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Diseases of the Aorta Flashcards

1
Q

Congenital syndrome characterized by a connective tissue disorder

A

Marfan Syndrome

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2
Q

List 3 physical features associated with Marfan’s Syndrome.

A
  1. Tall or normal stature
  2. Thin body habitus
  3. Long extremities
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3
Q

List 3 clinical presentations associated with Marfan’s Snydrome.

What are the clinical presentation of Marfan syndrome?

A
  • Asymptomatic*
  • Murmur may be present*
  • Palpitations or tachycardia*
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4
Q

Marfan syndrome: sonographic features

List 4 Echocardiographic features of Marfan’s Syndrome.

A
  • ascending aorta dilatation
  • MVP
  • annuloaortic ectasia *Annuloaortic ectasia is a dilatation or an enlargement of the ascending aorta, the aortic annulus and/or a loss of function of the aorta.
  • dissection of aorta
  • AR/MR
  • rupture of sinus of Valsalva/aneurysm
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5
Q

TEE offers excellent visualization of dilated aortic root.

T or F ?

A

T

TEE offers excellent visualization of dilated aortic root

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6
Q

What are the vessel layers of aorta?

A

intima

media

adventitia

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7
Q

Which vessel layer is affected by DM?

A

media

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8
Q

Aortic Aneurysm

List at least 4 etiologies of aortic aneurysms.

A
  1. atherosclerosis
  2. media degeneration (i.e. annuloaortic ectasia; Marfan syndrome; BAV)
  3. trauma
  4. mycotic *A mycotic aneurysm is an infection of vessel wall which can be bacterial, fungal, or viral in origin; they are a rare but severe
  5. noninfectious aortitis
  6. aortic dissection with dilatation of persistent false lumen
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9
Q

Aortic Aneurysm

clinical presentation:

  1. signs and symptoms?
  2. physical findings?
  3. auscultatory findings?
A
  1. asymptomatic, CP, back pain, hoarseness, cough
  2. abdominal bruit
  3. AR murmur (early diastolic murmur)
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10
Q

Classification of dissection based on the site of the intimal tear

A

Stanford system

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11
Q

Aortic Dissection Classifications

all dissections which involve the ascending aorta (DeBakey _______)

A

Stanford Type A/proximal

types I and II

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12
Q

Aortic Dissection Classifications

all dissections that do not include the ascending aorta (DeBakey ____

A

Stanford Type B (distal)

Debakey type III

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13
Q

This classification of aneurysm is characterized by a uniform dilatation of the entire circumference of the vessel. __________?___________

A

fusiform

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14
Q

This classification of aneurysm is characterized by a weakening in the vessel wall at one point which results in an outpouching with a narrow neck. ______?______.

A

saccular

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15
Q

Describe in 30 words or less the main goals for imaging when documenting aortic aneurysms.

A
    1. Confirm or exclude diagnosis*
    1. Measurement of diameter and length*
    1. Determine involvement of aortic valve or arch vessels*
    1. Differentiate from aortic dissection*
    1. Detect mural thrombus*
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16
Q

List 4 echocardiographic feautres of an aortic dissection:

A
  1. Dilated aortic root
  2. Normal aortic valve motion may be present
  3. AR** may be coexistent in ascending type with evidence of **diastolic MV flutter
  4. Large anechoic space posterior to LA** may be present with **descending type
  5. Entire thoracic aorta can be viewed using parasternal, suprasternal, subcostal, and occasionally the apical two-chamber view
  6. Allows localization of ascending aneurysm with high accuracy; descending type difficult to visualize. High right parasternal view can be utilized or apical two-chamber with slight posterior angulation and increased depth.
  7. May be useful for dissection with identification of an intimal flap
  8. Flow reversal may be seen in false lumen if dissection occurs.
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17
Q

TEE is superior to TTE in recognition of thoracic or descending aorta.

T or F ?

A

T

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18
Q

______________________ is a tear in the intima through which a column of blood enters the aortic wall, destroying the media and stripping the intima from the adventitia in a longitudinal fashion.

