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Cardiovascular > Disease of the Thoracic Aorta > Flashcards

Disease of the Thoracic Aorta Flashcards

1
Q

What are the 4 sections of the aorta divided into?

A

Ascending aorta
Aortic arch
Descending aorta
Aortic root

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2
Q

Describe parts of the aortic root?

A

Right, left and non-coronary sinus
Left coronary ostium
Right coronary ostium
Sino-tubular junction

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3
Q

Describe the tunica intima?

A

Layer of endothelial cells
Subendothelial layer - collagen and elastic fibres
Separated from tunica media internal elastic membrane

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4
Q

Describe the tunica media?

A

Smooth muscle cells
Secrete elastin in the form of sheets or lamellae

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5
Q

Describe the tunica adventitia?

A

Thin connective tissue layer
Collagen and elastic fibres
The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limit

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6
Q

What are the risk factors of atherosclerosis?

A

Hypertension, hypercholesterolaemia, smoking, diabetes, family history, male over female till menopause

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7
Q

What can atherosclerosis cause?

A

Myocardial infarction
Stroke
Peripheral vascular disease
Aneurysm

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8
Q

What is the definition of an aneurysm?

A

A localised enlargement of an artery by weakening of the vessel wall

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9
Q

What are the types of aneurysms?

A

True aneurysms
False/ Pseudo aneurysm
Dissecting aneurysm

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10
Q

Describe a true aneursysm

A

Weakness and dilation of wall
Involves all 3 layers of artery

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11
Q

What is true aneurysm associated with?

A

Hypertension, atherosclerosis, smoking, bicuspid aortic valve, collagen abnormalities, infection and trauma

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12
Q

Describe a false aneurysm

A

Rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by surrounding soft tissue ex. subcutaneous fat
Have high risk of rupture and haemorrhage

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13
Q

What are the factors that could cause a false aneurysm?

A

Trauma
Iatrogenic
Inflammation

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14
Q

What are some signs and symptoms of thoracic aneurysms?

A

Asymptomatic
Shortness of breath, dysphagia and hoarseness (compression), back pain, pulsatile mass
Symptoms of dissection
All based on location of aneurysm

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15
Q

What are symptoms of dissection?

A

Sharp chest pain, radiating to back (between shoulder blades) and hypotension

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16
Q

What investigations are used for thoracic aneurysms?

A

CXR, Echocardiogram, CT angiogram and MRI aorta
TOE and invasive aortogram are rarely done

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17
Q

How does ECG help in investigating thoracic aneurysms?

A

Assess aortic root size and aortic valve

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18
Q

What investigations are used in diagnostics for thoracic aneurysms?

A

CT angiogram aorta and MRI aorta
MRI aorta used for follow up

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19
Q

Describe an aortic dissection

A

Tear in the inner wall of the aorta
Blood forces walls apart - the media
Acute - medical/ surgical emergency

20
Q

What are some causes of aortic dissection?

A

Hypertension, atherosclerosis, Marfan’s syndrome (genetic condition affecting the connective tissue), bicuspid aortic valve and trauma

21
Q

What does the histology of aortic dissection have?

A

Cystic medial necrosis
Replacement of medial layer with smooth and elastic fibres which weakens

22
Q

What can happen in dissection?

A

False lumen can progress in an antegrade or retrograde direction
May occlude branches
Rupture - into lumen or mediastinum
Dilation of ascending aorta may cause acute aortic regurgitation

23
Q

What is the most common thoracic aortic dissection classification?

A

Stanford
Type A - involves the ascending aorta
Type B - not involving the ascending aorta
Can also use DeBakey classification

24
Q

What are the symptoms of aortic dissection?

A

Chest pain - severe, sharp, radiating to back - intrascapular
Collapse - tamponade, acute AR, external rupture
Stroke - involvement of carotid arteries

25
Q

What are the clinical presentations of aortic dissection on examination?

A

Reduced or absent peripheral pulses
Hypertension or hypotension
BP mismatch between sides
Soft early diastolic murmur
Pulmonary oedema
Signs of CVA - cerebrovascular accident

26
Q

What investigations can be used to investigate aortic dissection?

A

ECG - ST elevation which shows coronary involvement
CXR - widened mediastinum
Transthoracic echocardiogram (TTE) and CT angiogram aorta

27
Q

Which investigation confirms diagnosis in aortic dissection?

A

CT angiogram aorta

28
Q

What is the mortality rate of aortic dissection pre-hospital?

A

50%

29
Q

What is treatment for type A aortic dissection?

A

Blood pressure control - beta blockers, IVI nitrate, CCB and IVI sodium nitroprusside if rest fail
Emergency surgery

30
Q

What is the treatment for type B aortic dissection?

A

Blood pressure control - beta blockers, IVI nitrate, CCB and IVI sodium nitroprusside
Percutaneous intervention can also be considered

31
Q

What is Takayasu’s Arteritis?

A

Granulomatous vasculitis
Aorta and main branches
Can get stenosis, thrombosis, aneurysms, renal artery stenosis and neurological sx

32
Q

What is the treatment for Takayasu’s arteritis?

A

Steroids and immunosuppressive Tx
Surgery and percutaneous intervention may be required

33
Q

Explain syphilis

A

STD
Treponema pallidum
Antibiotics prevent late stages

34
Q

What can tertiary syphilis cause?

A

Cardiac syphilis
Syphilitic aortitis - aneurysm
Aortic regurgitation

35
Q

What are congenital aortic aneurysms?

A

Bicuspid aortic valve
Coarctation
Marfan’s syndrome - connective tissue

36
Q

Explain bicuspid aortic valve

A

2 cusps instead of 3
Associated with coarctation - aortic narrowing
Reduced tensile strength
Monitor with echo/ MRI

37
Q

What is bicuspid aortic valve prone to?

A

Aortic valve stenosis and maybe regurgitation
Aneurysm/ dissection

38
Q

Explain aortic coarctation

A

Aortic narrowing close to where ductus arteriosus inserts
Usually descending

39
Q

What are the 3 types of coarctation?

A

Pre-ductal - can be life-threatening if severe narrowing
Ductal
Post-ductal - most common in adults, hypertension in upper extremities and weak pulses in lower limbs. Associated with rib-notching

40
Q

What are the signs of coarctation?

A

Cold legs, poor leg pulses
If before left subclavian artery - radial-radial and right radial-femoral delay
If after - no radial-radial delay
Right and left radio-femoral delay

41
Q

What are symptoms of coarctation in infancy if severe?

A

Heart failure
Failure to thrive

42
Q

What are some later life symptoms of coarctation?

A

Hypertension - can be high in arms and low BP in legs
CV complications - heart failure, MI, CVA, aortic dissection

43
Q

What imaging is used for coarctation?

A

CXR - show notching of ribs and enlargement of intercostal arteries
CMRI

44
Q

What is the treatment of coarctation?

A

Percutaneous or surgical correction

45
Q

What is Marfan’s syndrome?

A

Connective tissue weakness
Fibrillin 1 gene
Affects skeletal system, eyes, vascular (aneurysm and dissection), Lungs and Heart
Aortic/ Mitral valve prolapse -regurgitation
Risk is increased in pregnancy

Cardiovascular (33 decks)

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