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#Phase 2.2: Acute Care > Aortic Dissection > Flashcards

Aortic Dissection Flashcards

1
Q

What is Aortic dissection? (2 points)

A
  1. Tear in Tunica Intima layer of Aortic wall
  2. Causing blood to flow between Tunica Intima + Media
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2
Q

What is the difference between Acute + Chronic Aortic dissection?

A
  • Acute: Dx within 14 days
  • Chronic: Dx after 14 days
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3
Q

What are the different classification system of Aortic Dissection? (2 things)

A
  1. Stanford classification
  2. DeBakey classification
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4
Q

What is the Stanford classification of Aortic dissection?

A
  • Type A: affects ascending aorta (before brachiocephalic artery)
  • Type B: affects descending aorta (after left subclavian artery)
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5
Q

Which Stanford Classification Aortic Dissection is more common?

A

Type A (2/3 of cases)

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6
Q

What is the DeBakey classification of Aortic dissection?

A
  • Type 1: Originates in Ascending aorta, involves at least aortic arch (if not whole aorta)
  • Type 2: Confined to Ascending aorta
  • Type 3: Originates in Descending aorta (after Subclavian artery)
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7
Q

Who is Type 1 DeBakey Aortic Dissection usually seen in?

A

Under 65 year olds

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8
Q

Which DeBakey Aortic dissection type has the highest mortality?

A

Type 1

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9
Q

Who is Type 2 DeBakey Aortic dissection usually seen in?

A

Elderly w Atherosclerotic disease + HTN

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10
Q

What are the RF for Aortic Dissection? (5 things)

A
  1. HTN
  2. Atherosclerotic disease
  3. Male
  4. CT disorders (e.g Marfans / Ehler’s Danlos)
  5. Bicuspid aortic valve
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11
Q

What is the general rule about Aortic Dissection RF? (2 things)

A
  1. Younger pts often associated w CT disorders
  2. Older pts often have underlying HTN / atherosclerosis
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12
Q

Why is Aortic Dissection a tricky Dx?

A

Difficult to spot, often missed

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13
Q

What are the CF of Aortic Dissection? (4 things)

A
  1. Chest pain (tearing / ripping) (severe)
  2. Aortic regurg
  3. HTN
  4. CF specific to certain arteries
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14
Q

Where does the Chest pain radiate to in Aortic dissection?

A

Radiates to back

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15
Q

What CF is specific to Aortic dissection in Coronary arteries?

A

Angina

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16
Q

What CF is specific to Aortic dissection in Spinal arteries?

A

Paraplegia

17
Q

What CF is specific to Aortic dissection in Distal aorta?

A

Limb ischaemia

18
Q

What investigations should you quickly do to exclude other causes of Chest pain (aka MI)? (2 things)

19
Q

What is a problem about Dx MI in sus Aortic dissection? (2 points)

A
  1. MI can occur in combination with Aortic dissection
  2. Tx of MI (aka thrombolysis) –> causes fatal progression of Aortic dissection
20
Q

What is the GOLD standard investigation to confirm Dx of Aortic dissection?

A

CT angiogram

21
Q

What investigation can you do after confirming Aortic dissection Dx with CTA?

A

MRI angiogram

22
Q

What is the use of MRI angiogram in Aortic dissection? (2 things)

A
  1. Provides more detail
  2. Helps plan management
23
Q

What are some DDx that present similarly to Aortic Dissection (4 things)

A
  1. MI
  2. PE
  3. Pericarditis
  4. MSK back pain
24
Q

How can you differentiate between MI and Aortic dissection? (3 things)

A

MI will have:
1. “Crushing” chest pain
2. CF of cardiac ischaemia on ECG
3. Raised Troponin

25
Q

How can you differentiate between PE and Aortic dissection? (3 things)

A

PE wil have:
1. Dyspnoea
2. Hypoxia on ABG
3. CTPA / V/Q scan confirms Dx

26
Q

How can you differentiate between Pericarditis and Aortic dissection? (3 things)

A

Pericarditis will have:
1. “Pleuritic” chest pain
2. ST elevation on ECG
3. Pericardial rub @ ausc

27
Q

How can you differentiate between MSK back pain and Aortic dissection? (2 things)

A

MSK back pain will have:
1. Tender to palpation of chest wall / paraspinal muscles
2. NO systemic signs of shock

28
Q

What are the Mx options for Aortic dissection? (3 things)

A
  1. Analgesia (e.g morphine)
  2. Beta blockers (for BP + HR control to reduce stress on aortic walls)
  3. Surgery
29
Q

What does the Surgery for Aortic dissection depend on?

A

Type of aortic dissection

30
Q

What are the Surgical Mx options for Type A Aortic dissection? (3 steps)

A

Open surgery (midline sternotomy)
1. Remove section of aorta w defect
2. Replace section with synthetic graft
3. Potentially replace Aortic valve

31
Q

What are the Surgical Mx options for Type B Aortic dissection? (2 steps)

A

Thoracic EndoVascular Aortic Repair (TEVAR)
1. Insert catheter via femoral artery
2. Insert stent graft into affected section of Descending aorta

32
Q

What will complication cases of Type B Aortic dissection require?

A

Open surgery

33
Q

What are the complications of Aortic dissection? (6 things)

A
  1. MI
  2. Stroke
  3. Paraplegia (motor / sensory impairment in legs)
  4. Cardiac tamponade
  5. Aortic regurg
  6. Death

#Phase 2.2: Acute Care (31 decks)

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