Diseases of the Aorta Flashcards
This type of aneurysm is when theres localized abnormal dilation of a blood vessel that involves an intact weakened arterial wall
True aneurysm
In a false aneurysm, there is a defect in the vascular wall, leading to the formation of what?
Extravascular hematoma
This condition rresults when blood splays apart the laminar planes of the media to form a blood filled channel within the aortic wall
Arterial dissection
How many sides of the vessel wall is buldging with a saccular aneurysm?
1
How many sides of the vessel wall is buldging with a fusiform aneurysm?
2
What are the 2 most important disordeers that predispose u to aortic aneurysms?
Atherosclerosis and HTN
However, atherosclerosis has a greeater instance of aortic aneurysms in which part of teh aorta?
Abdominal aorta
HTN has a greater instance of aortic aneurysms in which part of teh aorta?
Ascending aorta
This condition is from the defective synthesis of fibrillin, leading to weakening of the elastic tissue in the aorta.
Marfan syndrome
This condition is from muttations in TGF-B receptors, leading to abnormalities and collagen I and IIa
Loeys-Dietz syndrome
This syndrome results in a weak vessel wall due to defective type III collagen synthesis
Ehlers Danlos syndrome
This is the molecule that;s produced by macrophages in response to vasculitis by atherosclerotic plaques.
MMP (matrix metalloproteinase)
What is the action of MMP on the aterial wall?
Degrades the shit outta everything
Which layer of the vessel wall is ischemic due to diffusion problems with atheroscleoric thickening?
Media
Systemic HTN can cause outer medial ischemic by causing narrowing of which arteries that supply that part of the vessel?
Vasa vasorum
This type of AAA is characterized by dense perioaortic fibrosis with many macrophages and often giant cells.
Inflammatory AAA
This type of AAA is when lesions become infected by the lodging of circulating bugs in the GI (typically salmonella).
Mycotic AAA
What is the serious (fatal) complication to AAA’s?
Rupture and quick death.
“ticking time-bomb”
What is the clinical presentation of a AAA?
pulsating abdominal mass. kinda looks like a tumor. but it’s not.
Which condition is AAA’s associated with, again?
Atherosclerosis
Which condition is thoractic aortic aneurysms (TAA)’s assocaited with?
HTN
Why can u have respiratory and swallowing difficulties with TAA’s?
compression of the airways and esophagus
coughing due to recurrent laryngeal n.
What is the major risk factor for aortic dissections?
HTN
What are the 2 mechansims to cause diminished flow through the vasa vasorum to cause aortic dissections?
- medial hypertrophy
2. loss of smooth muscle cells of the vasa vasorum
Where is the name of the pattern of the degeneration to cause aortic degeneration?
cystic medial degeneration
True or False: in aortic dissections, inflammation is characteristically absent.
True!
What tears in aortic dissections?
Intima
Where in the aortic arch are aortic dissections usually found?
ascending aorta, ~10cm from the aortic valve
True or False: aortic dissections occur at 1 location and do not spread along the vessel wall.
False! It can extend retrograde or distally
What happens if the aortic dissection ruptures through the adventitia?
massive hemorrhage or cardiac tamponade
Is the paid sudden or gradual in aortic dissections?
Sudden
like RIPPPPPPPPPPPP
Where does the pain radiate in aortic dissections from the anterior chest?
to the back between the scapulae
This type of lesion involves either both the ascending and descending aorta or just the ascending aorta.
Proximal lesion (type A)
This type of lesion involves parts of the aorta usually beginning distal to the subclavian artery and NEVER the ascending aorta.
Distal lesions (type B)
How big must the aortic dissection be in the ascending aorta to do surgical repair?
> 5.5-6 cm
How big must the aortic dissection be in the thoracic aorta to do surgical repair?
> 6.5-7 cm
How big must the aortic dissection be in the abdominal aorta to do surgical repair?
> 5.5cm
What is the immediate goal to reduce of acute aortic dissection?
Reduce systolic BP
Which drugs can u give for the acute management of aortic dissections to reduce LV contractile force?
β-blockers
In type A dissections, what is the treatment of choice?
Surgery (it’s close to the heart)
In uncomplicated type B dissections, what is the treatment of choice?
Medical therapy
So when do u do surgery in pts with type B dissections?
clinical evidence of propogation of the dissection, compromist of majoy aortic branches, impending ruoture, continued pain
