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Cardiology > Diseases of thoracic aorta > Flashcards

Diseases of thoracic aorta Flashcards

1
Q

Name the three layers of the thoracic aorta

A

Tunica intima
Tunica media
Tunica adventitia

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2
Q

What is the tunica intima comprised of?

A

Endothelial cells

Subendothelial layer - elastic fibres and collagen

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3
Q

How is the tunica intima separated from the tunic media?

A

By the internal elastic membrane

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4
Q

What is the tunica media comprised of?

A

Smooth muscle cells

Secrete elastin in sheets, lamellae

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5
Q

What is the tunica adventitia comprised of?

A

Thin CT layer

Collagen and elastic fibres (not lamellae)

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6
Q

Function of collagen in tunica adventitia

A

Prevent stretch beyond physiological limit in systole

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7
Q

Risk factors for atherosclerosis

A 
Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Male
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8
Q

What is the key event in atherosclerosis?

A

Endothelial dysfunction

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9
Q

Describe the process of atherosclerosis according to age

A

1st decade - foam cells form fatty streak
3rd decase - intermediate lesion forms atheroma
4th decade- fibrous plaque forms complicated lesion which can rupture vessel

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10
Q

What risks are associated with atherosclerosis?

A

Stroke
MI
Aneurysm

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11
Q

Classification of aneurysms

A

Saccular
Fusiform
False
Dissecting

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12
Q

Which types of aneurysms are true aneurysms?

A

Saccular#Fusiform

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13
Q

Classification of aortic aneurysm according to site

A

Ascending
Aortic arch
Descending
Abdominal

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14
Q

Signs and symptoms of aneurysmal disease in aorta

A 
Asymptomatic
Dyspnoea
Heart failure
Dysphasia
Hoarseness
Sharp chest pain radiating to back and shoulders
Pulsatile mass
Hypotension
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15
Q

Classfication of aortic Dissection

A

DeBakey
I - originates in ascending to arch
II- confined to ascending
III- originates in descending, extends distally or retrograde to arch, ascending

Stanford
A- Any ascending involvement
B-No ascending involvement

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16
Q

Aetiological factors for aortic dissection

A

Trauma
Connective Tissue disease- Marfans
Atherosclerosis
Hypertension

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17
Q

What sign of aortic dissection is shown in hisotlogy?

A

Cystic medial necrosis

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18
Q

Signs and symptoms of aortic dissection

A

Tearing, severe chest pain radiating to back
Collapse (tamponade, acute (NEW)Aortic regurgitation, external rupture)
Hypotension
Tachycardia
Signs of end organ hypoperfusion

19
Q

Aortic dissection must be excluded when patient is presenting with signs of which condition?

A

Inferior stemi with back pain

20
Q

Signs of aortic dissection on examination

A 
Reduced peripheral pulse (BP mismatch)
Hypo/hypertension
Soft early diastolic murmur (AR)
Pulmonary oedema
Chest X ray - widened mediastinum
Confirm by ECHO and CT
21
Q

Treatment of aortic dissection

A

Type A Surgery

Type B - BP control, sodium nitroprusside and B blocker

22
Q

Which other conditions can present with aortic aneurysm/dissection?

A

Takayasu’s vasculitis

Syphilis

23
Q

Treatment of takayasu’s vasculitis

A

Steroids#Surgery

24
Q

Three types of presentation in third degree syphilis

A

Late neurological
Gummatous
Cardiac - syphilitic aortitis, aortic regurgitation

25
Q

2 types of congenital aortic aneurysm

A

Bicuspid aortic valve

Coarctation of aorta

26
Q

3 shunts in immature heart

A

Ductus arteriosus
Foramen ovale
Ductus venosus

27
Q

3 types of coarctation of aorta

A

Pre ductal
Ductal
Post ductal

28
Q

Which type of coarctation is most common in adults?

A

Post ductal

29
Q

What are the signs associated with post ductal aortic coarctation?

A

Hypertension in upper extremeties
Weak pulse in lower limbs
Rib notching - seen on CXR (collateral circulation)

Radial/Radial/Radial Femoral delay
Heart failure, FTT in infancy
Hypertension in later life

30
Q

Which genetic mutation occurs in Marfan’s syndrome?

A

Fibrillin I Gene

31
Q

Which murmur is associated with Marfan’s syndrome?

A

Regurgitation

32
Q

Signs of marfan’s syndrome

A 
Skeletal system affect
Eyes - cataracts, lens dislocation
Aneurysm dissection
Hyperexpanded lungs prone to pneumothorax
Arm span exceeeds height
Pectus excavatum
Arachnodactyly of hands and feet
Steinberg sign - tips of thumb protrude when folded in fist
33
Q

What is aortic dissection?

A

A tear in the intimal layer of the aortic wall.

Blood flows between and splits apart the tunica intima and tunica media

34
Q

When is aortic dissection diagnosed as acute or chronic?

A

Acute - less than 14 days

Chronic - more than 14 days

35
Q

Name some signs of end-organ hypoperfusion

A 
Reduced urine output
Paraplegia
Lower limb ischaemia
Abdominal pain secondary to ischaemia
Deteriorating conscious level
36
Q

Differential of aortic dissection

A

MI
PE
Pericarditis
Musculoskeletal back pain

37
Q

How to differentiate pericarditis from thoracic aortic dissection

A

Pleuritic chest pain
ST elevation on ECG
Pericardial rub on auscultation

38
Q

Investigations for aortic dissection

A 
Bloods - FBC, U&Es, troponin, LFTs, coagulation
ABG
ECG
CT angiogram
Transoesophageal ECHO
39
Q

Why are Type B dissections managed medically instead of surgically?

A

Endovascular repair carries risk of retrograde dissection

40
Q

When is surgery considered in Type B dissections?

A 
rupture
renal
visceral or limb ischaemia
refectory pain
uncontrollable hypertension
41
Q

What is the most common complication of chronic Type B dissection?

A

Aneurysm

42
Q

Complications of aortic dissection

A 
Aortic aneurysm rupture
Aortic regurgitation
Myocardial ischaemia
Cardiac tamponade
Stroke
Paraplegia
43
Q

Mortality rate of aortic dissection

A

20% before reaching hospital

Cardiology (7 decks)

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