Aortic Dissection

Question 1

How does aortic dissection occur

Answer 1

Occurs when a tear forms in the tunica intima (inner layer of the aorta) allowing blood to flow between the layers of aorta leading to false lumen

Question 2

Aortic dissection occurs when a tear forms in which layer of the aorta

Answer 2

Tunica intima (inner layer of the aorta)

Question 3

Name the three layers of the aorta

Answer 3

Tunica intima (inner layer)

Tunica media

Tunica adventitia

Question 4

What are the two classifications for aortic dissection

Answer 4

Stanford

DeBakey

Question 5

Risk factors for aortic dissection can be subdivded into congenital and acquired risk factors.

Name some of the congential risk factors for aortic dissection

Answer 5

• Connective tissue disorders (Marfan’s syndrome, Ehlers Danlos syndrome, Osteogenesis imperfecta)
• Turner’s syndrome
• Noonan’s syndrome
• Bicuspid aortic valve
• Metabolic disorders

Question 6

Risk factors for aortic dissection can be subdivded into congenital and acquired risk factors.

Name some of the acquired risk factors for aortic dissection

Answer 6

• Hypertension
• Syphilitic aortitis
• Pregnancy
• Trauma
• Iatrogenic (surgical; aortic cannulation, aortic cross-clamp)
• Cocaine use

Question 7

What is the key clinical feature of aortic dissection

Answer 7

Sudden onset ‘tearing’ chest pain or interscapular pain radiating to the back

Question 8

On examination, name three signs of aortic dissection

Answer 8

Radio-radial delay

Radio-femoral delay

BP differential between arms

Question 9

What is the gold standard investigation to diagnose aortic dissection

Answer 9

CT angiogram

Question 10

How is aortic dissection managed

Answer 10

• Surgical emergency – very high mortality
• Analgesia
• BP and HR – to reduce the stress on the aorta. Usually be beta blocker
• Surgical intervention
  
  • Either by removal of the affected section of the aorta and replacing it with synthetic graft or by thoracic endovascular aortic repair (TEVAR)