management for abdominal aortic aneurysm?

A
  • Small ones are just monitored
  • Treat the underlying cause
  • Modify risk factors
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16
Q

What is the pharmacological treatment for an abdominal aortic aneurysm?

A

Rigorous BP control

17
Q

When would surgical treatment be used in an abdominal aortic aneurysm?

A

When the aneurysm is symptomatic, more than 5.5cm and expandly yearly

18
Q

What are the two surgical options for aneurysm?

A
  • Open surgical repair - replace segment of artery with plastic tube
  • Endovascular repair - stent inserted via femoral or iliac arteries
19
Q

What is the pathology of a thoracic aortic aneurysm?

A

Involves inflammation, proteolysis and reduced survival of the smooth muscle cells in the aortic wall. Once the aorta reaches a crucial diameter it loses all distensibility so that a rise in BP to around 200mmHg can exceed the arterial wall strength and may trigger dissection or rupture

20
Q

What are some causes of thoracic aortic aneurysms?

A
  • Strong genetic link
  • Connective tissue disorders e.g Marfans
  • Aortic dissection in some cases
  • Weight lifting, cocaine and amphetamine use ( prehaps sure to large rise in BP when doing these activities)
21
Q

What are the risk factors of thoracic aortic aneursyms?

A
  • Hypertension
  • Increasing age
  • Smoking
  • Bicuspid or unicuspid aortic valves
  • Atherosclerosis
  • COPD
  • Renal failure
  • Previous aortic aneurysm repair
22
Q

What is the usual presentation of TAA’s?

A

Usually asymptomatic and found by accident

23
Q

What are the symptoms of TAA if not asymptomatic and what are these due to?

A

Chest pain and hemoptysis - due to the compression of local structures

24
Q

What are the signs of TAA?

A
  • Aortic regurgitation
  • Fever if there is infective cause
  • Collapse, shock and sudden death
  • Cardiac tamponade
25
Q

What investigations would you do in TAA?

A
  • CT or MRI used for assessment of TAA
  • Aortography may be helpful for assessing the position of the key branches in relation to the aneurysm
  • Transoesophageal echocardiography can be useful for identifying aortic dissection
  • Ultrasound
26
Q

What is the management of TAA?

A
  • Regular montioring with CT and MRI and treat the underlying cause.
27
Q

What is an aortic dissection?

A

Its a tear in the intimal lining of the aorta which allows blood to flow under pressure in between the intima and the adventitia creating a false lumen.

28
Q

What are the most common sites for intimal tears leading to aortic dissection?

A
  • Within 2-3cm of the aortic valve

- Distal to the left subclavian artery in the descending aorta

29
Q

What is the typical presentation in aortic dissection?

A

Very similar to an MI but the pain is maximal from the onset rather than increasing in intensity

30
Q

What are the signs of aortic dissection?

A
  • Hypertension
  • May have radio-radial delay
  • May have unequal BP in the each arm
  • Patients may be shocked and may have neurological symptoms secondary to loss of blood supply to the spinal cord
  • May develop aortic regurgitation, coronary ischaemia and cardiac tamponade
  • May develop acute limb ischaemia
31
Q

What investigations would you do in an aortic dissection?

A
  • CXR

- Urgent CT scan, Transoesophageal echocardiography or MRI will Confirm diagnosis

32
Q

What would you see on a CXR in an aortic dissection?

A

Widened mediastinum

33
Q

What pharmacological treatment would you give in aortic dissection?

A
  • Usually anti hypertensives as 50% of patients with have high BP.
  • Suitable analgesia e.g morphine
34
Q

What surgical management could be used in aortic dissection?

A
  • Surgery to replace aortic arch

- Endovascular intervention with stents

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