Aortic dissection

Question 1

Aortic dissection

Answer 1

Tear in the tunica intima of the wall of the aorta

Question 2

Features of aortic dissection

Answer 2

1. chest pain: typically severe, radiates through to the back and ‘tearing’ in nature
2. pulse deficit
   > weak or absent carotid, brachial, or femoral pulse
   > variation (>20 mmHg) in systolic blood pressure between the arms
3. aortic regurgitation
4. hypertension

Question 3

What is type A aortic dissection?

Answer 3

ascending aorta, 2/3 of cases

Question 4

What is type B aortic dissection?

Answer 4

descending aorta, distal to left subclavian origin, 1/3 of cases

Question 5

Investigations for aortic dissections

Answer 5

Chest x-ray
CT angiography of the chest, abdomen and pelvis 
Transoesophageal echocardiography (TOE)

Question 6

What are the chest x-ray changes in aortic dissection?

Answer 6

widened mediastinum

Question 7

What are the CT angiography of the chest, abdomen and pelvis changes in aortic dissection?

Answer 7

a false lumen is a key finding in diagnosing aortic dissection

Question 8

Management of Type A aortic dissection

Answer 8

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

Question 9

Management of Type B aortic dissection

Answer 9

a. conservative management
b. bed rest
c. reduce blood pressure IV labetalol to prevent progression

Question 10

Complications in aortic dissections

Answer 10

Forward and backwards tears