Thoracic Aortic Disease Flashcards
What are the different locations or classes of thoracic aneurysm?
Ascending Aorta
Aortic Arch
Descending Aorta
(After that your into Abdominal Aorta)
What are the types of aneurysm?
True & False
True aneurysms are split into saccular & fusiform
What is a true aneurysm?
Where all 3 layers of aortic wall are dilated.
One side = Saccular
All around = Fusiform
What is a false aneurysm?
Some or all of the wall layers rupture.
The haematoma is contained by the intact adventitia or surrounding soft tissue
What causes an aneurysm?
True:
- Atherosclerosis
- Connective Tissue Diseases (e.g. Marfan’s)
- Trauma
- Congenital Bicuspid Aortic Valve
- Infections e.g. Syphilis
False:
- Inflammatory Conditions (E.g. Takayasu’s Arteritis)
- Trauma
- Iatrogenic
Risk factors for an aneurysm?
Age Smoking Marfan's etc. Family History Hypercholesterolaemia Hypertension
What are the symptoms of a thoracic aortic aneurysm?
They vary with location and aer often asymptomatic but overall:
- SOB
- HF (if causing AR)
- Dysphagia/Hoarseness (If chronic asc. aortic aneurysm)
- Sharp Chest Pain radiating to Central upper back (spreads if dissection)
- Regional Hypotension
What are the clinical signs of a FALSE aneurysm?
Thrill - Bruit - Pulsatile MAss
What are the possible outcomes/complications of an aneurysm?
Rupture.
Ischaemia/Infarction
Distal Emboli causing their own infarctions
What is Takayasu’s Arteritis?
Granulomatous Vasculitis affecting the aorta & its main branches
What are the conditions caused by takayasu’s Arteritis?
Stenosis Thrombosis Aneurysms Renal Artery Stenosis Neurological Symptoms
Which gender is more affected by takayasu’s arteritis?
Women
How do we treat Takayasu’s Arteritis?
Steroids
Surgery
What is syphilis caused by?
The Treponema Pallidum Bacteria, its an STD
How does Syphilis become a cardiac problem?
without treatment it can develop to a tertiary stage in one of 3 forms:
Cardiac - Gummatous - Late-Neuro Syphilis
Cardiac Syphilis can cause AR and/or syphilitic Aortitis leading to aneurysm.
How do we prevent syphilis becoming serious and affecting cardiovascular system?
Antibiotics can prevent it progressing
What is Aortic Dissection and how does it spread?
A tear in the inner aortic wall.
Blood then enters the tear and forces itself between the layers forming a false 2nd lumen that propagates up or down the aorta.
Chronic or acute
What can cause aortic dissection?
Trauma - Cardiac Surgery - Marfan’s Syndrome - Bicuspid AV (congenital) - Atherosclerosis - Hypertension
What are the risk factors for aortic dissection?
Trauma - Smoking - Pregnancy - Cocaine Use - Arteririts - Hypercholesterolaemia - Hypertension
What are the symptoms of aortic dissection?
Chest Pain
Collapse
External Rupture Symptoms
Describe the pain of aortic dissection?
Its a severe tearing pain that often radiates to the back if on desc. aorta. Position depends on site of the tear.
Why does aortic dissetion cause collapse?
External rupture -> Tamponade restricting heart
External rupture -> Internal haemorrhage
Acute AR -> Collapse
What happens if theirs an external rupture of aortic dissection?
Pericardial Tamponade - SOB, pleuritic pain, weakness, dizziness & cough Pleural Effusion (Haemothorax) - Pleuritic Pain, SOB.
What are the clinical signs of aortic dissection?
Reduced/absent peripheral pulses
- BP mismatch between limbs
- AR murmur (soft, early diastolic)
- Hyper/Hypotension
- Pulmonary Oedema
- Inferior ST elevation
How do we investigate aortic dissection?
CXR - Mediastinal widening, loss of aortic knob, tracheal deviation, pleural effusion etc.
CTA/MRA - MRA is best
TOE - V common way to confirm diagnosis
How do we treat aotic dissection?
Stanford Type B gets medical treatment
Stanford Type A gets surgery
What medical treatment is there for Type B aortic dissection?
Beta Blockers
CCBs
Nitroprusside (vasodilator)
What surgical treatment s there for Type A aortic dissection?
Valve and/or a section of aorta replacement.
What are the possible complications of aortic dissection?
Rupturing into lumen, pericardium (tamponade) or Mediastinum (haemothorax)
Occlusion of important branches
How will a dissected aorta appear histologically?
There will be a loss of elastin & muscle fibres with an accumulation of mucopolysaccharides in cyst-like spaces.
This is called ‘Cystic Medial Necrosis’
