Aortic Dissection

Question 1

What is the pathophysiology of aortic dissection?

Answer 1

Tear in the tunica inteima of the aortic wall

Question 2

What are the conditions associated with aortic dissection?

Answer 2

Hypertension (most important risk factor)
Trauma,
Bicuspid aortic valve,
Collagen disorders,
Turner’s syndrome and Noonan’s syndrome,
Pregnancy,
Syphilis,

Question 3

What are the features of aortic dissection?

Answer 3

Tearing chest pain which radiated to the baclk. Chest pain more common in Type A. Back pain more common in type B.
- Pulse deficit (weak or absent pulses or variation in systolic BP.
- Aortic regurgitation
- Hypertension
- Features according to artery. If coronary then angina. If spinal arteries then paraplegia. If dorsal aorta then limb ischaemia

Question 4

What is the Stanford classification of aortic dissection?

Answer 4

Type A - Ascending aorta. (2/3rd of cases)
Type B - Descending aorta

Question 5

What are the investigations for aortic dissection?

Answer 5

Chest X ray - Widened mediastinum.
CT angiography - Investigation of choice.
TOE - If too unstable for CT

Question 6

What is the management of a Type A aortic dissection?

Answer 6

Surgical management. Ensure BP is controlled before surgery with systolic of 100-120mmHg

Question 7

What is the management of Type B aortic dissection?

Answer 7

Conservative management: Bed rest and BP control with IV labetalol

Question 7

What are the complications of aortic dissection?

Answer 7

Aortic incompetence/regurgitation
Myocardial infarction
Stroke
Renal failure