aortic disection

Question 1

what is an aortic dissection?

Answer 1

inner layer, tunica intima tears, creating a false lumen

false lumen can propagate distally

Question 2

what classification is used?

Answer 2

stanford classification:
A= ascending aorta, proximal to the left subclavian
B= does not involve ascending aorta- distal to the subclavian

Question 3

what are the symptoms?

Answer 3

tearing chest pain radiating to back

syncope (feeling faint)

Question 4

how may the patient appear on examination?

Answer 4

• may have radio-radial/ radio/femoral delay
• difference in BP between arms >10
• tachycardic and hypotensive

spinal arteries-> paraplegia

• coronary arteries-> angina
• distal aorta-> limb ischaemia

Question 5

which genetic disoder increases the risk of aortic disection?

Answer 5

Marfans

Question 6

what is the diagnostic investigation of choice?

Answer 6

CT angiogram

Question 7

when is a TOE considered?

Answer 7

• in very unstable patients to monitor in theatre or ITU

Question 8

which primary investigations would you do?

Answer 8

BEDSIDE:
-ECG: T wave inversion or ST depression, these are non specific

BLOODS:
FBC: anaemia may be present

UandE: prior to contrast CT and also looking for prerenal AKI

group and save and xmatch- 4-6 units available

IMAGING:
CXR- widened mediastinum and enlarged aortic notch
CT angiogram

Question 9

what is the management?

Answer 9

type A= more common, have higher rates of rupture so need immmediate surgery

• give IV labetalol and aim for bp 100-120
• then do an open surgical repair

uncomplicated type B:

• manage conservatively
• IV labetalol 120-130 bp, monitored closely in ITU or HDU

can do endovascular repair, but not standard practice

Question 10

what are the different complications of aortic dissection?

Answer 10

cardiovascular:

• pericardial tamponade
• aortic incompetence
• MI
• aortic rupture

neurological:
- stroke

renal:
- heart failure