A

aortic dissection

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19
Q

Aortic Dissection:

Etiology (3)

A
  1. congenital
  2. hypertension
  3. trauma
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20
Q

List at least 4 etiologies of aortic aneurysms.

A

Atherosclerosis

Medial degeneration (Annuloaortic ectasia; Marfan syndrome; Associated with bicuspid aortic valve; other heritable disorders)

Trauma

Mycotic - infection with or disease caused by a fungus

  • Noninfectious Aortitis*
  • Aortic dissection with dilatation of persistent false lumen*
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21
Q

An abdominal bruit is a physical finding of an aortic aneurysm.

T or F ?

A

T

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22
Q

Aortic Aneurysm

complications (3)

A

AR

thromboembolism

compression of adjacent structure (trachea/esophagus)

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23
Q

Aortic Aneurysm

management (2)

A

medical: antihypertensive medications; follow-up to evaluate changes, treatment for atherosclerosis, CAD, Penicillin for syphilis patients

surgical: Time of operation controversial; Depends on many factors (cause, size, rate of change); Endovascular stenting; Serial imaging; Aortic valve repair/replacement if damaged

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24
Q

A patient with an aortic aneurysm may present with these signs/symptoms to the ED except:

  • hematuria
  • chest or back pain
  • hoarseness
  • cough
A

hematuria

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25
Q

aortic aneurysm locations:

A

ascending

arch

descending

thoracoabdominal

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26
Q

Aortic Dissection Clinical Presentation

signs & symptoms (2)

A
  1. Chest pain, typically radiating to the back, sudden onset, unremitting
  2. Shock/hypotension
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27
Q

Aortic Dissection Clinical Presentation

hx/physical (10)

A
  1. systemic HTN
  2. CHD
  3. severe CP radiating to the back/abdomen
  4. MI
  5. HF
  6. CVA
  7. pulse deficit
  8. elevated jagular venous pressure
  9. brisk (quick/rapid) arterial pulse
  10. new AR murmur
28
Q

Aortic Dissection Classification

______　system is based on the anatomic location

29
Q

Aortic Dissection Classification

______ involves the ascending aorta, arch, and descending thoracic aorta and may progress to involve the abdominal aorta.

A

Debakey Type I

*more serious type

tear in AAO, AO arch, DAO

30
Q

Aortic Dissection Classification

________ is confined to the ascending aorta.

A

Debakey Type II

*tear in AAO

31
Q

Aortic Dissection Classification

involves descending thoracic or abdominal aorta

______ involves the descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery.

_______ dissection involves the thoracic and abdominal aorta distal to the left subclavian artery.

A

Type IIIa

Type IIIb

32
Q

Your patient is in the ED for a possible Aortic Dissection. What are 4 items that would possibly be in the patient’s history and physical that indicate the possiblity of an Aortic Disection.

A

systemic HTN

CHD

HF

severe CP radiating to back or abdomen

brisk atrial pulse

new AR murmur

CVA

33
Q

List the two major classification schools of thought for identification of aortic dissection.

A

Stanford

Debakey

34
Q

List 4 echocardiographic features of an aortic aneurysm.

A
  • Dilated aortic root
  • Normal aortic valve motion may be present
  • AR may be coexistent in ascending type** with evidence of **diastolic MV flutter
  • Large anechoic space posterior to LA may be present with descending type
  • Entire thoracic aorta can be viewed using parasternal, suprasternal, subcostal, and occasionally the apical two-chamber view
  • Allows localization of ascending aneurysm with high accuracy; descending type difficult to visualize. High right parasternal view can be utilized or apical two-chamber with slight posterior angulation and increased depth.
  • May be useful for dissection with identification of an intimal flap
  • Flow reversal may be seen in false lumen if dissection occurs.
35
Q

When performing the SSN view an aneurysm may be potentially found here.

