Aortic Dissection Flashcards
What features may a patient with aortic dissection have?
- Features of Marfan syndrome
2. Features of Ehlers-Danlos syndrome
What is a Type A aortic dissection?
- 70%
- Ascending aorta
What is a Type B aortic dissection?
- 30%
- Descending aorta
How is a type A aortic dissection managed?
need surgery
What is a type 1 aortic dissection?
ascending and descending aorta
What is a type II aortic dissection?
ascending aorta only
What is a type IIIa aortic dissection?
descending aorta only (above diaphragm)
What is a type IIIb aortic dissection?
descending aorta only (above and blow the diaphragm)
What are RF for aortic dissection?
- Hypertension
- Cholesterol
- Smoking
- Crack cocaine
- Coarcation of aorta (congenital)
- Male
How does an aortic dissection differ from AAA?
Above where a AAA happens
What is the patho of aortic dissection?
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
What is the key symptoms for aortic dissection?
acute severe chest pain – radiating to back tearing
What are the other symptoms specific to?
by blockages to braches of aorta
What are the symptoms of aortic dissection if the carotid artery is blocked?
- blackout
- dysphasia
What are the symptoms of aortic dissection if the coronary artery is blocked?
angina
What are the symptoms of aortic dissection if the subclavian artery is blocked?
LOC (subclavian steal syndrome)
What are the symptoms of aortic dissection if the renal artery is blocked?
anuria, renal failure
What are the signs of aortic dissection?
- Hypertension
- Left/right blood pressure differential (>50%)
- Diastolic murmur-indicating aortic incompetence (aortic regurg)
- Murmur on back – left scapula
- Signs of connective tissue disease
What murmur is usually heard in aortic dissection?
aortic regurgitation
What are DDx for aortic dissection?
- ACS
- Pericarditis
- Aortic aneurysm
- MSK pain
- PE
- Mediastinal tumour
What are possible complications of aortic dissection?
- Cardiac tamponade
- Aortic incompetence
- MI
- Aneurysmal degeneration/rupture
- Regional ischaemia
- Left arm ischaemia/subclavian steal syndrome
- Endoleak
What is the gold standard Ix for aortic dissection?
CT angiogram
What other imaging Ix are done for aortic dissection?
- ECG
- ECHO
- CXR
- CT
What would ECG show?
ST segment depression can occur – check signs of infraction – downstream effect of AD
What would echo show?
- intimal flap in acute or chronic dissection
- two lumen can be seen in chronic dissection
What would CXR show?
- widened mediastinum
- loss of aortic knuckle
- globular heart
What bloods are done and what would they show?
- Troponin: negative
- Renal function tests: elevated creatinine + urea
- LFTs: elevated AST and ALT
- Lactate
- FBC: reduced or normal rbc and anaemia in haemorrhage
- CRP: can be elevated
- Creatine kinase: elevated
- Procalcitonin: raised in infection
What other Ix are done?
- Group and save: for surgery
- Blood gas: metabolic acidosis
How do you manage a haemodynamically unstable suspected aortic dissection?
Advanced life support with haemodynamic support + opiod analgesia
How do you treat an acute TYPE A + B aortic dissection?
- Beta-blocker or non-dihydropyridine CCB
- opiod analgesia and vasodilator
- open surgery or endovascular repair
How do you manage ongoing chronic aortic dissection?
Beta blocker + lifestyle advice + risk factor management and additional antihypertensive therapy
What is the prognosis of aortic dissection?
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
What is the 5 year survival after thoracic endovascular aortic repair (TEVAR)?
for acute type B aortic dissection is 81%
