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Year One - Cardiovascular System > Aortic Dissection > Flashcards

Aortic Dissection Flashcards

1
Q

What is aortic dissection?

A

It is defined as a condition in which there is a tear within the intimal layer of the aortic wall, allowing blood to pass between the intima and media – creating a false lumen

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2
Q

Which section of the aorta tends to be affected by aortic dissection?

A

Ascending Aorta

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3
Q

What is the pathophysiological consequence of aortic dissection?

A

The false lumen can propagate longitudinally along the aorta either anterograde, towards the iliac arteries, or retrograde, towards the aortic valve

This can cause branch occlusion and ischaemia of the affected arterial territory – leading to end-organ malperfusion

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4
Q

What are the two classification systems used in aortic dissection?

A

Stanford Classification System

DeBakey Classification System

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5
Q

What are the two classifications of aortic dissection using the Stanford Classification System?

A

Type A Aortic Dissection

Type B Aortic Dissection

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6
Q

What is type A aortic dissection?

A

It is defined as dissection involving of the ascending aorta, with or without involvement of the arch and descending aorta

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7
Q

What is type B aortic dissection?

A

It is defined as dissection involving of the descending aorta, distal to the left subclavian artery, and/or the abdominal aorta

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8
Q

What is more common - type A aortic dissection or type B aortic dissection?

A

Type A

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9
Q

What are the three classifications of aortic dissection using the DeBakey Classification System?

A

Type I Aortic Dissection

Type II Aortic Dissection

Type III Aortic Dissection

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10
Q

What is type I aortic dissection?

A

It is defined as dissection originating in the ascending aorta, which propagates to the aortic arch and variable amounts of the descending aorta

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11
Q

What is type II aortic dissection?

A

It is defined as dissection that originates and is confined to the ascending aorta

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12
Q

What is type III aortic dissection?

A

It is defined as dissection originating in the descending aorta, distal to the left subclavian artery

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13
Q

What are the seven risk factors of aortic dissection?

A

Male Gender

Middle Aged, 50 – 70 Years Old

Hypertension

Atherosclerotic Disease

Connective Tissue Disorders

Bicuspid Aortic Valve

Coarctation of The Aorta

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14
Q

What is the most common risk factor of aortic dissection?

A

Hypertension

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15
Q

Which two connective tissue disorders are associated with aortic dissection?

A

Ehler’s Danos syndrome

Marfan’s syndrome

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16
Q

What two genetic conditions commonly cause congenital heart defects - such as biscupid aortic valve and coarctation of the aorta?

A

Turner’s syndrome

Noonan’s syndrome

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17
Q

What are the seven clinical features of aortic dissection?

A

Severe Sudden Chest Pain

Interscapular Back Pain

Asymmetrical Blood Pressures

Absent Peripheral Pulses

Hypertension

Tachycardia

Aortic Regurgitation Murmur

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18
Q

Describe the two features of chest pain associated with aortic dissection

A

It is described as sharp, ripping and tearing in nature

It settles spontaneously

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19
Q

What asymmetrical blood pressure readings are considered significant?

A

> 20mmHg blood pressure difference between limbs

20
Q

What are the six murmur features of aortic regurgitation?

A

Early-Diastolic, High Pitched, Blowing Murmur

Collapsing Pulse

Wide Pulse Pressure

Quincke’s Sign

De Musset’s Sign

Austin Flint Murmur

21
Q

Which two clinical features indicate type A aortic dissection?

A

Weak pulses

Aortic regurgitation

22
Q

What are the five investigations used to diagnose aortic dissection?

A

Blood Tests

ECG Scan

Chest X-Ray (CXR)

CT Angiogram of Chest, Abdomen & Pelvis (CTA-CAP)

Transoesophageal Echocardiography (TOE)

23
Q

What three blood test results indicate aortic dissection?

A

Increased Lactate Levels

Increased Troponin Levels

Positive D-Dimer Result

24
Q

What is the feature of aortic dissection on ECG scans?

A

Myocardial Ischaemia

This includes ST elevation in the inferior leads, new left bundle branch block, T wave inversion and Q waves

25
Q

What are the five features of aortic dissection on CXR?

A

Widened Mediastinum > 8cm

Double/Irregular Aortic Contour

Inward Displacement of Atherosclerotic Calcification

Pleural Effusion

Haemothorax

26
Q

What is the main feature of aortic dissection on CXR?

A

Widened Mediastinum > 8cm

27
Q

What two CXR features indicate that aortic dissection rupture?

A

Pleural Effusion

Haemothorax

28
Q

What is the gold standard investigation used to diagnose aortic dissection?

A

CT angiogram of the chest, abdomen & pelvis (CTA-CAP)

29
Q

When is CT angiogram recommended to investigate aortic dissection?

A

Stable patients

30
Q

How are CT angiograms used to investigate aortic dissection?

A

They are used to confirm diagnosis, classify disease and plan appropriate management

31
Q

What are the five features of aortic dissection on CT angiogram?

A

False Lumen

Entry Tear

Aortic Dilatation

End-Organ Malperfusion Features

Acute Aortic Rupture Features

32
Q

When is TOE recommended to investigate aortic dissection?

A

Unstable patients, in which CT angiograms scans are contraindicated

33
Q

What are the six immediate management options of aortic dissection?

A

High Flow Oxygen

Two Wide-Bore IV Cannulas

IV Opiate Analgesia

Arterial Line Insertion

Central Venous Catheter Insertion

Urinary Catheter Insertion

34
Q

How do we pharmacologically manage aortic dissection?

A

It involves the administration of cardiovascular agents that rapidly lower systolic blood pressure (100-120mmHg) and heart rate (60 -80bpm) levels

This is used to minimise the stress of the aortic dissection and limit further propagation

35
Q

What are the three pharmacological management options of aortic dissection?

A

Beta-Blockers

Calcium Channel Blockers

Vasodilators

36
Q

What is the first line pharmacological management option used in aortic dissection?

A

Beta-blockers

37
Q

Name a beta blocker used to manage aortic dissection

A

IV labetalol

38
Q

What is the second line pharmacological management option used in aortic dissection?

A

Calcium channel blockers

39
Q

Name a calcium channel blocker used to manage aortic dissection

A

IV nicardipine

40
Q

When are vasodilators used to manage aortic dissection?

A

They are used to control refractory hypertension

41
Q

Name a vasodilator used to manage aortic dissection

A

IV sodium nitroprusside

42
Q

What is the surgical management option of aortic dissection?

A

Open repair surgery

43
Q

What is open repair surgery of aortic dissection?

A

It involves removal of the ascending aorta, with or without the aortic arch, and replacement with a synthetic graft

44
Q

How do we manage type A aortic dissection?

A

Surgical management

However, whilst awaiting pharmacological management of blood pressure and heart rate is required

45
Q

How do we manage type B aortic dissection?

A

Pharmacological management is usually all that is required

In complicated type B aortic dissections, in which aortic rupture develops, surgical management is considered

46
Q

What are the seven complications of aortic dissection?

A

Aortic Regurgitation

Myocardial Ischaemia

Cardiac Tamponade

Ischaemic Stroke

Acute Limb Ischaemia

Renal Failure

Bowel Ischaemia

Year One - Cardiovascular System (20 decks)

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