Diseases of the Thoracic Aorta

Question 1

name the three cusps of the aortic valve

Answer 1

> left cusp
right cusp
non-coronary cusp

Question 2

define aneurysm

Answer 2

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

Question 3

define a true aneurysm

Answer 3

all three layers of the wall are involved

Question 4

name two types of true aneurysm

Answer 4

fusiform

sacculated

Question 5

what is a false aneurysm?

Answer 5

the wall of the aorta is ruptures with the haematoma either contained by the thin adventitial layer or the surrounding soft tissue.

Question 6

how is a dissection different from a rupture?

Answer 6

the second an first layer are split but the vessel is still intact

Question 7

why can aortic arch aneurysms be dangerous?

Answer 7

this is where the arteries come off

Question 8

what are the signs and symptoms of a thoracic aneurysm?

Answer 8

> asymptomatic
> shortness of breath
> heart failure
> dysphagia
> hoarseness
> sharp pain radiating to the back
> pulsatile mass
> hypotension

Question 9

describe an aortic dissection

Answer 9

there is a tear in the inner wall of the aorta and the blood forces the walls apart. this can be acute or chronic.

Question 10

describe a type a dissection on the Stanford scale

Answer 10

all dissections involving the ascending aorta regardless of the site of origin.

Question 11

describe a type b dissection on the Stanford scale

Answer 11

all dissections not involving the ascending aorta

Question 12

what are the aetiological factors for aortic dissection?

Answer 12

> hypertension
atherosclerosis
trauma
marfans syndrome

Question 13

what may happen due to dilation of the ascending aorta?

Answer 13

acute aortic regurgitation

Question 14

what are the symptoms of aortic dissection?

Answer 14

> tearing severe chest pain radiating to back
collapse
inferior st elevation

Question 15

what might you find on examining someone with an aortic dissection?

Answer 15

> reduced/absent peripheral pulses 
> hypo/hypertension
> soft early diastolic murmur
> pulmonary oedema
> widened mediastinum on chest xray

Question 16

what is type a treatment for aortic dissection?

Answer 16

surgery

Question 17

what is type b treatment for aortic dissection?

Answer 17

> meticulous blood pressure control

> sodium nitroprusside plus beta blocker

Question 18

what is takayasu’s arteritis?

Answer 18

granulomatous vasculitis affecting the aorta and main branches.

Question 19

what problems are associated with a bicuspid aortic valve?

Answer 19

> coarctation of the aorta
reduced tensile strength of the aorta
aneurysm and dissection

Question 20

what would you use to monitor a bicuspid aortic valve?

Answer 20

> an echocardiography

> MRI

Question 21

what is aortic coarctation?

Answer 21

aortic narrowing close to where the ductus arteriosus inserts

Question 22

name 3 types of coarctation

Answer 22

> pre-ductal
ductal
post-ductal

Question 23

what can post-ductal aortic coarctation cause?

Answer 23

hypertension in upper extremities and weak pulses in the lower limbs

Question 24

what are the signs of coarctation?

Answer 24

> cold legs
poor leg pulses
radial-radial and right radial-femoral delay if it is before the left subclavian artery
right and left radio-femoral delay if it is after the left subclavian artery

Question 25

what might you see on the ribs of a patient with aortic coarctation?

Answer 25

notching

Question 26

what does marfans syndrome cause?

Answer 26

``` > connective tissue weakness > aortic/mitral valve regurgitation > cataracts > vascular aneurysms and dissections > pneumothorax > aneurysm and dissection ```