Diseases of the thoracic aorta Flashcards
Name the three layers of the aorta from the vessel lumen to the outer surface
- Intima
- Media
- Adventitia
List the 6 risk factors associated with thoracic aneurism
- Hypertension
- Atherosclerosis
- Smoking
- Collagen abnormalities (Marfan’s, cystic medial necrosis)
- Trauma
- Infection (mycotic/syphillis)
What can false thoracic aneurisms be caused by?
- Inflammation (eg endocarditis with septic emboli)
- Trauma
- Iatrogenic
List some of the signs and symptoms associated with thoracic aneurism
- 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
What is an aortic dissection?
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
What is the name of the classification system used to classify thoracic aortic dissection?
The Stanford and DeBakey Classification System
According to the Stanford and DeBakey Classification System, what is a Type I thoracic aneurism?
Originates in the ascending aorta, propagates to at least the aortic arch and often beyond it distally
According to the Stanford and DeBakey Classification System, what is a Type II thoracic aneurism?
Originates in and is confined to the ascending aorta
According to the Stanford and DeBakey Classification System, what is a Type III thoracic aneurism?
Originates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta
According to the Stanford and DeBakey Classification System, what is a Type A thoracic aneurism?
All dissections involving the ascending aorta regardless of the site of origin
According to the Stanford and DeBakey Classification System, what is a Type B thoracic aneurism?
All dissections not involving the ascending aorta
List 4 aetiological factors associated with aortic dissection
- Hypertension
- Atherosclerosis
- Trauma
- Marfan’s syndrome
Which heart sound can be indicative of a dissecting thoracic aorta?
Acute aortic regurgitation (due to dilatation of the ascending aorta)
List the symptoms associated with aortic dissection
- 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%
What findings would you expect to find upon examination of a patient with a dissecting thoracic aorta?
- 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
What investigations should be conducted for a patient with suspected dissecting thoracic aorta?
- Chest X-Ray
- CT angiography
- Ultrasound
How is dissecting thoracic aorta treated?
Either type A= surgery
or
Type B= Meticulous blood pressure control & Sodium nitroprusside plus beta blocker
What organism causes syphillis?
treponema pallidum
How does primary syphillis present?
As a chancre
How does secondary syphillis present?
As a systemic skin condition
When does tertiary develop?
When the infection is not treated
What are the three different types of tertiary syphilis
- Late neuro-syphilis
- Gummatous syphilis
- Cardiac syphilis
How many years post-infection does syphilis occur?
10-30 years
What 2 conditions arise from cardiac syphilis?
- Syphilitic aortitis (an aneurysm)
- Aortic regurgitation
Name the inflammatory cause of
Takayasu’s Arteritis
What type of inflammation occurs in Takayasu’s Arteritis?
granulomatous vasculitis
What does Takayasu’s Arteritis cause?
stenosis, thrombosis, aneurysms, renal artery stenosis & neurological signs.
Which gender is more affected by Takayasu’s Arteritis?
females
How is Takayasu’s Arteritis managed?
Surgically
What causes bicuspid aortic valve?
Congenital causes
What does a bicuspid aortic valve cause and what does this increase the likelihood of?
(reduced tensile strength) and therefore increases the likelihood of aneurysm/ dissection
How are patients with bicuspid aortic monitored?
ECHO/MRI
What is coarctation of the aorta?
a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.
What are the three different types of coarctation of the aorta?
- Pre-ductal
- Ductal
- Post-ductal
What is the most common type of coarctation of the aorta?
Post ductal
Which type of coarctation of the aorta is associayed with turners syndrome and can be fatal?
Pre-ductal
What are the specific signs and symptoms associated with post-ductal coarctation of the aorta?
hypertension in the upper extremities & weak pulses in the lower limbs
rib-
notching
Which signs and symptoms are associated with coarcation of the aorta (all subtypes?)
- Cold legs
- Poor leg pulses
- Hypertension (if in adulthood)
What is the specific clinical sign associated with coarctation before the left subclavian artery?
Radial – radial and RIGHT radial-femoral delay
What is the specific clinical sign associated with coarctation after the left subclavian artery?
Right and left radio-femoral delay (but no radial-radial delay)
What clinical signs are associated with coarctation of the aorta in infancy?
Heart failure & failure to thrive
What causes marfan’s syndrome?
a mutation in the Fibrillin 1 gene
What are the cardiac effects of Marfan’s?
Aortic/ Mitral valve prolapse – regurgitation
Aneurysms and dissection
