Aortic Dissection Flashcards
What is an aortic dissection?
A tear in the intimate of the wall of the aorta
What is the most important risk are associated with an aortic dissection?
Hypertension is the most important risk factor, trauma, biscupid aortic valve
What are the syndromes associated with an aortic dissection?
Collagens syndromes such as Marfan’s and Ehlers-Danlos Syndrome
Turner’s and Noonan’s syndrome
What infection is associated with an aortic dissection?
Syphillis
3 main features of aortic dissection
‘Sharp’ or ‘tearing’ pain - chest pain with type A and B back pain
A pulse deficit - weak or absent carotid/brachial/femoral artery or variation in systolic BP between the arms
Aortic regurgitation
What is the systolic variation between the arms if an aortic dissection is suspected?
20mmHg
In minority of patient ST elevation are seen in which leads?
Inferior leads, the majority have no or non-specific ECG changes
What is the Stanford classification of aortic dissections?
type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases
Describe DeBakey Classification of an aortic dissection
type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
type II - originates in and is confined to the ascending aorta
type III - originates in descending aorta, rarely extends proximally but will extend distally
What investigation would you do if you think someone has an aortic dissection?
It’s important to remember that patients may present acutely and be clinically unstable. The choice of investigations will have to take account of this.
Mainly a CT angiogram - false lumen is found however a Tranoesophageal echocardiography (TOE) is more suitable for unstable patients
If you did a X-ray in a patient with an aortic dissection what would you see?
Widened mediastinum
What would may an ECG show if someone has an aortic dissection?
May show ischaemia in specific territories if dissection extends into coronary arteries.
What would may an echocardiogram show if someone has an aortic dissection?
May demonstrate pericardial effusion and aortic valve involvement.
What would blood tests show if someone has an aortic dissection?
Troponin may be raised
D-dimer may be positive
What would blood tests show if someone has an aortic dissection?
Troponin may be raised
D-dimer may be positive
How would you manage Type A and B aortic dissection?
Type A
surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
Type B*
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression
If there is evidence of end organ damage then endovascular/open repair may be performed.
What are the complications of aortic dissection?
Death due to internal haemorrhage
Rupture
End organ damage (renal or cardiac failure)
Cardiac tamponade
Stroke
Limb ischaemia
Mesenteric ischaemia
What are the complication of a backward tear?
aortic incompetence/regurgitation
MI: inferior pattern is often seen due to right coronary involvement
What are the complication of a forward tear?
unequal arm pulses and BP
stroke
renal failure
