Aortic Dissection

Question 1

What happens in aortic dissection?

Answer 1

Tear in the intima of the aorta, split forms in the media and blood tracks in the newly formed false lumen.

Question 2

What is this a presentation of?

Tearing pain between the shoulder blades, hypertension, asymmetric pulses.

Answer 2

Aortic dissection

Question 3

What is the difference between type A and type B aortic dissection in these features?

1. Location
2. Management

Answer 3

1. A - involves ascending aorta, B - does not.

2. A - immediate surgery (aortic root replacement), B - medical management (BP control)

Question 4

What are the three main risk factors for aortic dissection?

Answer 4

1. Hypertension
2. Abnormal media - Marfan’s, Ehlers-Danlos
3. Pregnancy

Question 5

What is the pathogenesis of aortic dissection?

Answer 5

1. False lumen reduces blood flow through true lumen.
2. Dissection may extend to other arteries and cause ischaemia/infarction of organs.
3. Dissection may rupture externally into pleural cavity, pericardial space, or abdominal space.

Question 6

What are the complications in a type A aortic dissection?

Answer 6

1. Compromise blood flow in branches (carotid dissection = stroke, coronary dissection = MI)
2. Rupture into pericardium - cardiac tamponade
3. Stretching of aortic valve - acute aortic regurgitation