Aortic dissection Flashcards
Definition (& 2 types)
Tears or leakage within the inner layer (intima) of the thoracic aorta
Type A. This more common and dangerous type involves a tear in the part of the aorta where it exits the heart. The tear may also occur in the upper aorta (ascending aorta), which may extend into the abdomen.
Type B. This type involves a tear in the lower aorta only (descending aorta), which may also extend into the abdomen.
Aetiology/ causes
Can be predisposed by Marfan’s syndrome, giant cell arteritis, turner syndrome and trauma
Risk factors
Hypertension
Atherosclerosis
An aortic valve defect (bicuspid aortic valve)
A narrowing of the aorta at birth (aortic coarctation)
Weakened and bulging artery (aortic aneurysm)
Epidemiology/ Population affected
More common in males
Most common between 60 and 70 years old
Clinical presentation
Abrupt very severe tearing chest pain, often in the mid-scapular area
Sudden severe stomach pain
Shortness of breath
Loss of consciousness
Leg pain/ difficulty walking/ sudden vision or speaking issues
Prognosis
Can be extremely dangerous or life threatening if left untreated
An aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or medications, depending on the area of the aorta involved.
Dissections affecting the ascending aorta or aortic arch usually entail an immediate risk of death because they may compromise important anatomical structures in the area (coronary arteries, carotid arteries, aortic valve)
Dissections located in the descending thoracic aorta (beyond the left subclavian artery), on the other hand, tend to have a better prognosis with a considerably lower risk of life-threatening complications, but their correct treatment still requires intensive medical management.
DDX
Myocardial infarction
Aortic aneurysm
Cardiac tamponade (from another cause)
Oesophageal rupture (Boerhaave syndrome),
Spontaneous pneumothorax
Pulmonary embolism
Stroke / transient ischaemic attack (TIA)
