Diseases of thoracic aorta Flashcards by Michael Alcorn

What are the big 3 most common risks associated with atherosclerosis?

Stroke - TE to brain

MI - TE to CA’s

Aneurysms boi

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What is an aneurysm?

Localised enlargement of an artery caused by weakening of the vessel wall

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What are the different types of aneurysm?

True:

Saccular - balloons out in one direction
Fusiform - balloons out in both directions

False

Dissecting

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Define what a true aneurysm is

Aneurysm in which there is weakness & dilation of the arterial wall, involving all 3 layers

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What causes True aneurysms?

Hypertension
Atherosclerosis
Smoking
Trauma

Collagen abnormalities:

Marfan’s syndrome
Cystic medial necrosis

Infection:

Mycotic
Syphilis

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Although true aneurysms involve dilation of all 3 layers of the arterial wall, why might the medial layer become relatively enlarged?

Haemorrhage of Vasa vasorum into Tunica media

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Define what a false aneurysm is

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

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What are the causes of false aneurysms?

Inflammation
- Endocarditis (septic emboli)
Trauma
Iatrogenic

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What are the indications of a false aneurysm on examination?

Thrill
Bruit
Pulsatile mass
Hypotension

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What are the clinical risks of false aneurysms?

Ischaemia

Rupture

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What are the different classes of aneurysms by site?

Ascending aortic aneurysm

Aortic arch aneurysm

Descending aortic aneurysm

Abdominal aortic aneurysm

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How are aortic aneurysms usually found?

Incidental finding as usually asymptomatic

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What are the general signs and symptoms of an thoracic aortic aneurysm?

Shortness of breath

Possible heart failure (aortic regurgitation)

Hypotension

Pulsatile mass

Dysphagia and hoarseness

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What signs/symptoms indicate an ascending aortic aneurysm?

Dysphagia & hoarseness (chronic)

Aortic regurgitation

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What signs/symptoms indicate an aortic dissection?

Sharp chest pain radiating to the back, between the shoulder blades

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What happens to the aorta in order for an aortic dissection to occur?

Tear in the tunica intima

Blood forces the walls apart and pushes into this tear

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Is aortic dissection acute or chronic?

Can be either

If acute - medical/surgical emergency

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In what two ways are aortic dissections classed?

DeBakey

Stanford

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What are the DeBakey classes?

Type I:
- originates in the ascending aorta & propagates to the arch or beyond

Type II:
- Originates & confined to ascending aorta

Type III:

Originates in descending aorta
Extends distally or rarely in retrograde

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What are the Stanford classes?

Type A:
- Involves the ascending aorta in any way

Type B:
- Doesn’t involve the ascending aorta in any way

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What are the aetiological risk factors for an aortic dissection?

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome (collagen abnormality)

What is the main histological feature of aortic dissection

Cystic medial necrosis

“Dissecting aneurysms create a false ______, that may extend _______ or _________”

False lumen

May extend antegrade or retrograde

What risk is posed by ‘rupturing’ of aortic dissecting aneurysms?

Either back into the lumen, into the pericardium (tamponade) or into the mediastinum

Why is it that an aneurysm can lead to a diastolic murmur associated with the aortic valve?

Ascending aortic dilation can cause acute aortic regurgitation, causing a diastolic murmur

What are the symptoms of aortic dissection?

Tearing, severe chest pain (radiating to between Shoulder blades) Collapse (tamponade, acute AR, external rupture) Beware inferior ST elevation ~50% mortality pre-hospital

What are the signs of aortic dissection?

Reduced or absent peripheral pulses (BP mismatch between sides) Hypotension/ hypertension Soft early diastolic murmur (AR) Pulmonary oedema Chest x-ray usually shows a widened mediastinum Diagnosis can be confirmed by echocardiogram or CT scanning

What would you look for on a CT and CXR for dissecting aneurysms?

False (darker) and true (lighter) lumen on cross section of vessel (CT) Enlarged upper heart shadow caused by ascending aorta/arch dilation on CXR

Treatment for aortic dissecting aneurysms depends on...

What standford type it is Type A: - Surgery Type B: - Meticulous BP control - Sodium nitroprusside plus beta blocker

What is Takayasu’s Arteritis?

granulomatous vasculitis - inflammation of the aorta and its major branches

What are the risks/problems that Takayasu's arteritis causes?

``` Aneurysms Aortic stenosis Throbosis Renal artery stenosis Neurological sx ```

How is Takayasu's arteritis treated?

Steroids | Surgery

What organism causes Syphilis?

Terponema pallidum Sexually transmitted

What are the signs of Syphilis?

Chancre on fingers - primary Diffuse rash - secondary

If untreated, a third of infected SYphilis patients develop one of three types of tertiary syphilis What are these types?

Late-neuro syphilis Gummatous syphilis Cardiac Syphilis - the one we care about right now

What are the potential effects of Cardiac syphilis?

Syphilitic aortitis: - Aneurysms Aortic regurgitation

What are the causes of Congenital aortic anuerysms?

Marfan's syndrome Bicuspid aortic valve Coarctation of the aorta

Why is a Bicuspid aortic valve bad?

Prone to stenosis +/- regurgitation Associated with coarctation The aorta itself is abnormal - reduced tensile strength is why it is a risk factor for aortic aneurysms

What is coarctation of the aorta?

Stenosis of the aorta distal to the left Sub-clavian artery

What are the 3 shunts related to coarctation of the aorta?

Ductus arteriosus Foramen ovale Ductus venosus

What are the 3 types of aortic coarctation?

Based on relation to ductus arteriosus Pre-ductal (5% turner’s): - can be life-threatening if severe narrowing Ductal Post-ductal: –most common in adults – hypertension in upper extremities, weak pulses in lower limbs - associated with rib-notching (collateral circulation)

What are the signs of aortic coarctation?

Cold legs Poor leg pulses If before left subclavian artery then both: - Radial–radial delay - RIGHT radial-femoral delay If after left subclavian artery: - No radial-radial delay - Right and left radio-femoral delay

What are the signs in infancy of coarctation of the aorta?

Heart failure | Failure to thrive

What are the signs of coarctation of the aorta in later life?

Hypertension

On a radiograph image, what feature of the ribs indicates coarctation of the aorta?

Small black areas on the inferior edge of ribs Gives the inferior edge a bumpy, cracked appearance and kinda looks like a fracture

Which imaging technique is best for aortic dissection?

CT is most reliable and easy way to diagnose

What is a mycotic aneurysm?

An aneurysm caused by through infection damaging (weakening) the arterial walls

Give an example of a mycotic aneurysm?

Aneurysm due to Aortitis due to Cardiac syphillis

What imaging is useful for investigating coarctation of the aorta and why?

CMRI - coarctation is clearly defined CXR - will show rib notching which is a sign of Coarctation of the aorta

Summarise the imaging used to investigate thoracic aneurysms and why each one is used/good

CT or MRI - assessment of aneurysm Aortography - can be used to assess positions of key branches in relation to the aneurysm ECHO - good for identifying dissections