Aortic Dissection

Question 1

What is an aortic dissection

Answer 1

A break or tear in the inner layer of the aorta

Question 2

What are the layers of the aorta

Answer 2

Intima
Media
Adventitia

Blood collects between the intima and the media

Question 3

What are the standford classification

Answer 3

Type A - ascending aorta involved (2/3rds)
Type B - Descending Aorta involved (1/3rd)

Question 4

What are the risk factors?

Answer 4

Male
Increasing age
smoking
diet
HTN
Marfans
Ehlers Danlos
Cocaine
Increased BP - weight lifting
Conditions and surgeries affecting the aorta

Question 5

What are the symptoms?

Answer 5

Sudden onset pain
severe rupturing chest pain
Anterior chest pain - ascending rupture
Back pain - descending rupture

Question 6

What are the signs?

Answer 6

HTN
difference in arm blood pressures >20mmHg
Radial pulse deficit in one arm
diastolic murmur
chest + abdo pain together
Focal neurological deficit (numbers or parasthesia)
syncope
Hypotension - LATE sign

Question 7

What might be fatal

Answer 7

Treatment for an MI - increasing blood flow and reducing clotting (fibrinolysis)

Question 8

What are the tests:

Answer 8

Rapid tests:
Chest x-ray - widened mediastinum
ECG - ecg and chest x ray might be normal
bedside ultrasound

Gold standard:
CT angiogram - shows false lumen

MRI Angiogram - gives more detail (usually not enough time)

Question 9

Which test is done for unstable patients?

Answer 9

Transoesophageal echocardiography (TOE)

Question 10

What is the management?

Answer 10

Type A:
surgical management
BP control target: systolic 100-120 mmHg using IV labetelol whilst awaiting intervention

Type B:
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression
Can later consider a TEVAR (catheter through femoral artery and give a stent graft)

Question 11

What are the complications

Answer 11

MI
stroke
paraplegia
cardiac tamponade
aortic regurgitation
death