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Z Year3 Cardio Conditions > Aortic Dissection > Flashcards

Aortic Dissection Flashcards

1
Q

What features may a patient with aortic dissection have?

A
  1. Features of Marfan syndrome

2. Features of Ehlers-Danlos syndrome

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2
Q

What is a Type A aortic dissection?

A
  • 70%

- Ascending aorta

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3
Q

What is a Type B aortic dissection?

A
  • 30%

- Descending aorta

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4
Q

How is a type A aortic dissection managed?

A

need surgery

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5
Q

What is a type 1 aortic dissection?

A

ascending and descending aorta

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6
Q

What is a type II aortic dissection?

A

ascending aorta only

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7
Q

What is a type IIIa aortic dissection?

A

descending aorta only (above diaphragm)

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8
Q

What is a type IIIb aortic dissection?

A

descending aorta only (above and blow the diaphragm)

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9
Q

What are RF for aortic dissection?

A
  1. Hypertension
  2. Cholesterol
  3. Smoking
  4. Crack cocaine
  5. Coarcation of aorta (congenital)
  6. Male
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10
Q

How does an aortic dissection differ from AAA?

A

Above where a AAA happens

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11
Q

What is the patho of aortic dissection?

A

where a tear in aortic intima flows blood to flow into a new false channel in between the inner and outer layers of the tunica media

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12
Q

What is the key symptoms for aortic dissection?

A

acute severe chest pain – radiating to back tearing

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13
Q

What are the other symptoms specific to?

A

by blockages to braches of aorta

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14
Q

What are the symptoms of aortic dissection if the carotid artery is blocked?

A
  • blackout

- dysphasia

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15
Q

What are the symptoms of aortic dissection if the coronary artery is blocked?

A

angina

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16
Q

What are the symptoms of aortic dissection if the subclavian artery is blocked?

A

LOC (subclavian steal syndrome)

17
Q

What are the symptoms of aortic dissection if the renal artery is blocked?

A

anuria, renal failure

18
Q

What are the signs of aortic dissection?

A
  1. Hypertension
  2. Left/right blood pressure differential (>50%)
  3. Diastolic murmur-indicating aortic incompetence (aortic regurg)
  4. Murmur on back – left scapula
  5. Signs of connective tissue disease
19
Q

What murmur is usually heard in aortic dissection?

A

aortic regurgitation

20
Q

What are DDx for aortic dissection?

A
  1. ACS
  2. Pericarditis
  3. Aortic aneurysm
  4. MSK pain
  5. PE
  6. Mediastinal tumour
21
Q

What are possible complications of aortic dissection?

A
  1. Cardiac tamponade
  2. Aortic incompetence
  3. MI
  4. Aneurysmal degeneration/rupture
  5. Regional ischaemia
  6. Left arm ischaemia/subclavian steal syndrome
  7. Endoleak
22
Q

What is the gold standard Ix for aortic dissection?

A

CT angiogram

23
Q

What other imaging Ix are done for aortic dissection?

A
  1. ECG
  2. ECHO
  3. CXR
  4. CT
24
Q

What would ECG show?

A

ST segment depression can occur – check signs of infraction – downstream effect of AD

25
Q

What would echo show?

A
  • intimal flap in acute or chronic dissection

- two lumen can be seen in chronic dissection

26
Q

What would CXR show?

A
  • widened mediastinum
  • loss of aortic knuckle
  • globular heart
27
Q

What bloods are done and what would they show?

A
  1. Troponin: negative
  2. Renal function tests: elevated creatinine + urea
  3. LFTs: elevated AST and ALT
  4. Lactate
  5. FBC: reduced or normal rbc and anaemia in haemorrhage
  6. CRP: can be elevated
  7. Creatine kinase: elevated
  8. Procalcitonin: raised in infection
28
Q

What other Ix are done?

A
  • Group and save: for surgery

- Blood gas: metabolic acidosis

29
Q

How do you manage a haemodynamically unstable suspected aortic dissection?

A

Advanced life support with haemodynamic support + opiod analgesia

30
Q

How do you treat an acute TYPE A + B aortic dissection?

A
  1. Beta-blocker or non-dihydropyridine CCB
  2. opiod analgesia and vasodilator
  3. open surgery or endovascular repair
31
Q

How do you manage ongoing chronic aortic dissection?

A

Beta blocker + lifestyle advice + risk factor management and additional antihypertensive therapy

32
Q

What is the prognosis of aortic dissection?

A

Left untreated, the natural history of proximal acute aortic dissection is of false channel rupture with fatal exsanguination in 50% to 60% of patients within 24 hours

33
Q

What is the 5 year survival after thoracic endovascular aortic repair (TEVAR)?

A

for acute type B aortic dissection is 81%

Z Year3 Cardio Conditions (22 decks)

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