Aortic Dissection

Question 1

Presentation

Answer 1

Tearing chest pain
Radiates to back
HTN
Aortic regurgitation - diastolic murmur loudest on right 2nd intercostal space

Question 2

Pathophysiology

Answer 2

Tear in the tunica intima of the aorta wall creating a false lumen

Question 3

CXR findings

Answer 3

Widened mediastinum

Question 4

Type A

Answer 4

Ascending aorta

Question 5

Type B

Answer 5

Descending aorta distal to the left subclavian origin

Question 6

Debakey classification

Answer 6

I - originates in ascending aorta and propagates to atleast the aortic arch and maybe distally

II - originates and confined to ascending aorta

III - originates in the descending aorta and rarely extends proximally

Question 7

Ix

Answer 7

Cardiac examinations 
Basic obs 
Bloods - FBC, U+Es, LFTs, CRP, Trop I 
ECG 
CXR 
CT angiography - false lumen 
Transoesophageal echocardiogram - if unstable for CT angio

Question 8

Mx

Answer 8

Type A - surgical management, BP controlled to 100 - 120 systolic

Type B - conservative Mx, bed rest and BP reduction using labetalol

Question 9

Complications

Answer 9

Backward tear:

• aortic incompetence/ regurgitation
• MI

Forward tear:

• unequal arm pulses and BP
• Stroke
• Renal failure

Question 10

When does the abdominal aorta start and terminate

Answer 10

T12 - L4

Question 11

Risk factors

Answer 11

HTN 
Bicuspid aortic valve 
Marfan’s syndrome 
Ehlos Danlos 
Pregnancy 
Syphilis