Diseases of the Thoracic Aorta

Question 1

What are the four parts of the aorta?

Answer 1

Aortic root
Ascending aorta
Aortic arch
Descending aorta

Question 2

What are some of the features of the aortic root?

Answer 2

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

Question 3

What is the tunica intima made of?

Answer 3

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

Question 4

What is the tunica media made of?

Answer 4

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

Question 5

What is the tunica adventitia made of?

Answer 5

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

Question 6

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

Answer 6

Prevents elastic arteries from stretching beyond their physiological limits during systole

Question 7

What is an aneurysm?

Answer 7

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

Question 8

What are the three types of aneurysm?

Answer 8

True, false. dissection

Question 9

What are the two types of true aneurysm?

Answer 9

Saccular
Fusiform

Question 10

Compare a true and false aneurysm.

Answer 10

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.

Question 11

What is a true aneurysm associated with?

Answer 11

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

Question 12

What is the cause of a false aneurysm?

Answer 12

Trauma
Iatrogenic
Inflammation ( eg endocarditis with septic emboli)

Question 13

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

Answer 13

Where the aneurysm is

Question 14

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

Answer 14

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

Question 15

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

Answer 15

Aortic regurgitation

Question 16

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

Answer 16

CXR
Echocardiogram
CT angiogram aorta
MRI aorta

Question 17

What a CXR of someone with an aneurysm look like?

Answer 17

Widened mediastinum

Question 18

What is an echocardiogram useful for?

Answer 18

Assessing aortic root size and aortic valve

Question 19

Which investigations are diagnostic?

Answer 19

CT angiogram of the aorta
MRI of the aorta

Question 20

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

Answer 20

MRI of the aorta

Question 21

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

Answer 21

Limited views of distal ascending aorta and arch

Question 22

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

Answer 22

MRI of aorta
CT of aorta

Question 23

What is an aortic dissection?

Answer 23

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

Question 24

What are some of the causes for aortic dissection?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

Stanford :)

Question 27

What are the types of classification in the Stanford classification?

Answer 27

Type A Type B

Question 28

What does a type A dissection involve?

Answer 28

Type A dissection is any dissection that involves the ascending aorta

Question 29

What does a type B dissection involve?

Answer 29

Any dissection that does NOT involve the ascending aorta.

Question 30

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

Answer 30

Chest pain Collapse Stroke

Question 31

Describe the chest pain felt in those with aortic dissection.

Answer 31

Severe Sharp Radiates to the back

Question 32

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

Answer 32

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

Question 33

What investigation would confirm a diagnosis of aortic dissection?

Answer 33

CT angiogram of the aorta

Question 34

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

Answer 34

ECG CXR

Question 35

What is the treatment for a type A dissection?

Answer 35

BP Control Surgery

Question 36

What is the treatment for a type B dissection?

Answer 36

BP control Percuraneous (endo-vascular) intervention

Question 37

Which treatments can help control BP?

Answer 37

Beta blocker, IVI nitrate, calcium channel blocker IVI Sodium nitroprusside used if others fail

Question 38

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

Answer 38

Syphilis

Question 39

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

Answer 39

Takayasu’s Arteritis

Question 40

What is Takayasu’s Arteritis?

Answer 40

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

Question 41

What is the treatment for Takayasu's Arteritis?

Answer 41

Steroids Immunosuppressive Therapy -sometimes surgery

Question 42

What is syphilis?

Answer 42

STD

Question 43

Which bacteria causes syphilis?

Answer 43

Treponema pallidum

Question 43

Which bacteria causes syphilis?

Answer 43

Treponema pallidum

Question 44

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

Answer 44

Bicuspid Aortic Valve Coarctation of aorta Marfan’s Syndrome

Question 45

What happens to the valve in Bicuspid Aortic Valve?

Answer 45

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

Question 46

What is the most common cardiac congenital abnormality?

Answer 46

Bicuspid Aortic Valve

Question 47

What is meant by aorta coarctation?

Answer 47

Narrowing/stenosis of the aorta

Question 48

What are some of the signs of aortic coarctation?

Answer 48

Cold legs Poor leg pulses

Question 49

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

Answer 49

Radial and right radial-femoral delay

Question 50

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

Answer 50

No radial pulse Right and left radio-femoral delay

Question 51

What are the symptoms of coarctation in early life?

Answer 51

Heart Failure Failure to thrive

Question 52

What are the symptoms of coarctation in later life?

Answer 52

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

Question 53

How is the diagnosis of coarctation made?

Answer 53

MRI or CT

Question 54

What is the treatment for coarctation ?

Answer 54

Percutaneous or surgical correction

Question 55

What is Marfan's Syndrome?

Answer 55

Connective tissue weakness

Question 56

Where in the body does Marfan's Syndrome affect?

Answer 56

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

Question 57

What is the cardiac manifestation of Marfan's Disease?

Answer 57

Aortic and mitral valve prolapse/regurgitation

Question 58

What is the normal diameter of the abdominal aorta?

Answer 58

2cm