Aortic Disection

Question 1

What happens in an aortic dissection

Answer 1

Tear in the intima

Question 2

What are causes/ risk factors for aortic dissection

Answer 2

Medial degeneration, increased aortic wall stress, systemic htn, weight lifting, cocaine, elderly, males

Question 3

S/s of aortic dissection

Answer 3

Sudden shearing/tearing pain in chest, back, or scapula
Syncope, SOB, hypo or htn, loss of pulse, aortic regurgitation, pulmonary edema, MI

Question 4

What are clinical manifestations that develop when aortic dissection compresses on adjacent structures

Answer 4

Stridor, Horner’s syndrome, superior vena cava syndrome, dysphagia, airway compromise

Question 5

What symptoms does a type A lesion cause

Answer 5

Cardiac tamponade

Question 6

S/s of acute aortic regurgitation

Answer 6

Bounding pulses, widening pulse pressure, diastolic murmur, HF s/s

Question 7

What is the Debakey classification for aortic directions

Answer 7

Type I: Intimal tear occupies ascending aorta. Involves descending aorta
Type II: Dissection limited to ascending aorta
Type III: Intimal tear located in descending aorta. Distal propagation of dissection

Question 8

What is the standford classification system for aortic dissections

Answer 8

Stanford
Type A:Involves ascending aorta (proximal
dissection)
Type B: Limited to arch and/or descending aorta
(distal dissection)

Question 9

What imaging should be ordered to confirm an aortic dissection

Answer 9

CT MRI or ECHO

Question 10

Medical management of an aortic dissection

Answer 10

Reducing cardiac contractility & systemic arterial
pressure
Beta blockade
Nipride infusion for SBP <120 mmHg
Hydralazine is contraindicated

Question 11

Surgical treatment of aortic dissection

Answer 11

Acute ascending aortic dissections, intramural hematomas or Type A: Emergent or surgical correction. Obliteration of false lumen. Placement of interposition graft.

Complicated Type B dissections: Thoracic endovascular aortic repair with stent graft