Aortic dissection Flashcards
What is an aortic dissection
Tear in the intimal layer of the aortic wall. causing blood to flow between and splitting the tunica intima and media
Definition of acute aortic dissection
Diagnosed < 14 days
Definition of chronic aortic dissection
Diagnosed >14 days
Population most affected by aortic dissections
More common in men with a peak onset between 50-70years
Connective tissue disorders
What are anterograde and retrograde dissections
Anterograde dissections propagate towards the iliac arteries
Retrograde dissections propagate towards the aortic valve(at the root of the aorta)
What can retrograde dissections result in
Prolapse of the aortic valve, bleeding into the pericardium, and cardiac tamponade
What are group A dissections
Involves the ascending aorta and can propagate to the aortic arch and descending aorta; the tear can originate anywhere along this path before the brachiocephalic artery
What are group B dissections
Do not involve the ascending aorta but affects the descending aorta after the left subclavian artery
Risk factors for aortic dissection
Hypertension Atherosclerotic disease Male Connective tissue disorders Bicuspid aortic valve
Clinical features of aortic dissection
Tearing chest pain classically radiating to the back
Tachycardia
Hypotension
New aortic regurg murmur
Signs of end-organ perfusion
Recommended imaging ix for aortic dissection
CT angiogram
Transoesophogeal ECHO
General initial mx of aortic dissection
A-E(high flow oxygen, IV access, fluid resus)
Lifelong antihypertensive therapy and surveillance imaging
Management of type A dissections
Surgery - removal of the ascending aorta and replacement with synthetic graft
Any additional branches of the aortic arch will require reimplantation into the graft (may require staged procedures)
Management of type B dissections
Antihypertensive therapy - IV beta blockers(labetalol)
- Ca2+ blockers as second line
Why is surgical intervention not recommended in type B dissections
Risk of retrograde dissection
