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The Cardiovascular System > The Aorta and Aneurysms > Flashcards

The Aorta and Aneurysms Flashcards

1
Q

What is the time taken for 20% of the circulating volume to pass from the heart to the aorta

A

12 seconds

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2
Q

What is the clinical implication of the short time taken for the circulating volume to pass from the heart to the aorta

A

If something goes wrong in the aorta, fast action is required as you can lose 20% of your cardiac output in 12 seconds.

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3
Q

What parts of the aorta are included under the term “thoracic aorta”

A

The ascending aorta, the arch of the aorta and the descending aorta.

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4
Q

What be a cause of abnormality in the thoracic aorta

A

Pathology of the aortic valve.

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5
Q

What condition tends to occur in the abdominal aorta particularly

A

Atherosclerosis

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6
Q

What are the non-paired arteries of the abdominal aorta

A

The coeliac trunk giving off the splenic artery, the hepatic artery and the gastric artery

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7
Q

What are the paired arteries of the abdominal aorta

A

The inferior and superior mesenteric arteries, the left and right renal arteries and the left and right iliac arteries.

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8
Q

What type of fibre is the aorta made up from which stains black in histology

A

Elastic

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9
Q

Why is the aorta an elastic artery

A

It needs to distend and contract in response to systole. It needs to respond to change in pressure.

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10
Q

What pathology can occur if there is degradation of the elastic wall of the aorta

A

Dissection of the aorta

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11
Q

What is an aneurysm

A

It is a localised, permanent, abnormal dilatation of a blood vessel.

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12
Q

What are the six types of aneurysm

A
  • dissecting
  • atherosclerotic
  • berry
  • micro
  • syphilitic
  • mycotic
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13
Q

What happens in a dissecting aortic aneurysm

A

There is separation of the layers of the aortic wall

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14
Q

What are the risk factors for aortic dissection

A
  • hypertension
  • atherosclerosis
  • Marfan’s syndrome
  • bicuspid aortic valve
  • chest trauma
  • cardiac surgery
  • coarctation of the aorta
  • cocaine use
  • pregnancy
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15
Q

What are the risk factors for atherosclerotic abdominal aortic aneurysm

A
  • age
  • male sex
  • genetics
  • hyperlipidaemia
  • hypertension
  • smoking
  • diabetes
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16
Q

What are the possible complications of atherosclerotic aneurysm

A
  • rupture
  • thrombosis
  • embolism
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17
Q

What are the anatomical planes of view

A

Axial, saggital and coronal

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18
Q

What does the saggital plane of view show

A

Left and right

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19
Q

What does the axial plane of view show

A

Superior and inferior

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20
Q

What does the coronal plane of view show

A

Dorsal and ventral/posterior and anterior

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21
Q

What looks radiopaque on an x-ray

A

Dense objects which block the x-rays such as bone

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22
Q

What looks radiodense on an x-ray

A

Less dense objects which allow the beam of x-rays pass through such as air.

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23
Q

At what diameter is dilatation of the aorta considered to be an aneurysm

A

More than 3cm

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24
Q

At what diameter is intervention of an aneurysm considered

A

more than 5.5cm (55mm)

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25
Q

Where do abdominal aortic aneurysms often occur

A

In the infra-renal area

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26
Q

What symptoms may a patient experience when the aneurysm is intact

A

It is often asymptomatic

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27
Q

In which sex is aneurysm more common

A

Male

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28
Q

In which sex is rupture of an aneurysm more common

A

Female

29
Q

What lifestyle factor majorly increases the risk of aneurysm rupture

A

Smoking

30
Q

What are the symptoms of abdominal aortic aneurysm rupture

A

Sudden onset of severe abdominal pain

31
Q

What investigations can be carried out to investigate possible aneurysm

A

Blood gas test, chest x-ray, ECG

32
Q

What is the emergency investigation carried out for AAA

A

FAST scan

33
Q

What are the next steps if the aortic aneurysm is shown to be unstable on a FAST scan

A

Proceed with treatment and no other investigations

34
Q

What are the next steps if the aortic aneurysm is shown to be stable on a FAST scan

A

Carry out a CT angiogram

35
Q

What is a CT angiogram

A

The use of intravenous contrast to demonstrate the vessel lumen on a CT scan.

