diseases of thoracic aorta Flashcards
where are the three points we measure the aortic root?
anulus
sinotubular junction
sinus of Valsalva
what are the risk factors of atherosclerosis?
Hypertension
Hypercholesterolaemia
Smoking
Diabetes
Family history
Male>female (relative protection in females until menopause)
what is an aneurysm?
A localised enlargement of an artery caused by a weakening of the vessel wall
what is a true and false aneurysm?
true aneurysm - Weakness & dilation of wall
Involves all 3 layers (associated with hypertension, atherosclerosis, smoking, bicuspid aortic valve, collagen abnormalities, infection, and trauma)
false aneurysm - Rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue (inflammation, endocarditis with septic emboli), so blood leaks and forms a haematoma.
what are the signs and symptoms of thoracic aneurism?
Asymptomatic (a lot of the time found accidentally on a CXR)
Based on the location and size of the aneurysm.
Shortness of breath (associated aortic regurgitation)
Dysphagia and hoarseness
Back pain
Symptoms of dissection - sharp chest pain radiating to back (between shoulder blades), hypotension
Pulsatile mass
what are the positives and negatives of using an echocardiogram in investigating thoracic aneurysms?
assess aortic root size and aortic valve
limited views of distal ascending aorta and arch
what are the 2 best tests to use to diagnose thoracic aneurysms?
CT angiogram aorta - diagnostic
MRI aorta - diagnostic and follow-up (used as follow up as no radiation like a CT)
what are the 2 classification systems for aortic dissection?
stanford (most widely used) and DeBakey
look up these classifications
what are the symptoms of aortic dissection
Chest pain – severe, sharp, radiating to back (inter-scapular)
Collapse (tamponade, acute AR, external rupture)
Stroke (involvement of carotid arteries)
what are the findings upon examination for aortic dissection?
Reduced or absent peripheral pulses
Hypertension or hypotension
BP mismatch between sides
Soft early diastolic murmur (aortic regurgitation)
Pulmonary oedema
Signs of CVA
what are treatments A for thoracic aneurysm?
Type A - used for ascending aorta
Blood Pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Emergency Surgery
what is treatment B for thoracic aneurysm?
Blood pressure control
beta blocker, IVI nitrate, calcium channel blocker, IVI Sodium nitroprusside
Percuraneous (endo-vascular) intervention
for investigating Aortic dissection what scan is used routinely and why?
CT angiogram aorta
takes shorter time and is more widely available than MRI
what is coartation?
aortic narrowing close to where the ductus arteriosus (ligamentum arteriosum) inserts
(Ligamentum arteriosum is the remnant of the ductus arteriosum which Is found in embryology )
what are the 3 types of coarctation
Pre-ductal (5% turner’s) can be life-threatening if severe narrowing (B)
Ductal (A)
Post-ductal (C) –most common in adults – hypertension in upper extremities, weak pulses in lower limbs (associated with rib-notching collateral circulation)
