Diseases of the Aorta

Question 1

This type of aneurysm is when theres localized abnormal dilation of a blood vessel that involves an intact weakened arterial wall

Answer 1

True aneurysm

Question 2

In a false aneurysm, there is a defect in the vascular wall, leading to the formation of what?

Answer 2

Extravascular hematoma

Question 3

This condition rresults when blood splays apart the laminar planes of the media to form a blood filled channel within the aortic wall

Answer 3

Arterial dissection

Question 4

How many sides of the vessel wall is buldging with a saccular aneurysm?

Answer 4

1

Question 5

How many sides of the vessel wall is buldging with a fusiform aneurysm?

Answer 5

2

Question 6

What are the 2 most important disordeers that predispose u to aortic aneurysms?

Answer 6

Atherosclerosis and HTN

Question 7

However, atherosclerosis has a greeater instance of aortic aneurysms in which part of teh aorta?

Answer 7

Abdominal aorta

Question 8

HTN has a greater instance of aortic aneurysms in which part of teh aorta?

Answer 8

Ascending aorta

Question 9

This condition is from the defective synthesis of fibrillin, leading to weakening of the elastic tissue in the aorta.

Answer 9

Marfan syndrome

Question 10

This condition is from muttations in TGF-B receptors, leading to abnormalities and collagen I and IIa

Answer 10

Loeys-Dietz syndrome

Question 11

This syndrome results in a weak vessel wall due to defective type III collagen synthesis

Answer 11

Ehlers Danlos syndrome

Question 12

This is the molecule that;s produced by macrophages in response to vasculitis by atherosclerotic plaques.

Answer 12

MMP (matrix metalloproteinase)

Question 13

What is the action of MMP on the aterial wall?

Answer 13

Degrades the shit outta everything

Question 14

Which layer of the vessel wall is ischemic due to diffusion problems with atheroscleoric thickening?

Answer 14

Media

Question 15

Systemic HTN can cause outer medial ischemic by causing narrowing of which arteries that supply that part of the vessel?

Answer 15

Vasa vasorum

Question 16

This type of AAA is characterized by dense perioaortic fibrosis with many macrophages and often giant cells.

Answer 16

Inflammatory AAA

Question 17

This type of AAA is when lesions become infected by the lodging of circulating bugs in the GI (typically salmonella).

Answer 17

Mycotic AAA

Question 18

What is the serious (fatal) complication to AAA’s?

Answer 18

Rupture and quick death.

“ticking time-bomb”

Question 19

What is the clinical presentation of a AAA?

Answer 19

pulsating abdominal mass. kinda looks like a tumor. but it’s not.

Question 20

Which condition is AAA’s associated with, again?

Answer 20

Atherosclerosis

Question 21

Which condition is thoractic aortic aneurysms (TAA)’s assocaited with?

Answer 21

HTN

Question 22

Why can u have respiratory and swallowing difficulties with TAA’s?

Answer 22

compression of the airways and esophagus

coughing due to recurrent laryngeal n.

Question 23

What is the major risk factor for aortic dissections?

Answer 23

HTN

Question 24

What are the 2 mechansims to cause diminished flow through the vasa vasorum to cause aortic dissections?

Answer 24

1. medial hypertrophy

2. loss of smooth muscle cells of the vasa vasorum

Question 25

Where is the name of the pattern of the degeneration to cause aortic degeneration?

Answer 25

cystic medial degeneration

Question 26

True or False: in aortic dissections, inflammation is characteristically absent.

Answer 26

True!

Question 27

What tears in aortic dissections?

Answer 27

Intima

Question 28

Where in the aortic arch are aortic dissections usually found?

Answer 28

ascending aorta, ~10cm from the aortic valve

Question 29

True or False: aortic dissections occur at 1 location and do not spread along the vessel wall.

Answer 29

False! It can extend retrograde or distally

Question 30

What happens if the aortic dissection ruptures through the adventitia?

Answer 30

massive hemorrhage or cardiac tamponade

Question 31

Is the paid sudden or gradual in aortic dissections?

Answer 31

Sudden

like RIPPPPPPPPPPPP

Question 32

Where does the pain radiate in aortic dissections from the anterior chest?

Answer 32

to the back between the scapulae

Question 33

This type of lesion involves either both the ascending and descending aorta or just the ascending aorta.

Answer 33

Proximal lesion (type A)

Question 34

This type of lesion involves parts of the aorta usually beginning distal to the subclavian artery and NEVER the ascending aorta.

Answer 34

Distal lesions (type B)

Question 35

How big must the aortic dissection be in the ascending aorta to do surgical repair?

Answer 35

> 5.5-6 cm

Question 36

How big must the aortic dissection be in the thoracic aorta to do surgical repair?

Answer 36

> 6.5-7 cm

Question 37

How big must the aortic dissection be in the abdominal aorta to do surgical repair?

Answer 37

> 5.5cm

Question 38

What is the immediate goal to reduce of acute aortic dissection?

Answer 38

Reduce systolic BP

Question 39

Which drugs can u give for the acute management of aortic dissections to reduce LV contractile force?

Answer 39

β-blockers

Question 40

In type A dissections, what is the treatment of choice?

Answer 40

Surgery (it’s close to the heart)

Question 41

In uncomplicated type B dissections, what is the treatment of choice?

Answer 41

Medical therapy

Question 42

So when do u do surgery in pts with type B dissections?

Answer 42

clinical evidence of propogation of the dissection, compromist of majoy aortic branches, impending ruoture, continued pain