Aortic Dissection

Question 1

Pathophysiology of aortic dissection

Answer 1

Tear in the tunica intima of the wall of the aorta

Question 2

Associations with aortic dissection

Answer 2

HTN, trauma, bicuspid aortic valve, collagens such as Marfan’s and Ehlers-Danlos syndrome, Turner’s, Noonan’s, pregnancy, syphilis

Question 3

Symptoms of aortic dissection

Answer 3

Chest and back pain, severe, sharp and tearing in nature. Maximal at onset.

Question 4

Signs of aortic dissection

Answer 4

Weak or absent carotid, brachial or femoral pulse. Variation of >20mmHg in systolic BP between arms. Aortic regurgitation, HTN, features from involvement of specific arteries

Question 5

Stanford classification of aortic dissection

Answer 5

Type A ascending aortic (66% cases)
Tybe B descending aortic, 33% cases)

Question 6

Investigations into stable patient with suspected aortic dissection

Answer 6

Chest XR - widened mediastinum
CT angiography of chest, abdo, pelvis - false lumen seen

Question 7

Investigation more suitable for unstable patients with suspeted aortic dissection

Answer 7

Transoesophageal echocardiohraphy

Question 8

Management of type A aortic dissection

Answer 8

Surgical management but blood pressure should be controlled to a target systolic of 100-120 whilst awaiting intervention

Question 9

Management of aortic dissection

Answer 9

Consevative management, bed rest, reduce BP by IV labetalol to prevent progression

Question 10

Complications of a forward tear

Answer 10

Unequal arm pulses and BP, stroke, renal failure