Aortic Dissection Flashcards
what is aortic dissection
tear in the aortic intima, this allows a false lumen to be made and allows blood to surge into the aortic wall causing a split between the inner and outer tunica media.
types of aortic dissection
type A (ascending aorta) - most common type B (descending aorta) - less common
aetiology/causes
degenerative changes in the smooth muscle of the aortic media
risk factors
hypertension, aortic atherosclerosis (hyperlipidaemia is. RISK FACTOR), connective tissue disorders like Marfans and Ehler-Danlos, congenital cardiac abnormalities, aortitis, iatrogenic, trauma and cocaine
what can expansion of the false lumen lead to
obstruction of the subclavian, carotid, coeliac and renal arteries… leading to hypo perfusion of these target organs
what does the subclavian artery supply
head and neck
what does the carotid artery supply
brain
what does the coeliac artery supply
foregut
what does the renal arteries supply
kidneys
summarise epidemiology of aortic dissection
most common in males aged between 40 and 60
Main presenting symptom of aortic dissection
sudden, ‘tearing’ central chest pain
in aortic dissection, where may the chest pain radiate to
the back, in between the shoulder blades
what are symptoms specific to
what artery has been obstructed
signs on physical examination
murmur on the back, below left scapula, descending towards the abdomen
hypertension
blood pressure difference between arms is greater than 20
what may hypotension suggest
cardiac tamponade; accumulation of fluid around the heart within the pericardial sac
signs of aortic regurgitation
high volume collapsing pulse
early diastolic murmur over the aortic area
investigations
Bloods, CXR, ECG and CT thorax
what would you see on abnormal CXR (aortic dissection)
widened mediastinum, globular heart
is the ECG significant
usually iy will be normal. but must be done to rule out STEMI
treatment of suspected aortic dissection, haemodynamically unstable
opioid analgesia, haemodynamic support and advanced life support
treatment of confirmed type A aortic dissection
beta blockers or calcium channel blockers with opioid analgesia
plus vasodilator and consider open surgery
treatment of confirmed unstable type B
same as type A
treatment of confirmed stable type B
same as type A
if chronic aortic dissection, how would you treat it
beta blocker, antihypertensive therapy and lifestyle advice and support
