Aortic dissection

Question 1

What is acute dissection

Answer 1

Tear in aortic intima -> false lymen fills with blood
Tear progresses -> branch vessel occlusion -> acute ischaemia or infaction
intramural haematoma

Question 2

Where do you get pain in aortic dissection

Answer 2

Aortic dissection pain = from front to back of chest (asc aorta = sternum, descending = thoracic spin)

Question 3

What is a type A aortic dissection

Answer 3

Ascending aorta

Question 4

What is type B aortic dissection

Answer 4

Descending aorta
Distal to L subclavian artery

Question 5

Causes of aortic dissection

Answer 5

70% HPTN or atherosclerosis
30% inherited componenet

Connective tissue disease
Cocaine
HPTN
Iatrogenic - cardiac catheterisation, surgery, intra-aortic pumo
Pregnancy
Structural defects - bicuspid aortic valve, coarctation, annuloaortic extasia
Syhilis
Trauma
Vasculitis - GCA, takayasi
ADPKD, osteogenesis imperfecta, homocystinuria, familial hypercholestrol, turners syndrome

Question 6

Symptoms of aortic dissection

Answer 6

Chest or back pain
- Sudden onset
- Radiates to
neck/jaw/abdomen
Malperfusion -> neuro, periph circulation, MI, bowel ischaemia
Often no systemic features

Question 7

Initial treatment for aortic dissection

Answer 7

ABC
BP control - <120/60
Beta blockers
Opiate analgesia - paina nd BP control

Question 8

Treatment for type A vs B aortic dissection

Answer 8

Immediate open surgical repair type A
Type B - uncomplicated medical
Complicated = TEVAR over open surgery
10-25% mortality from surgery in both

Question 9

What makes a type B dissection complicated

Answer 9

Aortic rupture or impending
Rapid expansion
Malperfusion
Ongoing pain
Refractory HPTN

Question 10

Features of aortic rupture

Answer 10

Hypotension
Haemathorax
Cardiac tamponade
Mediastinal haematoma
Retroperitoneal haemorrage

Question 11

Medical management for type B

Answer 11

BP control
Analgesia

Question 12

CT monitoring Type B aortic dissection

Answer 12

Medical treatment - CT 2-3 days, 1 week, 1 month, then 6 months and 1 year
TEVAR - CT after 4 weeks

Question 13

Complications of aortic dissection

Answer 13

Acute aortic regurgitation
MI
Dilatation of aneurysm
Ischaemic stroke/paraplegia
Acute limb ischaemia
Bowel ischaemia
Renal failure