Diseases of the Aorta Flashcards
True aneurysm
Dilatation of all three layers of the aorta (can be saccular or fusiform)
False aneurysm
Contained rupture through intima and media, contained by adventitia or by a perivascular clot
Etiology of Ascending Aortic Aneurysm
Cystic medial necrosis
Caused by Marfans, Ehlers-Danlos Syndrome, Bicuspid valve
SYPHILIS
Etiology of Descending Aortic Aneurysm
Atherosclerosis
Risk factors for Abdominal Aortic Aneurysm
Hypertension, age, smoking, family history, hyperlipidemia
Do abdominal aortic aneurysms expand?
Yes! by 1/4 mm/year.
Expand faster if active smoker, hypertensive
Risk of AAA rupture is related to…?
Size. If greater than 5.5 surgery immediately.
Presentation of aortic aneurysm
Most commonly asymptomatic. Can get compression of local structures (cough, dyspnea, dysphagia, horseness). Can get aortic regurgitation/CHF.
How to treat aortic aneurysm
B blockers to decrease BP and hemodynamic stress
ACEis- decrease afterload/preload
ARBs - decrease afterload/preload
Smoking cessation
Surgical repair
Aortic dissection
Life threatening condition where blood from the vessel lumen passes through an intimal tear and creates a new lumen in the media.
Type A vs Type B aortic aneurysm
A is ascending.
B is descending only
Related syndromes to aortic dissection
Penetrating ulcer or intramural hematoma
2 proposed mechanisms for pathogenesis of aortic dissection
Tear in the intima causes blood to enter media
Rupture of vasa vasorum causes hemorrhage into the media
When are aortic dissections most common?
In the sixth and seventh decades in men
Risk factors for aortic dissection
Hypertension, tobacco smoking, cocaine, connective tissue disorders, bicuspid aortic valve, aortic coarctation
