Week 3 - Aortic Disease

Question 1

What does aortic disease include?

Answer 1

Aneurysm, aortic dissection, atherosclerosis

Question 2

What are the 4 parts of the aorta?

Answer 2

• aortic root - aortic valve to sinotubular junction
• ascending thoracic aorta - sinotubular jnction to brachiocephalic artery
• aortic arch - brachiocephalic artery to left subclavian artery
• descending thoracic aorta - left subclavian artery to diaphragm

Question 3

What are the sections of the aortic root?

Answer 3

has right, left and and non-coronary sinus of valsalva. correspond to a cusp of the aortic valve - right coronary cusp, left coronary cusp, non-coronary cusp

Question 4

What is the histology of the aorta?

Answer 4

T. intima is endothelial cells with collagen and elastic fibres, separated from t.media by thin elastic membrane
T.media is smooth muscle which secrete elastin sheets
T. Adventitia is a thin connective tissue layer - collagen and elastic fibres - collagen prevents over stretch

Question 5

What are risk factors of atherosclerosis?

Answer 5

hypertension, smoking, hypercholesterolaemia, diabetes, family history

Question 6

What is an aneurysm?

Answer 6

enlargement of artery caused by weakening of vessel wall

Question 7

What are the types of aneurysm?

Answer 7

true aneurysm:
saccular - enlarged on one side
fusiform - enlarged on both sides

false aneurysm:
enlargement due to rupture in artery wall. blood is contained in either thin t.adventita layer, or external surrounding structures

Question 8

What are common causes of true aneurysm?

Answer 8

• hypertension,
• bicuspid aortic valve,
• collagen abnormalities,
• infection and trauma

Question 9

What are common causes of false aneurysm?

Answer 9

trauma, iatrogenic or inflammation

Question 10

What are the symptoms of an aortic aneurysm?

Answer 10

• depends on size and location.
• in aortic regurgitation, patient may have SoB or heart failure.
• it may compress other areas, causing dysphasia, hoarse voice, back pain

Question 11

What investigations can be carried out to diagnose aneurysm?

Answer 11

• CXR shows widened mediastinum.
• CT and MRI used to diagnose.
• echocardiogram shows root but not other parts of aorta

Question 12

What is the test of choice for aortic aneurysm?

Answer 12

CT and MRI

Question 13

What is an aortic dissection?

Answer 13

tear in intima of aorta, blood enters causing split in media.

Question 14

What is the cause of an aortic dissection?

Answer 14

same as aneurysm - hypertension, atherosclerosis, bicuspid aortic valve, trauma

Question 15

What do you find histologically in an aorta that causes an aortic dissection to occur?

Answer 15

cystic medial necrosis. cysts replace smooth muscle and elastic fibres in media, weakening it so tear is more likely to occur

Question 16

What are the symptoms of aortic dissection?

Answer 16

propagation of blood may occlude any of the main arteries - carotid, coronary, renal, etc. symptoms depend on this

Question 17

What classification system is there for aortic dissection?

Answer 17

stanford system.
A is any dissection involving ascending aorta
B is any dissection not involving ascending aorta

Question 18

What is the clinical presentation of aortic dissection?

Answer 18

• severe sharp chest pain radiating to back,
• collapse due to heart issues,
• stroke due to involvement of carotid arteries

Question 19

What is found on examination of aortic dissection?

Answer 19

• absent or reduced peripheral pulse,
• changed blood pressure,
• BP mismatch between limbs,
• aortic regurgitation murmur,
• signs of stroke if involving carotid

Question 20

What investigations are carried out for aortic dissection?

Answer 20

• CT angiogram aorta IS BEST - confirms diagnosis
• ECG to see if there’s coronary involvement
• CXR for widened mediastinum
• echocardiogram shows aortic root but nothing else

Question 21

What is the mortality rate of aortic dissection?

Answer 21

VERY HIGH! 50% die before hospital and many die after

Question 22

how do you treat aortic dissection?

Answer 22

depends on type

type A - control BP then go for emergency surgery
type B - control blood pressure and assess risk of rupture and involvement of branches of aorta. if so consider percutaneous

Question 23

What is takayasu’s arteritis?

Answer 23

granulomatous condition which affects aorta. may cause stenosis, thrombus, aneurysm. may need treatment

Question 24

What is syphilis?

Answer 24

STI which may cause aortic aneurysm or regurgitation in late stages

Question 25

What conditions predispose aortic aneurysm?

Answer 25

• aortic bicuspid valve,
• coarctation,
• marfan syndrome

Question 26

What is marfan syndrome?

Answer 26

connective tissue weakness causing proneness to aortic regurgitation, aortic dissection and aneurysm

Question 27

What is a false aneurysm?

Answer 27

A false aneurysm involves a collection of blood/haematoma which is either contained by the adventitial layer or the surrounding tissue

Question 28

What is notching of ribs a common sign of?

Answer 28

seen on xray. coarctation of aorta. causes enlargement of intercostal arteries