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Cardiovascular Medicine > Diseases of the thoracic aorta > Flashcards

Diseases of the thoracic aorta Flashcards

1
Q

Name the three layers of the aorta from the vessel lumen to the outer surface

A
  1. Intima
  2. Media
  3. Adventitia
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2
Q

List the 6 risk factors associated with thoracic aneurism

A
  • Hypertension
  • Atherosclerosis
  • Smoking
  • Collagen abnormalities (Marfan’s, cystic medial necrosis)
  • Trauma
  • Infection (mycotic/syphillis)
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3
Q

What can false thoracic aneurisms be caused by?

A
  • Inflammation (eg endocarditis with septic emboli)
  • Trauma
  • Iatrogenic
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4
Q

List some of the signs and symptoms associated with thoracic aneurism

A
  • Can be asymptomatic
    – shortness of breath or even heart failure (AR)
    – dysphagia and hoarseness (ascending aorta, chronic)
    – Sharp chest pain radiating to back –between shoulder blades –Possible dissection!
    – Pulsatile mass
    – Hypotension
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5
Q

What is an aortic dissection?

A

a tear in the inner wall of the aorta which is then blown ope n by the force of the blood flow inside the aorta

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6
Q

What is the name of the classification system used to classify thoracic aortic dissection?

A

The Stanford and DeBakey Classification System

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7
Q

According to the Stanford and DeBakey Classification System, what is a Type I thoracic aneurism?

A

Originates in the ascending aorta, propagates to at least the aortic arch and often beyond it distally

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8
Q

According to the Stanford and DeBakey Classification System, what is a Type II thoracic aneurism?

A

Originates in and is confined to the ascending aorta

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9
Q

According to the Stanford and DeBakey Classification System, what is a Type III thoracic aneurism?

A

Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

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10
Q

According to the Stanford and DeBakey Classification System, what is a Type A thoracic aneurism?

A

All dissections involving the ascending aorta regardless of the site of origin

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11
Q

According to the Stanford and DeBakey Classification System, what is a Type B thoracic aneurism?

A

All dissections not involving the ascending aorta

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12
Q

List 4 aetiological factors associated with aortic dissection

A
  • Hypertension
  • Atherosclerosis
  • Trauma
  • Marfan’s syndrome
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13
Q

Which heart sound can be indicative of a dissecting thoracic aorta?

A

Acute aortic regurgitation (due to dilatation of the ascending aorta)

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14
Q

List the symptoms associated with aortic dissection

A
  • Tearing, severe chest pain (radiating to back)
  • Collapse (tamponade, acute AR, external rupture)
  • Beware of inferior ST elevation
  • The prehospital mortality rate is around 50%
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15
Q

What findings would you expect to find upon examination of a patient with a dissecting thoracic aorta?

A
  • Reduced or absent peripheral pulses (BP mismatch between sides)
  • Hypotension/ hypertension
  • Soft early diastolic murmur (AR)
  • Pulmonary oedema
  • Chest x-ray usually shows a widened mediastinum
  • Diagnosis can be confirmed by echocardiogram or CT scanning
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16
Q

What investigations should be conducted for a patient with suspected dissecting thoracic aorta?

A
  • Chest X-Ray
  • CT angiography
  • Ultrasound
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17
Q

How is dissecting thoracic aorta treated?

A

Either type A= surgery

or

Type B= Meticulous blood pressure control & Sodium nitroprusside plus beta blocker

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18
Q

What organism causes syphillis?

A

treponema pallidum

19
Q

How does primary syphillis present?

A

As a chancre

20
Q

How does secondary syphillis present?

A

As a systemic skin condition

21
Q

When does tertiary develop?

A

When the infection is not treated

22
Q

What are the three different types of tertiary syphilis

A
  • Late neuro-syphilis
  • Gummatous syphilis
  • Cardiac syphilis
23
Q

How many years post-infection does syphilis occur?

A

10-30 years

24
Q

What 2 conditions arise from cardiac syphilis?

A
  • Syphilitic aortitis (an aneurysm)

- Aortic regurgitation

25
Q

Name the inflammatory cause of

A

Takayasu’s Arteritis

26
Q

What type of inflammation occurs in Takayasu’s Arteritis?

A

granulomatous vasculitis

27
Q

What does Takayasu’s Arteritis cause?

A

stenosis, thrombosis, aneurysms, renal artery stenosis & neurological signs.

28
Q

Which gender is more affected by Takayasu’s Arteritis?

A

females

29
Q

How is Takayasu’s Arteritis managed?

A

Surgically

30
Q

What causes bicuspid aortic valve?

A

Congenital causes

31
Q

What does a bicuspid aortic valve cause and what does this increase the likelihood of?

A

(reduced tensile strength) and therefore increases the likelihood of aneurysm/ dissection

32
Q

How are patients with bicuspid aortic monitored?

A

ECHO/MRI

33
Q

What is coarctation of the aorta?

A

a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.

34
Q

What are the three different types of coarctation of the aorta?

A
  1. Pre-ductal
  2. Ductal
  3. Post-ductal
35
Q

What is the most common type of coarctation of the aorta?

A

Post ductal

36
Q

Which type of coarctation of the aorta is associayed with turners syndrome and can be fatal?

A

Pre-ductal

37
Q

What are the specific signs and symptoms associated with post-ductal coarctation of the aorta?

A

hypertension in the upper extremities & weak pulses in the lower limbs

rib-
notching

38
Q

Which signs and symptoms are associated with coarcation of the aorta (all subtypes?)

A
  1. Cold legs
  2. Poor leg pulses
  3. Hypertension (if in adulthood)
39
Q

What is the specific clinical sign associated with coarctation before the left subclavian artery?

A

Radial – radial and RIGHT radial-femoral delay

40
Q

What is the specific clinical sign associated with coarctation after the left subclavian artery?

A

Right and left radio-femoral delay (but no radial-radial delay)

41
Q

What clinical signs are associated with coarctation of the aorta in infancy?

A

Heart failure & failure to thrive

42
Q

What causes marfan’s syndrome?

A

a mutation in the Fibrillin 1 gene

43
Q

What are the cardiac effects of Marfan’s?

A

Aortic/ Mitral valve prolapse – regurgitation

Aneurysms and dissection

Cardiovascular Medicine (24 decks)

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