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Year 1-Cardiovascular System > Diseases of the Thoracic Aorta > Flashcards

Diseases of the Thoracic Aorta Flashcards

1
Q

What are the four parts of the aorta?

A

Aortic root
Ascending aorta
Aortic arch
Descending aorta

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2
Q

What are some of the features of the aortic root?

A

Right sinus of Valsalva
Left sinus of Valsalva
Non coronary sinus
Right coronary ostium
Left coronary ostium

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3
Q

What is the tunica intima made of?

A

Layer of endothelial cells and sub-endothelial collagen and elastic fibres.

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4
Q

What is the tunica media made of?

A

Smooth muscle cells
Secretes elastin in the form of sheets, or lamellae

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5
Q

What is the tunica adventitia made of?

A

Thin connective tissue layer
Collagen fibres and elastic fibres (not lamellae)

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6
Q

What is the function of the collagen in the tunica adventitia?

A

Prevents elastic arteries from stretching beyond their physiological limits during systole

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7
Q

What is an aneurysm?

A

A localised enlargement of an artery caused by a weakening of the vessel wall

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8
Q

What are the three types of aneurysm?

A

True, false. dissection

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9
Q

What are the two types of true aneurysm?

A

Saccular
Fusiform

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10
Q

Compare a true and false aneurysm.

A

True- Weakness & dilation of wall involving all three layers.

False- rupture of the aorta wall with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue.

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11
Q

What is a true aneurysm associated with?

A

Hypertension
Atherosclerosis
Smoking
Bicuspid aortic valve
Collagen abnormalities (Marfan’s)
Infection (mycotic/syphillis)
Trauma

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12
Q

What is the cause of a false aneurysm?

A

Trauma
Iatrogenic
Inflammation ( eg endocarditis with septic emboli)

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13
Q

What do the signs and symptoms of an aneurysm depend on?

A

Where the aneurysm is

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14
Q

What are some of the possible symptoms for a patient with an aneurysm?

A

Shortness of breath
Dysphagia and hoarseness
Back pain
Symptoms of dissection - sharp chest pain radiating to back (between shoulder blades), hypotension
Pulsatile mass

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15
Q

What is the SOB in those with an aneurysm associated with?

A

Aortic regurgitation

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16
Q

Which investigations would be carried out if there to confirm an aneurysm?

A

CXR
Echocardiogram
CT angiogram aorta
MRI aorta

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17
Q

What a CXR of someone with an aneurysm look like?

A

Widened mediastinum

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18
Q

What is an echocardiogram useful for?

A

Assessing aortic root size and aortic valve

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19
Q

Which investigations are diagnostic?

A

CT angiogram of the aorta
MRI of the aorta

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20
Q

Which investigation can also be used as a follow up for someone w an aneurysm?

A

MRI of the aorta

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21
Q

What is a disadvantage of an ECG in terms of aneurysms?

A

Limited views of distal ascending aorta and arch

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22
Q

Therefore, which are the two most important investigations when diagnose thoracic aneurysms?

A

MRI of aorta
CT of aorta

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23
Q

What is an aortic dissection?

A

Tear in the inner wall of aorta where blood forces the walls apart

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24
Q

What are some of the causes for aortic dissection?

A

Hypertension
Atherosclerosis
Marfan’s syndrome
Bicuspid aortic valve
Trauma

And aneurysm! Those who already have an aneurysm are more likely to get an aortic dissection

25
Q

What can a aortic dissection cause to happen in the body?

A

May occlude branches (e.g. coronary, mesenteric, carotid, renal, spinal)
Rupture - back into the lumen or externally in to pericardium (tamponade) or mediastinum
Dilation of ascending aorta may cause acute aortic regurgitation

26
Q

What is the classification type of thoracic aorta dissections that we should learn?

A

Stanford :)

27
Q

What are the types of classification in the Stanford classification?

A

Type A
Type B

28
Q

What does a type A dissection involve?

A

Type A dissection is any dissection that involves the ascending aorta

29
Q

What does a type B dissection involve?

A

Any dissection that does NOT involve the ascending aorta.

30
Q

What are some of the clinical presenting symptoms for a patient with aortic dissection?

A

Chest pain
Collapse
Stroke

31
Q

Describe the chest pain felt in those with aortic dissection.

A

Severe
Sharp
Radiates to the back

32
Q

What might you see upon examination of someone with an aortic dissection?

A

-Reduced or absent peripheral pulses
-Hypertension or hypotension
-BP mismatch between sides
-Soft early diastolic murmur (aortic regurgitation)
-Pulmonary oedema
-Signs of CVA

33
Q

What investigation would confirm a diagnosis of aortic dissection?

A

CT angiogram of the aorta

34
Q

Which other investigations could be used to assist with the diagnosis of an aortic dissection?

A

ECG
CXR

35
Q

What is the treatment for a type A dissection?

A

BP Control
Surgery

36
Q

What is the treatment for a type B dissection?

A

BP control
Percuraneous (endo-vascular) intervention

37
Q

Which treatments can help control BP?

A

Beta blocker, IVI nitrate, calcium channel blocker

IVI Sodium nitroprusside used if others fail

38
Q

Name an infection which can predispose patients to thoracic aortic disease.

A

Syphilis

39
Q

Name an inflammation which can predispose patients to thoracic aortic disease.

A

Takayasu’s Arteritis

40
Q

What is Takayasu’s Arteritis?

A

Granulomatous vasculitis which affects the aorta and the main branches of the aorta

41
Q

What is the treatment for Takayasu’s Arteritis?

A

Steroids
Immunosuppressive Therapy

-sometimes surgery

42
Q

What is syphilis?

A

STD

43
Q

Which bacteria causes syphilis?

A

Treponema pallidum

43
Q

Which bacteria causes syphilis?

A

Treponema pallidum

44
Q

Name some congenital conditions which can predispose patients to thoracic aortic disease.

A

Bicuspid Aortic Valve

Coarctation of aorta

Marfan’s Syndrome

45
Q

What happens to the valve in Bicuspid Aortic Valve?

A

Usually the aortic valve has three cusps but two cusps fuse in those with this congenital condition.

46
Q

What is the most common cardiac congenital abnormality?

A

Bicuspid Aortic Valve

47
Q

What is meant by aorta coarctation?

A

Narrowing/stenosis of the aorta

48
Q

What are some of the signs of aortic coarctation?

A

Cold legs
Poor leg pulses

49
Q

If the coarctation if before the left subclavian artery, what happens upon examination?

A

Radial and right radial-femoral delay

50
Q

If the coarctation is after the left subclavian artery, what happens upon examination?

A

No radial pulse
Right and left radio-femoral delay

51
Q

What are the symptoms of coarctation in early life?

A

Heart Failure
Failure to thrive

52
Q

What are the symptoms of coarctation in later life?

A

Hypertension
CV complications (heart failure, MI, CVA, aortic dissection)

53
Q

How is the diagnosis of coarctation made?

A

MRI
or
CT

54
Q

What is the treatment for coarctation ?

A

Percutaneous or surgical correction

55
Q

What is Marfan’s Syndrome?

A

Connective tissue weakness

56
Q

Where in the body does Marfan’s Syndrome affect?

A

Skeletal system
Eyes (cataract, lens dislocation)
Vascular – aneurysm, dissection
Lungs (pneumothorax)
Heart

57
Q

What is the cardiac manifestation of Marfan’s Disease?

A

Aortic and mitral valve prolapse/regurgitation

58
Q

What is the normal diameter of the abdominal aorta?

A

2cm

Year 1-Cardiovascular System (41 decks)

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