thoracic aorta disease Flashcards
how does blood get into the coronary arteries
through the right and left coronary ostium
where are the coronary ostium’s located
in the right and left sinus of Valsalva (behind the aortic valve)
what are the parts of the aorta
the ascending
the arch
descending
thoracic
abdominal
what are the 3 layers of the aorta
tunica intima
tunica media
tunica adventitia
what is in the tunica intima
layer of endothelia cells
subendothelial collagen and elastic fibres
what is in the tunica media
smooth muscle cells
create elastin sheets - called lamellae
what is in tunica adventitia
thin connective tissue
collagen and elastin fibres (that are not lamellae)
what does the collagen in elastic arteries do
prevents them from stretching beyond their physiological limits during systole
what is an aneurysm
a localised enlargement of an artery caused by a weakness of the vessel wall
what is a false aneurysm
when there is a tear in the inner layers (intima, media) leading to collection of blood and stretching of the tunica adventitia
what is a saccular aneurysm
when there is a bulge in only one side (true aneurism)
what is fusiform aneurysm
where the budge is on both sides
what can a false aneurysm be caused by
dissection of the two inner layers
what are the sings and symptoms of a thoracic aneurisms
asymptomatic
location dependents SOB heart failure pulsate mass hypotension pain
how would pain suggest a aortic dissection
sharp chest pain
radiating to back
what can aortic dissections be - what happens
acute - surgical emergency
chronic
blood forces walls apart
what can lead to aortic dissection
turbulent flow
hypertension
atherosclerosis
vessel wall weakness/damage
trauma
marfans syndrome
what are the symptoms of aortic dissection
tearing, severe chest pain - radiation to back
collapse (tamponade, acute AR (aortic regurgitation)
what is the prognosis for a aortic dissection
bad 50% mortality rates pre-hospital
what would you find on examination of a aortic dissection
reduced or absent peripheral pulsed
hypotension
pulmonary oedema
hiw can a diagnosis of a aortic dissection be confirmed
chest x ray - wider mediastinum
echo - CT for confirmation
what is the treatment for a aortic dissection
most - surgery
mild cases
meticulous BP control
NA nitroprusside
beta blocker
what are the congenital aortic aneurisms
bicuspid aortic valve
marfans syndrome
coarctation
what is the infection that can cause aortic problems
syphilis
aortic regurgitation - late stage
treat with antibiotics
what is the inflammation disease that causes problems with the aorta
Takayasu’s arteritis
what dose the inflammation do to the aorta and the main branches (Takayasu’s arteritis)
stenosis, thrombosis
aneurysms
steroids
and surgery
what are sings of aortic coarctation
cold legs
poor leg pulses
infancy - heart failure, failure to thrive
later in life - hyper tension
what can marfans syndrome cause
aneurysm, aortic dissection
pneumothorax in the lungs
how do you monitor a bicuspid aortic valve
monitor with echo/ MRI
what is the most common congenital abnormality
bicuspid aortic valve 1-2%
what does having a bicuspid aortic valve possibly lead to
coarctation
prone to stenosis/ regurgitation
aneurysm/ dissection
where does coarctation occur around
the ductus arteriosa which becomes the ligamentum arteriosum
what are the 3 types of coarctation
pre-ductal
ductal
post ductal
what is important about preductal
can be life threatening if there is sever stenosis of the aorta
linked to turners syndrome
what is the most common coarctation in adults - symptoms
post ductal
hypertension upper limb extremities areas, weak lower limb pulses
what is coarctation
aortic narrowing close to where the ligamentum artriosum attaches to the aorta (end of the aortic arch)
how can you image a coarctation
lateral CXR
contrast MRI
