Aortic Dissection Flashcards

1
Q

ESSENCE

A

Break or tear forms in inner layer of aorta, allowing blood to flow between layers (enters between intima and media layers)

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2
Q

AETIOLOGY

Risk factors

A
  • Same as peripheral arterial disease
  • Hypertension
  • Conditions/procedures that affect aorta
    • Bicuspid aortic valve
    • Coarctation of aorta
    • Aortic valve replacement
    • CABG
  • Conditions that affect connective tissues
    • Ehlers-Danlos syndrome
    • Marfans syndrome
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3
Q

CLINICAL FEATURES

Presentation

A
  • Sudden onset, severe ripping or tearing chest pain
    • Anterior if ascending aorta, back if descending
  • Hypertension
  • Differences in BP between arms
  • Radial pulse deficit
  • Diastolic murmur
  • Focal neurological deficit
  • Chest and abdominal pain
  • Collapse (syncope)
  • Hypotension as dissection progresses
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4
Q

Is murmur systolic or diastolic

A

Diastolic

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5
Q

INVESTIGATIONS

First line

A
  • 1) CT angiogram - confirm diagnosis
  • ECG and x-ray to exclude other cause
  • MRI angiogram - greater detail but takes longer
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6
Q

COMPLICATIONS

A
  • Myocardial infarction
  • Stroke
  • Paraplegia (motor or sensory impairment in legs)
  • Cardiac tamponade
  • Aortic valve regurgitation
  • Death
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7
Q

MANAGEMENT

General

A
  • Analgesia
  • Beta blockers - control blood pressure and heart rate
  • Surgical intervention
    • Type A - open surgery (midline sternotomy)
    • Type B - endovascular aortic repair (TEVAR)
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8
Q

CLASSIFICATION

A
  • Stanford system
    • A - ascending aorta before brachiocephalic artery
    • B - descending aorta, after left subclavian artery
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