Aortic Dissection

Question 1

What is it?

Answer 1

Rupture of tunica intima allowing blood to flow between the intima and media

Question 2

What are the causes?

Answer 2

Chronic HTN
Connective tissue diseases e.g. Marfans
Noonans Syndrome
Pregnancy
Syphilis
Congenital bicuspid valve
Trauma

Question 3

What are the symptoms?

Answer 3

Tearing chest pain radiating to back
Absent or decreased peripheral pulses 
HTN
Aortic regurgitation
Symptoms based on other blood vessels affected
-coronary arteries= myocardial ischaemia
-peripheral arteries= limb ischaemia
-spinal arteries= neurological symptoms

Question 4

What is the classification?

Answer 4

Stanford

• Type A= involves ascending aorta
• Type B= does not involve ascending aorta

DeBakey

• I= involves ascending aorta, aortic arch and descending aorta
• II= ascending aorta only
• III= descending aorta only

Question 5

What investigations are needed?

Answer 5

CXR- widened mediastinum

CT angiography- gold standard if patient stable to find dissection

Transoesophageal ECH0- if unstable

Question 6

What is the management?

Answer 6

A-E resus
ITU admission

Type A

• surgery
• SBP control to 100-120

Type B

• conservative management
• IV labetalol to control BP

Question 7

What are complications?

Answer 7

Myocardial Infarction (inferior)
Renal impairment
Cardiac tamponade