diseases of thoracic aorta

Question 1

Describe the clinical presentation of Acute Thoracic aneurysm

Answer 1

asymptomatic and based on location of aneurysm
-shortness of breath
-dysphagia and hoarseness
-back pain
symptoms of dissection- sharp chest pain radiating to back
pulsatile mass

Question 2

components of root of aorta

Answer 2

right and left sinus of valsalva, sinotubular junction

Question 3

what Is the internal structure like in aorta

Answer 3

same as artery- tunica intimal, tunica media, tunica adventitia

Question 4

true aneurysm

Answer 4

weakness and dilation of wall and involved all three layers. associated with hypertension, athersclerosis, smoking bicuspid aortic valve

Question 5

false aneurysm

Answer 5

rupture of wall of aorta with the haemotoma (poll of clotted blood) contained by thin adventitial layer or by soft tissue

Question 6

what is an aortic dissection

Answer 6

tear in inner wall of aorta and blood forces walls apart

Question 7

Investigations for Thoracic Aneurysms

Answer 7

CXR- show widened mediastinum
echocardiogram- assess root size and aortic valve
CT angiogram aorta
MRI aorta

Question 8

type A thoracic aortic dissection

Answer 8

anything above the ascending aorta

Question 9

type B thoracic aortic dissection

Answer 9

not involving ascending aorta

Question 10

clinical presentation of aortic dissection

Answer 10

Chest pain – severe, sharp, radiating to back (inter-scapular)
Collapse (tamponade, acute AR, external rupture)
Stroke (involvement of carotid arteries)

Question 11

examination of aortic dissection

Answer 11

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

Question 12

investigations of aortic dissection

Answer 12

ECG – might show ST elevation/ischaemia indicating coronary involvement
CXR - widened mediastinum
Transthoracic echocardiogram (TTE) – assess aortic root (limited views), aortic regurgitation? pericardial effusion ?
CT angiogram aorta - confirms diagnosis

Question 13

treatment for type A

Answer 13

blood pressure control and surgery

Question 14

treatment for type B

Answer 14

blood pressure control and percuraneois intervention (no surgery )

Question 15

what is coarctation

Answer 15

aortic narrowing close to where ductus arterioles inserts
pre-ductal, ductal, post ductal

Question 16

signs of coarctation

Answer 16

Cold legs- reduced blood supply and pressure
Poor leg pulses
If before left subclavian artery:
Radial – radial and RIGHT radial-femoral delay due to narrowing of descending aorta
If after left subclavian artery:
No radial- radial delay
Right and left radio-femoral delay

Question 17

signs of coarctation

Answer 17

Cold legs- reduced blood supply and pressure
Poor leg pulses
If before left subclavian artery:
Radial – radial and RIGHT radial-femoral delay due to narrowing of descending aorta
If after left subclavian artery:
No radial- radial delay
Right and left radio-femoral delay

Question 18

marfans syndrome

Answer 18

fibrillar 1 gene causes connective tissue weakness.
aortic/mitral valve prolapse
lungs causing pneumothorax
cause aneurysm and dissection