Aortic Dissection

Question 1

What is aortic dissection?

Answer 1

Tear in the tunica intima (inner layer) of the wall of the aorta

Question 2

What happens in an aortic dissection?

Answer 2

A false lumen of blood is formed within the wall of the aorta

Question 3

Which part of the aorta is more commonly affected by aortic dissection?

Answer 3

The ascending aorta and aortic arch

Question 4

What is the most important risk factor for aortic dissection?

Answer 4

Hypertension

Question 5

What are the 2 classification systems for an aortic dissection?

Answer 5

The Stanford system

The DeBakey system

Question 6

What is the Stanford system divided into?

Answer 6

Type A

Type B

Question 7

What is Type A of the Stanford system?

Answer 7

Affects the ascending aorta, (before the brachiocephalic artery)

Question 8

What is Type B of the Stanford system?

Answer 8

Affects the descending aorta, (after the left subclavian artery)

Question 9

What is the DeBakey system divided into?

Answer 9

Type I
Type II
Type III

Question 10

What is Type 1 of the DeBakey system?

Answer 10

Originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally

Question 11

What is Type 2 of the DeBakey system?

Answer 11

Originates in and is confined to the ascending aorta

Question 12

What is Type 3 of the DeBakey system?

Answer 12

Originates in descending aorta, rarely extends proximally but will extend distally

Question 13

What can also increase the risk of aortic dissection?

Answer 13

Ehlers-Danlos Syndrome
Marfan’s Syndrome
Bicuspid aortic valve

Question 14

What is the main presentation of aortic dissection?

Answer 14

Sudden onset, severe, “ripping” or “tearing” chest pain

Question 15

Where is the pain usually felt with a type B aortic dissection?

Answer 15

Upper back

Question 16

Where is the pain usually felt with a type A aortic dissection?

Answer 16

In the chest

Question 17

What are the other possible symptoms of aortic dissection?

Answer 17

Pulse deficit
Aortic regurgitation
Hypertension
Diastolic murmur

Question 18

What is a pulse deficit?

Answer 18

Weak or absent carotid, brachial, or femoral pulse
Differences in blood pressure between the arms (more than a 20mmHg difference is significant)
Radial pulse deficit (the radial pulse in one arm is decreased or absent and does not match the apex beat)

Question 19

What is the main method of diagnosis of an aortic dissecton?

Answer 19

CT angiogram of chest, abdomen and pelvis

Question 20

What finding on a CT angiogram would suggest an aortic dissection?

Answer 20

False lumen

Question 21

What other investigations could you do for the diagnosis of an aortic dissection?

Answer 21

X-ray
Transoesophageal echocardiography (TOE)

Question 22

What might you find on an x-ray of someone with aortic dissection?

Answer 22

Widened mediastinum

Question 23

When might you carry out a Transoesophageal echocardiography (TOE)?

Answer 23

In unstable patients who are too risky to take to CT scanner

Question 24

What is the management of Type A aortic dissection?

Answer 24

Surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B*
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

Question 25

What needs to be controlled while waiting for surgery for Type a aortic dissection?

Answer 25

Blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Question 26

What is the management of type B aortic dissection?

Answer 26

Conservative management
bed rest
reduce blood pressure

Question 27

What medication would you give to reduce progression of type b aortic dissection?

Answer 27

IV labetalol to prevent progression

Question 28

What surgical management can be used for type b aortic dissection? (more likely to be used in the future but not so much now)

Answer 28

Thoracic endovascular aortic repair (TEVAR)

Question 29

What are possible complications of type A aortic dissection?

Answer 29

unequal arm pulses and BP
stroke
renal failure

Question 30

What are possible complications of type b aortic dissection?

Answer 30

aortic incompetence/regurgitation
MI: inferior pattern is often seen due to right coronary involvement