diseases of the arteries Flashcards
tunica adventitia
Thin connective tissue layer
Collagen fibres and elastic fibres (not lamellae)
The collagen in the adventitia prevents elastic arteries from stretching beyond their physiological limits during systole
tunica media
smooth muscle cells
secrete elastin in the form of sheets, or lamellae
tunica intima
Layer of endothelial cells
Subendothelial layer – collagen and elastic fibres
Separated from tunica media internal elastic membrane.
diseases of the aorta
atherosclerosis
coarctation
aneurysms
syphilis
atherosclerosis
hypertension
hypercholesterolaemia
smoking
diabetes
family history
males as females have some protection until menopause
diseases associated with atherosclerosis
myocardial infarction
stroke
peripheral vascular disease
aneurysm
true aneurysm
weakness and dilatation of the wall that involves all the three layers.
what are true aneurysms associated with?
hypertension
atherosclerosis
smoking
collagen abnormalities
infection
what are false aneurysms
rupture of the wall of the aorta with blood contained in the adventitial layer or the surrounding soft tissue
what is the aetiology of a false aneurysm
trauma
iatrogenic
inflammation
thoracic aneurysms symptoms
often asymptomatic but comes with back pain , dysphagia and hoarseness , shortness of breath and hypotension together with a pulsatile mass
investigations for thoracic aneurysms
Echocardiogram
chest xray
mri aorta
ct angiogram
aortic dissection
a tear in the inner wall of the aorta
factors that cause dissection
hypertension
atherosclerosis
trauma
bicuspid aortic valve
trauma
there is medial necrosis in the histology
rupture back in the lumen or externally in the mediastinum or the pericardium
stanford classification of aortic dissection
type A any dissection involving ascending aorta
type b any dissection not involving the ascending aorta
debakey classifications of thoracic aortic dissection
type 1 originates in the ascending aorta and is involving all parts of the aorta
type 2 originates in the ascending aorta
and is confined in the aortic arch
type 3 originates in the descending aorta
and is confined in the descending aorta
symptoms of aortic dissection
chest pain which is severe , sharp and is radiating to the back (interscapular)
colla[sing pulse
stroke when the carotid arteries are involved
examination of aortic dissection
reduced and absent pulses
hypertension or hypertension
pulmonary oedema
aortic regurgitation
blood pressure mismatch between the different sides
investigation of aortic dissection
ECG
CXR
Transthoracic echocardiogram
ct angiogram aorta which confirms diagnosis
treatment for type A and B dissection
blood calcium channel blocker pressure control by beta blocker , nitrate , calcium channel blocker and IV sodium nitroprusside
takayasu`s arteritis
inflammation of the arteries
takayasu`s arteritis presentation
stenosis
thrombosis
aneurysms
renal artery astenosis
treatment of takayasu`s arteritis
steroids and immunosuppression
surgery and pci
syphilis cause
treponema pallidum
tertiary syphilis
cardiac syphilis
syphilitic aortitis
aortic regurgitation
congenital aortic aneurysm
coarctation
marfan`s syndrome
bicuspid aortic valve
what is bicuspid aortic valve
on of the valve fails to split such that there is only two functional valves
bicuspid aortic valve presentation
Associated with coarctation
Abnormal aorta (reduced tensile strength)
Prone to aneurysm/ dissection
Monitor with echo/ MRI
aortic coarctation
narrowing below the left subclavian artery
signs of coarctation
cold legs
poor leg pulses
if before subclavian artery there is radial -radial delay
if after left subclavian artery there is no radial to radial delay but there is radiofemoral delay
symptoms of coarctation
in infancy - heart failure and failure to thrive
later in life -hypertension and cv complications ( heart failure , MI , CVA and aortic dissection )
