Aortic Dissection

Question 1

what is aortic dissection?

Answer 1

blood enters between the intima and media layers of the aorta

Question 2

which area does aortic dissection commonly affect?

Answer 2

ascending and arch

Question 3

stanford system?

Answer 3

type A: ascending aorta, before brachiocephalic artery
type B: affects descending aorta after the left subclavian artery

Question 4

debakey system?

Answer 4

type 1: begins in ascending aorta, involves at least the arch if not the whole aorta

type2: isolated to ascending aorta

type 3a: begins in descending aorta and involves above diaphragm

type3b: begins in descending aorta and involves aorta below diaphragm

Question 5

Risk factors for aortic dissection?

Answer 5

male, age, smoking, HTN, poor diet, reduced physical activity, raised cholesterol.

HTN can be caused by- heavy weightlifting/ use of cocaine

bicuspid aortic valve, aortic valve replacement, CABG, coarctation of the aorta (narrow)

ehlers-danlos, marfans, turners noonans, pregnancy syphilis

Question 6

presentation of aortic dissection?

Answer 6

sudden onset, severe ripping or tearing chest pain. Anterior chest- ascending aorta
back-descending aorta
difference in bp in both arms >20
radial, caortid, brachial, femoral pulse deficit
diastolic murmur- aortic regurgitation
chest and abdominal pain
collapse
paraplegia, angina, limb ischaemia
hypotension
ST elevation in inferior leads

Question 7

first line investigation for aortic dissection?

Answer 7

CT angiogram- false lumen

Question 8

management of aortic dissection?

Answer 8

analgesia-morphine
blood pressure/heart rate- beta blockers
type A- open surgery replace with synthetic graft, aortic valve may need to be replaced. Target systolic 100-120 for intervention

type B- Thoracic endovascular aortic repair TEVAR, femoral artery inserting a stent graft

Question 9

complications of aortic dissection:

Answer 9

MI
Stroke
paraplegia (motor/sensory impairment in legs)
cardiac tamponade
aortic valve regurgitation
death

Question 10

what will CXR show in aortic dissection?

Answer 10

widened mediastinum

Question 11

when to do a transoesophageal echocardiography?

Answer 11

when unstable patient too risky to take to CT scanner

Question 12

type b dissection management?

Answer 12

bed rest, conservative, reduce bp iv labetalol

Question 13

complications of forward tear?

Answer 13

unequal arm pulses and BP
stroke
renal failure

Question 14

complications of backward tear?

Answer 14

aortic incompetence/regurgitation
MI: inferior pattern is often seen due to right coronary involvement

Question 15

CXR for aortic dissection will show?

Answer 15

Widened mediastinum: > 8.0-8.8 cm at the level of the aortic knob on portable anteroposterior chest films
Double aortic contour
Irregular aortic contour
Inward displacement of atherosclerotic calcification (>1 cm from the aortic margin)

Depending on the aetiology there may also be signs of peri-aortic or mediastinal haematoma, such as deviation of mediastinal structures, oesophageal or tracheal deviation to the right and inferior displacement of the left main bronchus