36
Q

What can be seen in imagine if the abdominal aortic aneurysm has ruptured

A

Blood outside the blood vessel wall.

37
Q

What is used to treat ruptured AAA

A

Open surgery using a graft of EVAR (endovascular aneurysm repair).

38
Q

What is the typical presentation of a ruptured AAA

A

An older male with sudden onset, severe central abdominal pain

39
Q

What are some specialised imagining techniques for AAA

A

PET and wall stress maps.

40
Q

What does a PET-CT involve in AAA imaging

A

It involves radiation and a radio tracer The radio tracer lights up areas of micro-calcification.

41
Q

What does wall stress maps involve in AAA imaging

A

Gradation of biomechanical wall stress.

42
Q

At what aortic diameter do most dissection occur

A

Above 5.5cm

43
Q

What risk factors are associated with acute thoracic dissection

A
  • age
  • male sex
  • atherosclerosis
  • hypertension
  • smoking
44
Q

What is type A thoracic aortic dissection

A

Dissection in the ascending aorta

45
Q

What is type B thoracic aortic dissection

A

Dissection In the descending aorta

46
Q

What happens in the process of aortic dissection

A

A small tear develops between the intimal and medial layers of the blood vessel wall. Blood enters this tear and it extends. The layers of the wall are then pulled apart. A plaque can form.

47
Q

What are the symptoms of aortic dissection

A

Severe pain that radiates through the chest and particularly between the scapula.

48
Q

What are the clinical signs of aortic dissection

A

High blood pressure, reduced pulse volume in one arm compared to the other, loss of carotid pulses on one side compared to the other, aortic regurgitation, loss of femoral pulses.

49
Q

What happens if the dissection involves the root of the aorta

A

There can be regurgitation of the aortic valve.

50
Q

What is cardiac tamponade

A

A bleed from the root of the aorta into the pericardial cavity,

51
Q

What type of treatment is key in aortic dissection

A

Surgical treatment.

52
Q

How can aortic dissection lead to MI

A

If the root of the aorta is involved, the coronary arteries may be affected which can lead to MI.

53
Q

What is the false lumen in aortic dissection

A

This is where blood forces itself between the intima and the media of the vessel wall.

54
Q

What surgical treatment is used for dissection

A

Cardiopulmonary bypass to remove the dissected area and replace it with a graft.

55
Q

What is the most important risk factor for aneurysm

A

Smoking

56
Q

Which layers of the vessel wall are involved in an aneurysm

A

All three layers

57
Q

What will you feel in the abdomen if there has been AAA rupture

A

Pulsation

58
Q

What type of rupture is typical of patients with ruptured AAA who make it to hospital

A

Posterior rupture.

59
Q

What condition is thought to be protective against dissection

A

Diabetes

60
Q

What condition is significant in aortopathies

A

Marfan Syndrome

61
Q

What gene mutation is associated with Marfan syndrome and aortopathies

A

Mutation of the fibrillin 1 gene. This is involved in the production of the ECM. Mutation causes weakness of the scaffolding around the aorta.

62
Q

What is homocysteinuria

A

An autosomal recessive condition in which there are high levels of homocysteine present in the blood and the urine

63
Q

What is homocysteinuria associated with

A

Aortic dissection and aneurysm

64
Q

What was the first condition to suggest that aneurysm is not always due to wall weakness

A

Loeys-Dietz Syndrome

65
Q

What gene is mutated in Loeys-Dietz syndrome

A

TGFBR1/2

66
Q

What does mutation in TGFBR1/2 lead to in LDS

A

Abnormal cell signalling.

67
Q

What are the main types of aneurysm

A

Dissecting and atherosclerotic

68
Q

What can be important in early detection of aneurysm

A

Calcification

69
Q

Why is monitoring of inflammation important in aneurysm management

A

It allows better prediction of expansion and rupture.

The Cardiovascular System (15 decks)

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