Aortic Dissection Flashcards
What is aortic dissection?
Tear in the tunica intima (inner layer) of the wall of the aorta
What happens in an aortic dissection?
A false lumen of blood is formed within the wall of the aorta
Which part of the aorta is more commonly affected by aortic dissection?
The ascending aorta and aortic arch
What is the most important risk factor for aortic dissection?
Hypertension
What are the 2 classification systems for an aortic dissection?
The Stanford system
The DeBakey system
What is the Stanford system divided into?
Type A
Type B
What is Type A of the Stanford system?
Affects the ascending aorta, (before the brachiocephalic artery)
What is Type B of the Stanford system?
Affects the descending aorta, (after the left subclavian artery)
What is the DeBakey system divided into?
Type I
Type II
Type III
What is Type 1 of the DeBakey system?
Originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
What is Type 2 of the DeBakey system?
Originates in and is confined to the ascending aorta
What is Type 3 of the DeBakey system?
Originates in descending aorta, rarely extends proximally but will extend distally
What can also increase the risk of aortic dissection?
Ehlers-Danlos Syndrome
Marfan’s Syndrome
Bicuspid aortic valve
What is the main presentation of aortic dissection?
Sudden onset, severe, “ripping” or “tearing” chest pain
Where is the pain usually felt with a type B aortic dissection?
Upper back
Where is the pain usually felt with a type A aortic dissection?
In the chest
What are the other possible symptoms of aortic dissection?
Pulse deficit
Aortic regurgitation
Hypertension
Diastolic murmur
What is a pulse deficit?
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)
What is the main method of diagnosis of an aortic dissecton?
CT angiogram of chest, abdomen and pelvis
What finding on a CT angiogram would suggest an aortic dissection?
False lumen
What other investigations could you do for the diagnosis of an aortic dissection?
X-ray Transoesophageal echocardiography (TOE)
What might you find on an x-ray of someone with aortic dissection?
Widened mediastinum
When might you carry out a Transoesophageal echocardiography (TOE)?
In unstable patients who are too risky to take to CT scanner
What is the management of Type A aortic dissection?
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
What needs to be controlled while waiting for surgery for Type a aortic dissection?
Blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
What is the management of type B aortic dissection?
Conservative management
bed rest
reduce blood pressure
What medication would you give to reduce progression of type b aortic dissection?
IV labetalol to prevent progression
What surgical management can be used for type b aortic dissection? (more likely to be used in the future but not so much now)
Thoracic endovascular aortic repair (TEVAR)
What are possible complications of type A aortic dissection?
unequal arm pulses and BP
stroke
renal failure
What are possible complications of type b aortic dissection?
aortic incompetence/regurgitation
MI: inferior pattern is often seen due to right coronary involvement
