Disease of the Aorta Flashcards
What comes from the
- Left coronary sinus
- Right coronary sinus
- Posterior coronary sinus?
The left aortic sinus gives rise to the left coronary artery.
The right aortic sinus gives rise to the right coronary artery.
Usually, no vessels arise from the posterior aortic sinus, which is therefore known as the non-coronary sinus.
Each aortic sinus can also be referred to as the sinus of Valsalva
What is the definition of an aneurysm?
A localised enlargement of an artery caused by a weakening of the vessel wall
What are the different types of aneurysm?
True aneurysms - Saccular and Fusiform
False Aneurysm
Which layers of the aorta does a true aneurysm involve?
All three layers
What are the risk factors for true aneurysm?
Hypertension
Atherosclerosis
Smoking
Collagen abnormalities (Marfan’s)
Trauma
Infection (mycotic / syphilis)
What are the features of a false aneurysm?
A rupture of the wall of the aorta with the haemotoma either contained by the thin adventitial layer or by the surrounding soft tissue
What are the clinical features of a false aneurysm?
Thrill
Bruit
Pulsatile mass
What is the difference between a false aneurysm (pseudo aneurysm) and a dissecting aneurysm?
Pseudoaneurysm: Collection of blood that forms between the two outer layers of an artery, the muscularis and the adventitia.
Dissecting aneurysm: When blood from the vessel lumen tracks between the two inner layers, the intima and the muscularis.
What are the different classifications of aortic aneurysms?
What are potential signs and symptoms of aneurysms?
Dependant on location:
SOB
Heart Failure
SHarp Chest Pain radiating to the back - between shoulder blades (possible sign of dissection)
Pulsatile mass
Hypotension - due to compliance of the aorta
What is the Stanford classification of aortic dissection?
Type A - involves ascending aorta
Type B - Doesn’t
What are the potential risk factors for dissection?
Hypertension
Atherosclerosis
Trauma
Marfan’s Syndrome
What direction can the dissection progress in?
Antegrade or Retrograde Direction
Antegrade – arch to distal aorta
Retrogade – back to ascending aorta
What are the potential branches that an aortic dissection may occlude?
Mesenteric, carotid, renal or spinal
Carotid - Aortic dissection can present with neurological symptoms as a result of carotid blood occlusion
What are the potential complications of a ruptured dissection?
•Rupture - back into the lumen or externally in to pericardium (tamponade) or mediastinum
What is the effect of dissection on the ascending aorta?
May cause dilation and therefore aortic regurgitation
What are the symptoms 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 are the features of aortic dissection on examination?
Reduced / absent peripheral pulses (BP mismatch between sides)
Hypotension / hypertension
Soft early diastolic murmur (AR)
Pulmonary oedema
Widened mediastinum on X - Ray
Diagnosis can be confirmed by echocardiogram or CT scanning
What is the treatment of dissection?
What is the pathology of takayasu’s arteritis?
Stenosis due to fibrosis - scarring of the blood vessels due to repeated inflammation (bracocephalic, left common carotid, left subclavean)
Granulomas present in artery wallls
What are the common signs and symptoms of Takayasu’s arteritis?
Weak / absent peripheral pulses, difference in blood pressure between arms is possible
Bad/blurry/double vision
Reduced cognition
Bruit and thrill in carotid if stenosed
What is the treatment for takayasu’s arteritis?
Steroids
Surgery
What is cardiac syphilis?
Infection of the heart and related blood vessels by the syphilis bacteria
What are the conditions associated with cardiac syphilis?
Narrowing of the blood vessels that supply blood to the heart, which may lead to heart attack and possibly death.
Damage to heart valves that may lead to heart failure. (aortic regurgitation)
Aortic aneurysm. If a vessel becomes weak enough, it can rupture and cause death.
What are the types of congenital aortic aneurysm?
- Bicuspid Aortic Valve
- Marfan’s Syndrome
- Coarctation
What causes the formation of a bicuspid valve?
The fusion of two cusps, so only two functional cusps
What are the complications of bicuspid aortic valve?
Prone to stenosis and regurgitation
Associated with coarctation
Abnormal aorta, meaning reduced tensile strength
Prone to aneurysm / dissection
How do you monitor a bicuspid valve?
Echo / MRI
Where does coarctation occur?
Close to where the ductus arteriosus inserts (ligamentum arteriosum)
What are the three types of coarctation?
What are the signs of coractation?
Cold legs
Poor leg pulses
If before left subclavian artery: radial - radial and right radial - femoral delay
If after left subclavian artery: No radial - radial delay, but right and left radio - femoral delay
What are the symptoms of coarctation?
What is one of the signs of coarctation on an X - ray?
Rib notching (colalteral circulation)
What are the pathologies associated with marfan’s syndrome?
