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CVS pathophysiology > Diseases of the thoracic aorta > Flashcards

Diseases of the thoracic aorta Flashcards

1
Q

Describe the histology of thw aorta

A

Tunica Intima

  • layer of endothelial cells
  • subendothelial layer - collagen and elastic fibres
  • seperated fro T.media and internal elastic membrane

Tunica media

  • smooth muscle cells
  • secretes elastin in the form of sheets/lamelle

Tunica adventitia

  • thin connective tissue layer
  • collagen fibres and elastic fibres
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2
Q

Function of collagen in T.adventia

A

-the collagen in T.adventia prevents the elastic arteries from stretching beyond their physiological limits during systole

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3
Q

State the risk factors of atherosclerosis

A 
Hypertension
Hypercholesterolaemia
smoking
diabetes
FMX
M>F ( untill menopause)
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4
Q

What can severe atherosclerosis lead to?

A
  • Stroke
  • MI
  • aneurysm
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5
Q

What is an aneurysm

A

-localised enlargement of an artery caused by the weakening of the vessel

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6
Q

Types of anerysm

A
  • True(saccular[unequal]/fusiform[equal])
  • False
  • Dissecting
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7
Q

What is a true aneurysm

A

-aneurysm that involes all 3 layers

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8
Q

Causes of true aneurysms

A
  • Hypertension
  • atherosclerosis
  • smoking
  • collagen abnormalities ( marfan’s, cystic medial necrosis)
  • ttrauma
  • infection ( mycotic/syphillis)
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9
Q

What is a false aneurysm

A

-rupture of a wall of aorta with the haematoma contained by T.adventia or surrounding tissue

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10
Q

Causes of false aneurysms

A
  • inflammation ( endocarditis with septal emboli)
  • trauma
  • iatrogenic ( catheters)
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11
Q

What is an aortic dissection?

A

tear in T.intima of aorta + blood forces the walls apart

-acute(E)/chronic

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12
Q

Types of thoracic aortic dissections

A

Debankey
Type I
Type II
Type III

Stanford
Type A - dissection involving ascending aorta
Type B - all dissections except asending aorta

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13
Q

Risk factors of aortic dissection

A
  • hyper tension
  • atherosclerosis
  • trauma
  • marfan’s syndrome
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14
Q

Problems of aortic dissection

A
  • occlude branches ( mesenteric, carotid, renal, spinal)

- Can rupture back into the lumen/externally into meiastinum/pericardium( tamponade)

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15
Q

Dilation of ascending aorta in an aortic dissection

A

-dilation of ascending aorta may cause acute aortic regurgitation

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16
Q

What can a false lumen lead to?

A

-antegrade/retrograde direction

17
Q

Symptoms of aortic dissection

A
  • chest pain that radiates to back

- collapse ( tompanade, acute AR external rupture)

18
Q

Examination of aortic dissecion

A

-low/absent peripheral pulses ( BP mismatch between sides )
-hypotension/hyper
-diastolic murmur ( AR)
-pul.oedema
-CXR shows widened mediastinum
-

19
Q

Investigation of aortic dissection

A
  • CXR shows widened mediastinum
  • CT scan
  • ECHO
20
Q

Treatment of aortic dissection

A

Type A
-surgery

Type B

  • meyiculous blood pressure control
  • sodium nitroprusside + beta blocker
21
Q

Microbes responsible of infection and inflammation of AI

A

Infection;syphillis

inflammation; takayasu’s arteritis

22
Q

What is Takayasu’s arteritis

A

a family of rare disorders characterized by inflammation of the blood vessels, which can restrict blood flow and damage vital organs and tissues.

23
Q

What does granulomatous vasculitis affect?

A
  • aorta and main branches

- causes stenosis, thrombosis, aneurysms, renal artery stenosis and neurological sx

24
Q

What is granulomatous vasculitis?

A
  • a type of takayasu’s arteritis
25
Q

Risk factors of takayasu’s arteritis

A

F>M

26
Q

Treatment of granulomatous vasculitis

A

-steroids, surgery

27
Q

Where is syphillis from?

A

Primary(chancre)/Secondary

  • STD
  • trepenoma pallidum
28
Q

Treatment of syphillis

A

Primary/secondary
Abx

Tertiary

29
Q

Without treatment of teritiary syhphillis what cant this lead to?

A
  • late neurosyphillis
  • gummatous syphillis
  • cardiac syphillis ( sypillitic aortitis which is an aneurysm and aortic regurgitation)
30
Q

State conditions that can lead tocongenital aneurysms?

A
  • bicuspid aortic valve
  • marfan’s syndrome
  • coarctation
31
Q

What can bicuspid aortic valve lead to?

A
  • associated with coarctation
  • cbnormal aorta ( reduced tensile steength)
  • prone to aneurysm/disssection/stenosis
32
Q

Monitoring bicuspid aortic valve

A

ECHO

MRI

33
Q

3 shunts in coarctation

A
  • ductus arteriosus
  • foramen ovale
  • cutus venosus
34
Q

Types of coarctation

A
  • aortic narrowing to where ductus arteriosus inserts ( ligamentum arteriosum)

3 types:

  • preductal( can be life threatening if severe narrowing)
  • ductul
  • postductal ( most common in adults, hypertension in upper extemeties, weak pulses in lower limbs) ; associated with rib notching ( collateral circulation)
35
Q

Clinical signs of coarcation

A

-cold legs
-poor leg pulses
-if before subclav then
radial- radial + right radial-femoral delay
-If after subclav then no radial-radial delay
-right and left radio-femoral delay

36
Q

Symptoms of coarctation

A

Infancy(severe)
-HF, failure to thrive

Adults
-Hypertension

37
Q

Imaging of Coarctation

A

CXR

CMRI

CVS pathophysiology (23 decks)

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