Aortic dissection

Question 1

Where is the most common site of initial tear in aortic dissection? Which layer does the rupture occur?

Answer 1

ascending aorta

tunica intima

Question 2

List three risk factors for aortic dissection

Answer 2

male
50-70
HTN
connective tissue disorders
congenital disorders: bicuspid aortic valve or coarctation of the aorta
pre-existing athersclerotic disease

Question 3

What is the main presenting symptom of aortic dissection?

Answer 3

severe sudden onset chest or interscapular back pain- sharp, ripping, tearing pain. Often non specific symptoms and the pain can settle

Question 4

List two clinical signs on exam of aortic dissection

Answer 4

tachycardia
difference in blood pressure between limbs
HTN
Diastolic murmur

Question 5

Three differential diagnoses for aortic dissection?

Answer 5

ACS
Pericarditis
PE
MSK pain
Oesophageal tear
Cardiac tamponade
Spontaneous pneumothorax

Question 6

Which imaging is first line to confirm aortic dissection?

Answer 6

CT angio of whole aorta

Question 7

Name two findings on CT angio in aortic dissection

Answer 7

1. Double lumen (true and false lumens) thus confirming the diagnosis of AAD
2. The entry tear (where the dissection begins)
3. Any evidence of aortic dilatation (aneurysmal change)
4. Evidence of end-organ malperfusion (for example non-enhancing kidney)
5. Features of acute rupture (including extravasation of contrast or haemothorax)

Question 8

Which classification system is there for aortic dissection?

Answer 8

Stanford classification

Question 9

How is the Stanford classification divided?

Answer 9

Type A: dissection involves the ascending aorta with or without involvement of the arch and descending aorta. Accounts for 60-70% of cases.
Type B (TBAD): Involves only the descending aorta (distal to the left subclavian artery) and/or abdominal aorta. Accounts for 30-40% of cases

Question 10

Which type of aortic dissection has a higher mortality rate?

Answer 10

type A

Question 11

Which type can be managed medically and which requires surgery?

Answer 11

Type B medically

Type A surgically

Question 12

Describe three complications of aortic dissection

Answer 12

aortic rupture
MI
cardiac tamponade
acute aortic regurg
Renal failure
Bowel ischaemia
Acute limb ischaemia