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)
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
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
4
Q
Is murmur systolic or diastolic
A
Diastolic
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
6
Q
COMPLICATIONS
A
- Myocardial infarction
- Stroke
- Paraplegia (motor or sensory impairment in legs)
- Cardiac tamponade
- Aortic valve regurgitation
- Death
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)
8
Q
CLASSIFICATION
A
- Stanford system
- A - ascending aorta before brachiocephalic artery
- B - descending aorta, after left subclavian artery