Aortic Dissection

Question 1

What is an aortic dissection?

Answer 1

Aortic dissection refers to when a break or tear forms in the inner layer of the aorta, allowing blood to flow between the layers of the wall of the aorta. Blood enters between the intima and media layers of the aorta and a false lumen full of blood is formed within the wall of the aorta.

Question 2

Where does an aortic dissection most commonly occur?

Answer 2

The ascending aorta and the aortic arch

Question 3

1) In the Stanford system, what is a type A aortic dissection?
2) In the Stanford system, what is a type B aortic dissection?
3) Which type - type A or B - is the most common

Answer 3

1) Dissection that affects the ascending aorta before the brachiocephalic artery
2) Dissection that affects the descending aorta after the left subclavian artery
3) Type A

Question 4

1) In the DeBakey system, what is a type I aortic dissection?
2) In the DeBakey system, what is a type II aortic dissection?
3) In the DeBakey system, what is a type IIIa aortic dissection?
4) In the DeBakey system, what is a type IIIb aortic dissection?

Answer 4

1) Dissection that begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
2) Dissection that is isolated to the ascending aorta
3) Dissection that begins in the descending aorta and involves only the section above the diaphragm
4) Dissection that begins in the descending aorta and involves only the section below the diaphragm

Question 5

1) Name 3 risk factors for an aortic dissection
2) Name 2 conditions that increases the risk for an aortic dissection
3) Name a connective tissue condition that increases the risk for an aortic dissection

Answer 5

1) Hypertension, age, male, smoking, poor diet, lack of activity
2) Bicuspid aortic valve, coronary artery bypass graft, coarctation of the aorta, aortic valve replacement
3) Ehler-Danlos syndrome, Marfan syndrome

Question 6

1) What is the typical presentation of an aortic dissection?
2) Name 2 other features of presentation that may be associated with an aortic dissection

Answer 6

1) Ripping or tearing chest pain
2) Hypertension, radio-radial delay, differences in blood pressure between both arms, diastolic murmur, syncope, focal neural deficit, syncope, hypotension as the dissection progresses

Question 7

1) What 2 investigations are usually used to exclude other diagnoses?
2) What investigation is usually used to diagnose an aortic dissection?
3) What investigation is usually more suitable for unstable patients?

Answer 7

1) Chest x-ray and ECG
2) CT angiogram
3) Transoesophageal echocardiography

Question 8

1) How is a type A aortic dissection managed?
2) How is a type B aortic dissection managed?

Answer 8

1) IV labetalol (BP control) and surgery
2) IV labetalol

Question 9

Name 3 complications of an aortic dissection

Answer 9

• MI
• Cardiac tamponade
• Aortic valve regurgitation
• Stroke
• Paraplegia
• Coma
• Death

Question 10

What may be seen on a CXR of a patient with an aortic dissection?

Answer 10

• Widened mediastinum
• Irregular aortic contour

Question 11

In a CT angiography, what is the key diagnostic feature of an aortic dissection?

Answer 11

False lumen