Aortic dissection Flashcards
What is aortic dissection?
When a break or tear forms in the inner layer of the aorta, allowing blood to flow between the intima and media layers (intramural), forming a false lumen
What is the stanford system classification types?
Type A - affects the ascending aorta, before the brachiocephalic artery
Type B - affects the descending aorta, after the left subclavian artery
What classification types can be used for aortic dissection?
The Stanford system
The DeBakey system
What conditions can increase the risk of aortic dissection?
Conditions affecting the aorta
- Bicuspid aortic valve
- Coarction of the aorta
- Aortic valve replacement
- Coronary artery bypass graft
Connective tissue disorders
- Ehlers-Danlos syndrome
- Marfan’s syndrome
What are some risk factors for aortic dissection?
Old age Male Smoking Obesity Poor diet Inactivity Hypetension Hyperlipidaemia
Events that temporarily dramatically increase BP - e.g. heavy weightlifting
How does aortic dissection present?
Sudden onset, severe ripping / tearing chest pain
Differences in BP between the arms
Radial pulse deficit
Diastolic murmur
Focal neurological deficit - limb weakness or paraesthesia
Syncope
Hypotension
How is aortic dissection diagnosed?
ECG + chest X-RAY - used to rule out other causes such as MI
CT angiogram
MRI angiogram
How is aortic dissection managed?
Analgesia
Control BP and HR to reduce stress on aortic walls - normally beta-blockers
Emergency surgery
- Type A - open surgery to remove the section of the aorta + replace with synthetic graft. Aortic valve may need to be replaced
- Type B - thoracic endovascular aortic repair (TEVAR) - catheter inserted in femoral artery with a stent graft into affected surgery
What are the complications of aortic dissection?
Myocardial infarction Stroke Paraplegia (motor or sensory impairment in the legs) Cardiac tamponade Aortic valve regurgitation Death
