11 17 2014 Aortic Dissection

Question 1

What are the risk factors for aortic dissection?

Answer 1

• Chronic HTN
• Aging
• cystic medial degeneration = Marfan or Ehlers- Danlos syndrome ( CT disorders)
• traumatic insult to aorta

Question 2

Class A vs. Class B anatomy

Answer 2

Class A involves the proximal aorta ( ascending –> aortic arch) regardless of where the tear originated.

Class B involves the deciding aorta

Question 3

Aortic Dissection

Answer 3

Blood from aorta passes through a tear in the intima into the medial layer and spreads along the artery

Another postulate origin is rupture of vasa vasorum with hemorrhage into the media

Question 4

Etiology of Aortic Dissection

Answer 4

Common in 6th and 7th decades and occur more frequently in men

• most common in ascending thoracic aorta ( 65%)

Proximal aortic involvement tends to be more devastating because of the potential for extension into the coronary and arch vessels

Question 5

Clinical presentation

1. pain
2. associated symptoms

Answer 5

severe tearing or ripping quality in the anterior chest or between the scapula ( radiates to back)

Pain can radiate along the aorta or anywhere in the thorax or abdomen
- painless tear is possible but uncommon

2. HTN due to the pain or the decrease in renal flow – increase RAAS

Type A can have aortic regurgitation.
Leakage from type A = cardiac tamponade

Question 6

Treatment for Type A aortic dissection

Answer 6

REDUCE SYSTOLIC BP

• beta blockers ( decrease HR and contractility)
• Vasodilators (sodium nitroprusside)– rapidly reduces blood pressure

Early SURGICAL correction!
-synthetic aortic graft

Question 7

Treatment for uncomplicated Type B aortic dissection

Answer 7

MEDICATION
* early surgery does not improve outcome in patients

If gets worse – catheter-based repair with endovascular stent grafts is successful in specific stable patients

Question 8

Symptoms of thoracic aortic aneurysms

Answer 8

• compress trachea or mainstream bronchus
  = cough, dyspnea, pneumonia
• Compression of esophagus
  = dysphagia

-Involvement of the recurrent laryngeal
= hoarseness

Question 9

Symptoms of ascending aorta

Answer 9

dilate aortic ring = aortic regurgitation and symptoms of heart failure

Question 10

Symptoms of abdominal aorta

Answer 10

pulsating mass
abdominal or back pain
nonspecific gastrointestinal symptoms

Question 11

Ascending aortic aneurysm is associated with what conditions?

Answer 11

HTN, Marfan syndrome, Loeys-Dietz syndrom, and Ehlers-Danlos syndrome ( CT disorders)

Question 12

aneurysms of the descending aorta and abdominal aorta are related to what disease

Answer 12

Atherosclerosis

• genetic predisposition
• local vessel inflammation