Aortic Dissection Flashcards
What is aortic dissection
False lumen in between the intima and media as a result of a tear in the intimal layer of the aorta
What are the risk factors of aortic dissection
MALE>50 HTN Marfan's Valvular disease Cocaine Smoking AAA
What are the two Stanford classes of Aortic Dissection
Stanford A - Ascending aorta (Left subclavian Prox.)
Stanford B - Descending aorta (Left subclavian distal)
What is the presentation of Aortic Dissection
Sudden Tearing chest pain radiating to the back
Hypotension
Shock and Syncope
Aortic regurgitation
What are the clinical signs of aortic dissection
Radio-radial delay
Radio-Femoral delay
BP different between arms
Cardiac tamponade
What are the investigations for Aortic Dissection
1st = Chest XRay = wide mediastinum
GS = TOE (Specific and sensitive than TTE) to classify A/B and show false lumen
CT Angiogram = used if haemodynamically stable
Where does the blood in the false lumen go
Back to heart = cardiac tamponade
Mediastinum = death
Back in to true lumen
How would you manage Type A aortic dissection
Maintain haemodynamic stability with fluids Opiods for pain Aortic Graft (surgery)
How would you manage Type B aortic dissection
Blood pressure control
EVAR
What are some complications of aortic dissection
Internal haemmorhage rupture End organ damage Cardiac tamponade ischemia stroke
What is the pathology of aortic dissection
Media and Lumina dissected and blood pools in the false lumen
Blood moves anterograde/retrograde
Reduces end organ perfusion = shock and fail
What is the pharmacological management of aortic dissection
Hypotension? IV Fluid/ Transfusion/ Adrenaline
Esmolol/Labeteol (Lowers BP and prevents reflex tachycardia)
Sodium nitroprusside (Vasodiation)
What are the complications of Aortic dissection
Cardiac Tamponade
Aortic regurgitation
Pre renal AKI
