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Aortic Dissection and Aneurysm (Pathoma) (Aortic Dissection (Major…
Aortic Dissection and Aneurysm (Pathoma)
Aortic Dissection
intimal tear w/ dissection of blood thru the media of aortic wall, dissecting along the media
Aortic dissection requires 2 things
tons of stress: to rip thru wall
hence: happens in proximal 10 cm of aorta
preexisting weakness of the media
most commonly via HTN
normally blood in lumen provides O2 to tissue layers
Aorta, the intima is thick. Hence vaso vasorum
HTN leading to hyaline arteriolosclerosis in vaso vasorum, decreases blood flow, atrophy of smooth muscle (
weakening the media
)
inherited defect of connective tissue
marfans: bad fibrillin , bad elastic fibers
Ehlers Danlos: weak elastin
Presentation
Sharp tearing chest pain
radiates to the back
chest pain that moves
chest pain assd w HTN
Major Complication:
Pericardial Tamponade
most common cause of death
Rupture w/ fatal hemorrhage
Mechanism: Obstruction of arteries branching off aorta
in prox. 10 cm, dissection occurs thru the media. May push down on the renal artery, creating obstruction
end organ ischemia to kidney
or backward dissection to pericardium, pericardial tamponade
as described previously: common cause of death
or dissection into mediastinum
causing fatal hemorrhage
Thoracic Aneurysm
Definition: balloon like dilation of the thoracic aorta
classically 2 places
Thorax
classically: Tertiary Syphilis
syphilis is
end arteritis
: inflammation of small bv's, decreases lumen, atrophy of muscle wall, weakened aortic wall
tree-bark appearance of the aorta
scarring and fibrosis due to end arteritis
Complications
dilation of the aortic valve root
dilation causes pulling on the root of aorta
results in aortic insufficiency
Compression of mediastinal structures (same mechanism: ballooning compresses)
Thrombosis or embolus
Abdomen
occurs below the renal arteries/ above the aortic bifurcation
occurs due to atherosclerosis
thick intima: thickened diffusion barrier:
atrophy of the wall
and weakness
same risk factors for atherosclerosis
males, smokers, >60 yo
Presentation
pulsatile abdominal mass
grows over time
aneurysms increase wall stress and can expand
leads to rupture (major complication)
Complications: rupture
esp when >5cm in diameter
rupture presentation: Triad
hypotension
internal bleeding
pulsatile abdominal mass
flank pain
Requirement
weakness in the aortic wall
