Aortic Dissection (1)

Question 1

What occurs here?

What are its risk factors?

What are its complications?

How is it classified?

Answer 1

➊ Tear in t. intima creates a false lumen where blood can flow between the layers

➋ HTN, Valvular HD, Cocaine/amphetamine use

➌ • Rupture and internal haemorrhage
• Cardiac tamponade
• Embolism - Stroke, Limb and mesenteric ischaemia

➍ Stanford:
• Type A - Involves the ascending and aortic arch
• Type B - Involves the descending aorta

Question 2

How does it present?

What is found O/E?

Answer 2

➊ Sudden onset ‘tearing’ chest pain that radiates to the back

➋ • Blood pressure difference between arms (sys > 20mmHg difference)
• Radio-radio delay (Type A)
• Radio-femoral delay (Type B)

Question 3

What are the important investigations to do?

How is it initially managed?

How is it definitively managed?

Answer 3

➊ • BP
• CT angiogram
• CXR

➋ • Cardiac monitoring
• Strict BP control w/B-blocker

➌ Depends on the type of dissection:
• Type A - Surgical intervention (e.g. aortic graft)
• Type B - Conservative intervention with BP control (B-blockers 1st line) and Opioid analgesia