Aortic Disection And Anuerysms

Question 1

What is aortic dissection?

Answer 1

Important acute aortic pathology where a tear occurs and blood goes into it creating a false lumen that has no outflow so it is under huge amounts of pressure and is t risk of rupturing. It also deprives the true lumen of blood and blood to the rest of the body causing ischemia , causes tearing chest pain
Maybe due to uncontrolled prolonged hypertension
Rapidly fatal

Question 2

Clinical picture of an aortic dissection?

Answer 2

Hypertensive patient with tearing chest pain that is not relieved by sublingual nitrates (differential diagnosis: MI,PE or aortic dissection) , but when you measure the blood pressure you find that it is hypotensive since low amounts of blood reach the aortic branches aka radial artery
If there is a discrepancy greater than 20 between left and right arms then there is an aortic dissection since subclavian arteries are in a different place

Question 3

How to diagnose?

Answer 3

ECO , trans esophageal specifically would be more acurate
Or MRI/CT most sensitive and conclusive method for diagnosing an aortic dissection
CT angiography

Question 4

How to manage an aortic dissection?

Answer 4

1. Decreasing blood pressure and shearing forces of myocardial contractility
2. Antihypertensive therapy ; beta blockers for all stable chronic aortic dissections
3. Pain management
4. Emergency surgical correction is most preferred
   Area with initial tear is replaced with a Dacron graft

Question 5

Relevance of aortic dissection to dental practice?

Answer 5

• beware of patient with episodes of hypertension in a predisposed patient
• nervous patients may get hypertensive so reduce stress and anxiety
• consider aortic dissection if patient feels severe chest and back pain and feel very unwell , impending doom or death
• stop procedure , give oxygen amd arrange emergency transport to hospital

Question 6

What are arterial aneurysms?

Answer 6

Focal dilation or bulge in the wall of an artery due to weakening , it may be saccular (cerebral) or fusiform (aorta) 2 most commonly affected areas

Could be due to uncontrolled hypertension -> control blood pressure
Or could be a genetic defect in mesenchymal cells , meaning this patient would have lots of aneurysms in their body