Acute Aortic Syndromes Flashcards
When are acute aortic syndromes more common?
Circadian variation - early morning and winter due to times of increased BP
Name the risk factors for acute aortic syndromes
Increasing age
Male sex
Diabetes
Pre-existing aortic disease
Connective tissue disorders
Bicuspid aortic valve
Hypertension
Iatrogenic
Trauma
Previous aortic surgery
Family history
What are acute aortic syndromes?
Aortic dissection
Intramural haematoma
Penetrating aortic ulcer
Describe aortic dissection
Tear in the intima of the aorta that allows blood to form a pathological cleavage plane between itself and the adventitia by disrupting the media
What is the name for the channels created in aortic dissection?
False and true lumens
Describe the blood flow in the lumens
Pressure higher in the false lumen as outflow is a small re-entry tear leading to compression of the true lumen
What are the two types of vessel malperfusion?
Dynamic - mobile dissection flap intermittently shuttering the ostia of vessels
Static - fixed flap
What is intramural haematoma?
Clotted blood in the intramural space without an obvious intimal tear
What causes IMH?
Rupture of medial vasa vasora leading to tear in the aortic lumen
What disease associated with IMH?
Hypertension
What causes penetrating aortic ulcer?
Focal ulceration of an atherosclerotic plaque into the media
What part of the vessel is affected in PAU?
Intima
How do aortic syndromes present?
Severe chest pain with radiation to neck/back
BP abnormality depending on type
Collapse/death/neuro deficit/limb ischaemia
How is aortic dissection classified?
DeBakey System (type A proximal type B - distal)
I - ascending to descending aorta
II - ascending aorta only
III - beyond origin of LSA
What are the findings in a complicated dissection?
Impending or frank rupture
Malperfusion
Persistent pain
Refractory hypertension
