Disease of the Thoracic Aorta Flashcards
Name the seven parts of the Aorta
Annulus Aortic root Sinotubular junction Ascending thoracic aorta Aortic arch Descending thoracic aorta Abdominal aorta
What is the commonest cause of death in the West?
Atherosclerosis
What are the risk factors for atherosclerosis?
Hypertension Hypercholesterolaemia Smoking Diabetes Family history Male
When does atherosclerosis usually begin?
Early childhood
What are the different stages in the atherosclerosis timeline?
Foam cells Fatty streak Intermediate lesion Atheroma Fibrous plaque Complicated lesion/rupture
What can atherosclerosis cause?
Stroke
MI
Aneurysm
What is an aneurysm?
A localised enlargement of an artery caused by a weakening of the vessel wall
What are the different types of aneurysms?
True aneurysms
False aneurysm
Dissecting aneurysm
What are the two types of true aneurysms?
Saccular
Fusiform
What is a true aneurysm?
Weakness and dilation of the artery wall that involves all three layers
What is a true aneurysm associated with?
Hypertension Atherosclerosis Smoking Collagen abnormalities Trauma Infection
What diseases can cause collagen abnormalities?
Marfan’s syndrome
Cystic medial necrosis
What are false aneurysms?
Rupture of the wall of the aorta with haematoma either contained by the thin adventitial layer or by the surrounding soft tissue
What can cause a false aneurysm?
Inflammation
Trauma
Iatrogenic
What happens as a result of a false aneurysm?
Ischaemia
Rupture
How can you tell if a person has a false aneurysm?
Thrills
Bruit
Pulsatile mass
What is a dissecting aneurysm?
When the wall of the aorta is ripped and blood flows into it separating the layers of the wall.
What are the possible signs and symptoms of a thoracic aneurysm?
Asymptomatic SOB Heart failure Dysphagia and hoarseness Sharp chest pain radiating to back Pulsatile mass Hypotension
What does acute aortic dissection count as?
A medical/surgical emergency
What causes aortic dissection?
Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome
What are the two types of aortic dissections?
Antegrade
Retrograde
What are the different ways that an aortic dissection can rupture?
Back into the lumen
Externally into the pericardium or mediastinum
What can dilation of the ascending aorta cause?
Acute aortic regurgitation
What are the signs and symptoms of aortic dissection?
Tearing, severe chest pain radiating to the back
Collapse (tamponade, acute AR, external rupture)
Inferior ST elevation
Reduced or absent peripheral pulses/mismatch between sides
Hypotension/hypertension
Soft early diastolic murmur
Pulmonary oedema
Widening mediastinum
What investigations should be done to check for aortic dissection?
CT
CXR
Ultrasound
MRI
What are the treatment options for aortic dissection?
Surgery
Meticulous blood pressure control
Sodium nitroprusside puls beta blocker
What is Takayasu’s arteritis?
A form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing. It normally effects the aorta and its main branches
What can Takayasu’s arteritis cause?
Stenosis
Thrombosis
Aneurysm
Renal artery stenosis
How is Takayasu’s arteritis treated?
Steroids
Surgery
Which gender does Takayasu’ arteritis effect more?
Females
What is Syphilis?
A STD caused by the bacteria, Treponema palladium, and can be treated by antibiotics
What are the 3 types of tertiary syphilis?
Late neuro-syphillis
Gummatous syphillis
Cardiac syphillis
What can cardiac syphillis cause?
Syphilitic aortic aneurysm
Aortic regurgitation
What can cause congenital aortic aneurysms?
Bicuspid aortic valve
Marfan’s syndrome
Coarctation
What is the most common congenital abnormality?
Bicuspid aortic valve
What is a bicuspid aortic valve prone to?
Stenosis and/or regurgitation
What is a bicuspid aortic valve associated with?
Coarctation
How does a bicuspid aortic valve effect the aorta?
Reduces tensile strength
How is a bicuspid aortic valve monitored?
With echo/MRI
What is aortic coarctation?
Aortic narrowing close to where the Ductus arteriosus inserts
What are the signs of coarctation?
Cold legs
Poor leg pulses
Radial-radial and right radial femoral delay if before left subclavian artery
Right and left radio-femoral delay with no radial-radial delay if after left subclavian artery
What are the symptoms of coarctation in infancy?
Heart failure
Failure to thrive
What are the symptoms of coarctation in later life?
Hypertension
What imaging can be used to investigate for coarctation?
CXR
CMRI
What is Marfan’s syndrome?
Connective tissue weakness
How can marina’s syndrome effect the body?
Aortic/mitral valve prolapse - regurgitation Cataracts Lens dislocation Aneurysm Dissection Pneumothorax Skeletal system
What are the 3 types of coarctation?
Pre-ductal
Ductal
Post-ductal
What is the most common type of coarctation in adults?
Post-ductal
