Aortic Dissection

Question 1

What is an aortic dissection?

Answer 1

Refers to when a break/tear forms in the inner layer of the aorta allowing blood to flow between the layers and to form a a false lumen in the wall of the aorta.

Most commonly effects the ascending aorta and aortic arch

Hypertension is a big risk factor

Question 2

Name the 2 types of aortic dissection classifcation systems.

Answer 2

The stanford system:
* Type A- affects the ascending aorta, before brachiocephalic artery
* Type B- Affects the descending aorta, after the left subclavian artery

The DeBakery system:
* Type 1- whole aorta
* Type 2- isolated to the ascending aorta
* Type 3a- begins in decsending aorta and involves scetion above diaphragm
* Type 3b- begins in the descending aorta and involves aorta below the diaphragm

Question 3

A man aged around 60 with a background of hypertension presneting with a sudden onset tearing chest pain=

Answer 3

Aortic dissection

Question 4

Presentation of aortic dissection?

Answer 4

Sudden onset tearing/ripping chest pain can radiate down arms and into neck

Anterior chest wall if anterior aorta affected
Posterior chest wall if descending aorta affected

Other features:
* Hypertension
* Difference in BP between arms >20mmHg
* Radial pulse deficit
* syncope

Question 5

How is aortic dissection diagnosed?

Answer 5

ECG and chest x-ray- exclude MI

CT angiogram- inital investigation to confrim diagnosis

MRI angiogram- provides more detail for management plan

Question 6

Aortic dissection management?

Answer 6

Surgical emergency
Midline sternotomy
Thoracic endovascular repair (TEVAR)

Question 7

A 23-year-old woman presents with localized left-sided chest pain that is exacerbated by coughing and is particularly painful on light pressure to that area. Pain is relieved by aspirin. The ECG is unremarkable. What is the most likely diagnosis?

Answer 7

Idiopathic costochondritis- Tietze’s syndrome
localised tenderness to palpation is important for diagnosis

Question 8

Treatment of type A aortic dissection?

Answer 8

Urgent cardiothoracic surgical advice should be sought

Question 9

Treatment of Type B aortic dissection?

Answer 9

Urgent referal to vascular surgery should be made and admitted for BP control