  • Ascending aorta
  • Aprtoc arch
  • Decending aorta
  • All are correct
A

All are correct

36
Q

Aortic Dissection

Echocardiographic Features

A
  • Intimal flap appears as an oscillating linear echo within aortic lumen
  • True lumen opens in systole** and is **closed in diastole
  • LV enlargement if AR is present
  • Common for thrombus to form in false lumen
  • Effusion
  • Increased aortic wall thickness (intramural hematoma)
  • Aortic regurgitation due to: Aortic root dilatation; Asymmetric dissection causes incomplete coaptation; Dissection into commissure causes incomplete coaptation; Intimal flap prolapses through AoV; Pericardial and/or pleural effusion
37
Q

Aortic Dissection

Role of TEE and advantage

A

Improve identification of intimal flap and true and false lumen & improves overall imaging; Limitations-risks, time, availability

38
Q

Aortic Dissection

management

A

medical : treatment for systemic HTN and follow-up

surgical : endovascular stenting

39
Q

Aortic Dissection

differential diagnosis (4)

A
  1. reverberation, catheters
  2. mirror image artifacts
  3. Hemiazygous sheath
  4. thoracic aortic aneurysm with thrombus
40
Q

*Which is not a complication of a sinus of valsalva aneurysm?

  • TR
  • AR
  • Endocarditis
  • MR
41
Q

Sinus of Valsalva Aneurysm

Associated congenital anomalies of a sinus of valsalva aneurysm include:

  • VSD
  • ASD
  • BAV
  • All are included
A

All are included

42
Q

Sinus of Valsalva Aneurysm

most common origin/location?

A

right coronary sinus

43
Q

Sinus of Valsalva Aneurysm

The rupture of the right coronary sinus into RV is considered a most common finding in a sinus of valsalva aneurysm.

True

False

A

T

note: Rupture of non-coronary sinus in RA is less common

44
Q

________________________\_ is a congenital syndrome characterized by a connective tissue disorder.

A

Marfan Syndrome

45
Q

Sinus of Valsalva Aneurysm

Echocardiographic Features (5)

A
  1. Round or fingerlike (windsock) outpouchings
  2. Abnormal dilation** of one or more sinuses; **most often the right
  3. TV systolic flutter best seen on M- mode
  4. High velocity systolic/diastolic flow pattern with color and CW Doppler
  5. Compression of adjacent structures i.e. trachea, esophagus
46
Q

Sinus of Valsalva Aneurysm

complications

A
  1. Rupture into cardiac chamber
  2. RVOT obstruction
  3. Endocarditis
  4. AR
  5. TR
  6. Erosion into ventricular septum
  7. Obstruction of adjacent structures: Coronary artery compression; SVC obstruction; Tricuspid stenosis
47
Q

An auscultatory finding of an aortic aneurysm is a TR murmur.

True or False ?

A

F

*Aneurysms of the root or ascending aorta may produce secondary aortic regurgitation, so a diastolic murmur may be detected on physical examination or, less often, patients may present with congestive heart failure.

48
Q

***For a patient with a sinus of valsalva aneurysm, a rupture into the pericardium is almost 100% fatal and unusual.

True or False?

49
Q

Sinus of Valsalva Aneurysm

***associated anomalies (3)

A

BAV

coarctation of the aorta

VSD

50
Q

Additional Aortic Pathology (5)

A
  1. Aortic atherosclerosis – May visualize wall thickening, calcifications, ulceration, mural thrombi or atheromatous debris

2. Aortic Pseudoaneurysm:

  • A contained rupture of the aorta characterized by a sac communicating with the aorta via a narrow neck
  • May be the result of spontaneous rupture with sealing off of the hemorrhage, or as a result of aortic dissection, or the result of iatrogenic injury.
  • 3. Penetrating aortic ulcer*
  • 4. Aortic hematoma*
  • 5. Traumatic injury of the aorta may result in dissection or tear*
51
Q

List 4 possible causes of a Sinus of Valsalva Aneurysm.

