Aortic dissection

Question 1

Aortic dissection pathophysiology

Answer 1

Break/tear forms in inner layer of aorta
Allows blood to flow between intima and media layers
False lumen full of blood within wall
commonly ascending aorta and aortic arch - esp right lateral area of ascending aorta

Question 2

Aortic dissection classification:

Answer 2

Stanford system:
Type A - ascending aorta before brachiocephalic artery
Type B - ascending aorta after L subclavian artery

DeBakey system:
Type I - begins in ascending aorta and involves at least aortic arch
Type II - isolated to ascending aorta
Type IIIa- begins in descending aorta and involves only section above diaphragm
Type IIIb - descending aorta and involves aorta below diaphragm

Question 3

Aortic dissection risk factors

Answer 3

Age
Male sex
Smoking
HTN - can be triggered by increase in HTN (cocaine or weightlifting)
Poor diet
Reduced physical activity
Raised cholesterol
Bicuspid aortic valve
Coarctation of aorta
Aortic valve replacement
CABG
Ehlers-Danlos syndrome
Marfan’s syndrome

Question 4

Aortic dissection presentation

Answer 4

Severe, sudden, ripping/tearing chest pain
Anterior chest if ascending, back if descending
HTN
>20mmHg difference between arms
Radial pulse deficit
Diastolic murmur
focal neurological deficit
Chest and abdominal pain
Collapse
hypotension

Question 5

Aortic dissection diagnosis

Answer 5

CT angiogram = initial
MRI angiogram

Question 6

Aortic dissection managemenet

Answer 6

Surgical emergency
Analgesia
Control BP and HR - beta blockers
Surgical intervention
Type A - open surgery
Type B - thoracic endovascular aortic repair
Do not treat any MI - worsen

Question 7

Aortic dissection complications

Answer 7

MI
Stroke
Paraplegia
Cardiac tamponade
Aortic valve regurgitation
Death