Disease of the Thoracic Aorta Flashcards
What type of cells are found in the tunica intima?
- layer of endothelial cells
- Subendothelial layer -(collagen and elastic fibres)
- Seperated from tunica media internal elastic membrane
What type of cells are found in the tunica media?
- Smooth muscle cells
- Secrete elastin in the form of sheets or lamellae
What type of tissue is found in the tunica adventita?
-Thin connective tissue layer
-Collagen fibres and elastic fibres (not lamellae)
-
What is a true aneurysm?
- weakness & dilation of wall
- Invovles with all 3 layers
What is a true aneurysm associated with?
- Hypertension
- Atherosclerosis
- Smoking
- Collagen abnormalities
- Trauma
- Infection
What is a false aneurysm?
Rupture of wall of aorta with the haematoma either contained by the thin adventita or by surrounding soft tissue
When can a false aneurysm happen?
- Inflammation (eg endocarditis with septic embolism)
- trauma
- Iatrogenic
What can be seen on physical exam when false aneurysm occurs?
- Thrill
- Bruit
- Pulsitile mass
What are the signs and symptoms of thoracic aneurysms?
- shortness of breath (even heart failure)
- Dysphagia and hoarseness
- Sharp chest pain radiating to back-between shoulder blades
- Pulsatile mass
- Hypotension
What are the two types of classification for aortic dissections?
Debakey
Stanford
Name the three stages of the debakey system?
1-Originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distallly
2-originates in and is confined to the ascending aorta
3-Orginates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta
What re the two classes in the stand ford method?
A- All disections involving the ascending aorta, regardless of the site of origin
B-All dissections not involving the ascending aorta
Symptoms of aortic dissection?
- Tearing,severe chest pain (radiating to back)
- Collapse (tamponade, acute AR, external rupture)
- Inferior ST elevation
What is found upon examination with someone with aortic dissection?
- reduced or absent peripheral pulses (BP mismatch between sides)
- Hypotension/hypertension
- Soft early diastolic murmur
- Pulmonary oedema
- Chest X-ray usually shows a widened mediastinum
- Diagnosis can be confirmed with echo or ECG
How do you treat type A dissection?
Surgery
How do you treat type B dissection?
- Maticulous blood pressure control
- Sodium nitroprusside plus beta blocker
What is Takayasu`s Arteritis?
Granulomatous vasculitis
What does Takayasu`s arteritis cause?
-Stenosis,thrombosis, aneuryms,renal artery stenosis, neurological
Hoe do you treat Takayasu`s arteritis?
Steroids
Surgery
Whay bacteria is causes syphilis?
Treponema pallidum
What can be seen on examination in a patient with syphilis?
Primary-Chancre
Secondary-Rash
Without treatment what does one third of syphilis cases turn into?
- Late neuro-syphillis
- Gummatous syphillis
- Cardiac syphillis
What are the three shunts that form at birth?
- Ductus arteriosus
- Foramen ovale
- Ductus venosus
What are the signs of coartication?
- cold legs
- poor leg pulses
- If before left subclavian ( radial-radial and RIGHT radial femoral delay)
- If after left subclavian artery?
- No radial radial delay
- -right and left radiofemoral delay
What causes Marfans syndrome?
-fibrillin 1 gene mutation