A
  1. Congenital
  2. Trauma
  3. Infective endocarditis
  4. Syphilis
  5. Marfan syndrome
52
Q

Sinus of Valsalva Aneurysm

clinical presentation (3)

A
  1. dyspnea, CP (gradual onset and progression of symptoms)
  2. wide pulse pressure
  3. Auscultatory findings – Almost continuous murmur (“machine-type”)
53
Q

which of the following conditions is associated with aortic aneurysm?

  1. Marfan syndrome
  2. Ebstein anomaly
  3. Down syndrome
  4. Hypotension
  5. William syndrome
54
Q

aortic dilatation is the most common abnormality of the aorta. Which if the following is NOT a cause of aortic dilatation?

  1. hypertension
  2. cystic medical necrosis
  3. poststenotic disease
  4. atherosclerosis
  5. hypotension
A
  1. hypotension
    note: Cystic medial necrosis (CMN) is a disorder of large arteries, in particular the aorta, characterized by an accumulation of basophilic ground substance in the media with cyst-like lesions.
55
Q

which of the following echocargiographic findings would be associated with aortic dissection?

  1. an aortic area of 1.0 cm2
  2. a LVOT diameter 0f 1.8cm
  3. a LV wall measurement of 5mm
  4. WMA associated with obstruction of the right coronary artery territory
  5. AS
A
  1. WMA may be present with dissection when the false lumen obstructs the coronary artery ostia. This results in decreased flow to the myocardium and on echocardiography manifests as a regional wall motion abnormality
56
Q

aortic plaques are defined as complex when their thickness is:

  1. greater than 4 mm with clot or ulcerations
  2. greater than 4 mm without clot or ulcerations
  3. less than 4mm with clot or ulcerations
  4. less than 3mm with or without clot or ulcerations
  5. less than 2 mm with or without clot or ulcerations
A
  1. aortic plaques that are greater than 4mm in thickness and that contain clot or ulceration are considered “vulnerable” plaques at high risk for peripheral arterial embolism
57
Q

A Stanford classification type A aortic dissection is one that:

  1. involves any portion of the ascending aorta
  2. is distal to the origin of the innominate artery and proximal to the origin of LCC
  3. is distal to the origin of the LCC and proximal to the origin of the LSA
  4. is distal to the origin of the LCC and extends into the LCC
  5. is confined to DAO
A
  1. involves any portion of ascending aorta
58
Q

complications associated with dissection of the aorta include all of the following except:

  1. underperfusion to the systemic circulation
  2. cleft MV
  3. rupture of the aorta
  4. pericardial tamponade post rupture of the aorta
  5. AI
A

1 cleft MV

59
Q

sinus of Valsalva aneurysm can be caused by:

  1. infection
  2. Marfan syndrome
  3. AI
  4. 1 & 2 only
  5. 1, 2 & 3
A
  1. infection & Marfan syndrome
60
Q

a sinus of Valsalva aneurysm in the right coronary sinus usually protrudes into the:

  1. LA
  2. LV
  3. RVOT
  4. RA
  5. RV
61
Q

a sinus off Valsalva aneurysm in the left coronary sinus usually protrudes into the:

  1. LA
  2. LV
  3. RVOT
  4. RA
  5. RV
62
Q

auscultation of your patient has revealed an Austin Flint murmur. Which valve do you suspect to be abnormal?

A

AoV

*Austin Flint murmur includes a short ejection murmur, an early-diastolic decrescendo murmur, and a mid-diastolic murmur over the cardiac apex and indicated the presence of AI

63
Q

AAA (abdominal aortic aneurysm) risk factor (7)

A

male

65+ yrs

hx of smoking

caucasian

family hx of AAA or other aneurysm

HTN

atherosclerosis

65
Q

A tear in the tunica intima that allows blood to move along the length of the aorta in a “false channel” is a _______ aneurysm.

*type

66
Q

Which of the following characterizes a saccular aortic aneurysm:

67
Q

Which of the following accurately describes abdominal aortic aneurysms:

Echo (35 decks)

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