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Cardio > Diseases of thoracic aorta > Flashcards

Diseases of thoracic aorta Flashcards

1
Q

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

A

Stroke - TE to brain

MI - TE to CA’s

Aneurysms boi

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2
Q

What is an aneurysm?

A

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

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3
Q

What are the different types of aneurysm?

A

True:

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

False

Dissecting

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4
Q

Define what a true aneurysm is

A

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

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5
Q

What causes True aneurysms?

A

Hypertension
Atherosclerosis
Smoking
Trauma

Collagen abnormalities:

  • Marfan’s syndrome
  • Cystic medial necrosis

Infection:

  • Mycotic
  • Syphilis
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6
Q

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

A

Haemorrhage of Vasa vasorum into Tunica media

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7
Q

Define what a false aneurysm is

A

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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8
Q

What are the causes of false aneurysms?

A

Inflammation
- Endocarditis (septic emboli)
Trauma
Iatrogenic

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9
Q

What are the indications of a false aneurysm on examination?

A

Thrill
Bruit
Pulsatile mass
Hypotension

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10
Q

What are the clinical risks of false aneurysms?

A

Ischaemia

Rupture

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11
Q

What are the different classes of aneurysms by site?

A

Ascending aortic aneurysm

Aortic arch aneurysm

Descending aortic aneurysm

Abdominal aortic aneurysm

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12
Q

How are aortic aneurysms usually found?

A

Incidental finding as usually asymptomatic

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13
Q

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

A

Shortness of breath

Possible heart failure (aortic regurgitation)

Hypotension

Pulsatile mass

Dysphagia and hoarseness

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14
Q

What signs/symptoms indicate an ascending aortic aneurysm?

A

Dysphagia & hoarseness (chronic)

Aortic regurgitation

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15
Q

What signs/symptoms indicate an aortic dissection?

A

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

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16
Q

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

A

Tear in the tunica intima

Blood forces the walls apart and pushes into this tear

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17
Q

Is aortic dissection acute or chronic?

A

Can be either

If acute - medical/surgical emergency

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18
Q

In what two ways are aortic dissections classed?

A

DeBakey

Stanford

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19
Q

What are the DeBakey classes?

A

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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20
Q

What are the Stanford classes?

A

Type A:
- Involves the ascending aorta in any way

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

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21
Q

What are the aetiological risk factors for an aortic dissection?

A

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome (collagen abnormality)

22
Q

What is the main histological feature of aortic dissection

A

Cystic medial necrosis

23
Q

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

A

False lumen

May extend antegrade or retrograde

24
Q

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

A

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

25
Q

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

A

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

26
Q

What are the symptoms of aortic dissection?

A

Tearing, severe chest pain (radiating to between Shoulder blades)

Collapse (tamponade, acute AR, external rupture)

Beware inferior ST elevation

~50% mortality pre-hospital

27
Q

What are the signs of aortic dissection?

A

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

28
Q

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

A

False (darker) and true (lighter) lumen on cross section of vessel (CT)

Enlarged upper heart shadow caused by ascending aorta/arch dilation on CXR

29
Q

Treatment for aortic dissecting aneurysms depends on…

A

What standford type it is

Type A:
- Surgery

Type B:

  • Meticulous BP control
  • Sodium nitroprusside plus beta blocker
30
Q

What is Takayasu’s Arteritis?

A

granulomatous vasculitis - inflammation of the aorta and its major branches

31
Q

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

A 
Aneurysms
Aortic stenosis
Throbosis
Renal artery stenosis 
Neurological sx
32
Q

How is Takayasu’s arteritis treated?

A

Steroids

Surgery

33
Q

What organism causes Syphilis?

A

Terponema pallidum

Sexually transmitted

34
Q

What are the signs of Syphilis?

A

Chancre on fingers - primary

Diffuse rash - secondary

35
Q

If untreated, a third of infected SYphilis patients develop one of three types of tertiary syphilis

What are these types?

A

Late-neuro syphilis

Gummatous syphilis

Cardiac Syphilis - the one we care about right now

36
Q

What are the potential effects of Cardiac syphilis?

A

Syphilitic aortitis:
- Aneurysms

Aortic regurgitation

37
Q

What are the causes of Congenital aortic anuerysms?

A

Marfan’s syndrome

Bicuspid aortic valve

Coarctation of the aorta

38
Q

Why is a Bicuspid aortic valve bad?

A

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

39
Q

What is coarctation of the aorta?

A

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

40
Q

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

A

Ductus arteriosus
Foramen ovale
Ductus venosus

41
Q

What are the 3 types of aortic coarctation?

A

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)

42
Q

What are the signs of aortic coarctation?

A

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
43
Q

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

A

Heart failure

Failure to thrive

44
Q

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

A

Hypertension

45
Q

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

A

Small black areas on the inferior edge of ribs

Gives the inferior edge a bumpy, cracked appearance and kinda looks like a fracture

46
Q

Which imaging technique is best for aortic dissection?

A

CT is most reliable and easy way to diagnose

47
Q

What is a mycotic aneurysm?

A

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

48
Q

Give an example of a mycotic aneurysm?

A

Aneurysm due to Aortitis due to Cardiac syphillis

49
Q

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

A

CMRI - coarctation is clearly defined

CXR - will show rib notching which is a sign of Coarctation of the aorta

50
Q

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

A

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

Cardio (41 decks)

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