Disease of the Thoracic Aorta

Question 1

Name the seven parts of the Aorta

Answer 1

Annulus 
Aortic root 
Sinotubular junction 
Ascending thoracic aorta 
Aortic arch 
Descending thoracic aorta 
Abdominal aorta

Question 2

What is the commonest cause of death in the West?

Answer 2

Atherosclerosis

Question 3

What are the risk factors for atherosclerosis?

Answer 3

Hypertension 
Hypercholesterolaemia 
Smoking 
Diabetes 
Family history 
Male

Question 4

When does atherosclerosis usually begin?

Answer 4

Early childhood

Question 5

What are the different stages in the atherosclerosis timeline?

Answer 5

Foam cells 
Fatty streak 
Intermediate lesion 
Atheroma 
Fibrous plaque 
Complicated lesion/rupture

Question 6

What can atherosclerosis cause?

Answer 6

Stroke
MI
Aneurysm

Question 7

What is an aneurysm?

Answer 7

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

Question 8

What are the different types of aneurysms?

Answer 8

True aneurysms
False aneurysm
Dissecting aneurysm

Question 9

What are the two types of true aneurysms?

Answer 9

Saccular

Fusiform

Question 10

What is a true aneurysm?

Answer 10

Weakness and dilation of the artery wall that involves all three layers

Question 11

What is a true aneurysm associated with?

Answer 11

Hypertension 
Atherosclerosis 
Smoking 
Collagen abnormalities 
Trauma 
Infection

Question 12

What diseases can cause collagen abnormalities?

Answer 12

Marfan’s syndrome

Cystic medial necrosis

Question 13

What are false aneurysms?

Answer 13

Rupture of the wall of the aorta with haematoma either contained by the thin adventitial layer or by the surrounding soft tissue

Question 14

What can cause a false aneurysm?

Answer 14

Inflammation
Trauma
Iatrogenic

Question 15

What happens as a result of a false aneurysm?

Answer 15

Ischaemia

Rupture

Question 16

How can you tell if a person has a false aneurysm?

Answer 16

Thrills
Bruit
Pulsatile mass

Question 17

What is a dissecting aneurysm?

Answer 17

When the wall of the aorta is ripped and blood flows into it separating the layers of the wall.

Question 18

What are the possible signs and symptoms of a thoracic aneurysm?

Answer 18

Asymptomatic 
SOB 
Heart failure 
Dysphagia and hoarseness 
Sharp chest pain radiating to back
Pulsatile mass 
Hypotension

Question 19

What does acute aortic dissection count as?

Answer 19

A medical/surgical emergency

Question 20

What causes aortic dissection?

Answer 20

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome

Question 21

What are the two types of aortic dissections?

Answer 21

Antegrade

Retrograde

Question 22

What are the different ways that an aortic dissection can rupture?

Answer 22

Back into the lumen

Externally into the pericardium or mediastinum

Question 23

What can dilation of the ascending aorta cause?

Answer 23

Acute aortic regurgitation

Question 24

What are the signs and symptoms of aortic dissection?

Answer 24

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

Question 25

What investigations should be done to check for aortic dissection?

Answer 25

CT CXR Ultrasound MRI

Question 26

What are the treatment options for aortic dissection?

Answer 26

Surgery Meticulous blood pressure control Sodium nitroprusside puls beta blocker

Question 27

What is Takayasu's arteritis?

Answer 27

A form of large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing. It normally effects the aorta and its main branches

Question 28

What can Takayasu's arteritis cause?

Answer 28

Stenosis Thrombosis Aneurysm Renal artery stenosis

Question 29

How is Takayasu's arteritis treated?

Answer 29

Steroids | Surgery

Question 30

Which gender does Takayasu' arteritis effect more?

Answer 30

Females

Question 31

What is Syphilis?

Answer 31

A STD caused by the bacteria, Treponema palladium, and can be treated by antibiotics

Question 32

What are the 3 types of tertiary syphilis?

Answer 32

Late neuro-syphillis Gummatous syphillis Cardiac syphillis

Question 33

What can cardiac syphillis cause?

Answer 33

Syphilitic aortic aneurysm | Aortic regurgitation

Question 34

What can cause congenital aortic aneurysms?

Answer 34

Bicuspid aortic valve Marfan's syndrome Coarctation

Question 35

What is the most common congenital abnormality?

Answer 35

Bicuspid aortic valve

Question 36

What is a bicuspid aortic valve prone to?

Answer 36

Stenosis and/or regurgitation

Question 37

What is a bicuspid aortic valve associated with?

Answer 37

Coarctation

Question 38

How does a bicuspid aortic valve effect the aorta?

Answer 38

Reduces tensile strength

Question 39

How is a bicuspid aortic valve monitored?

Answer 39

With echo/MRI

Question 40

What is aortic coarctation?

Answer 40

Aortic narrowing close to where the Ductus arteriosus inserts

Question 41

What are the signs of coarctation?

Answer 41

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

Question 42

What are the symptoms of coarctation in infancy?

Answer 42

Heart failure | Failure to thrive

Question 43

What are the symptoms of coarctation in later life?

Answer 43

Hypertension

Question 44

What imaging can be used to investigate for coarctation?

Answer 44

CXR | CMRI

Question 45

What is Marfan's syndrome?

Answer 45

Connective tissue weakness

Question 46

How can marina's syndrome effect the body?

Answer 46

``` Aortic/mitral valve prolapse - regurgitation Cataracts Lens dislocation Aneurysm Dissection Pneumothorax Skeletal system ```

Question 47

What are the 3 types of coarctation?

Answer 47

Pre-ductal Ductal Post-ductal

Question 48

What is the most common type of coarctation in adults?

Answer 48

Post-ductal