Aortic dissection

Question 1

An aortic dissection involves a tear in the ____ resulting in blood dissecting through the ____, separating layers apart

Answer 1

intima
media

Question 2

An aortic dissection is a s____ e______

Answer 2

surgical emergency

Question 3

What group are most likely to have an aortic dissection?

Answer 3

Men 50-70

Question 4

What are risk factors of aortic dissection?

Answer 4

Hypertension
Connective tissue disorders
Family history of AAA or AD
Trauma
Smoking

Question 5

What is the most common location for an aortic dissection?

Answer 5

Sinotubular junction (where aortic root becomes “tubular” aorta, near aortic valve)

Question 6

Other than the sinotubular junction, where is a common site for an aortic dissection to occur?

Answer 6

Just distal to the left subclavian artery (in descending thoracic aorta)

Question 7

What is used to categorise aortic dissections based on location?

Answer 7

Stanford Classification

A = proximal to left subclavian artery (ascending and arch)

B = distal to left subclavian artery (descending thoracic)

Question 8

In an aortic dissection, blood dissects media and intima and pools in the f___ l____which can propagate forwards or backwards.

Answer 8

false lumen

Question 9

An aortic dissection means _____ perfusion to end organs leading to organ failure and s___

Answer 9

decreased
shock

Question 10

What are symptoms of an aortic dissection?

Answer 10

Sudden onset ripping/tearing chest pain
Shock/ hypotension
New aortic insufficiency murmur (aortic regurgitation)
Neurology deficit (affecting carotid perfusion)
Decreased left arm peripheral pulse
Cardiac tamponade
Radio-radial differences (each arm pulse different time)

Question 11

What is a differential diagnosis to aortic dissection with sudden onset ripping chest pain?

Answer 11

MI
Would have central crushing with gradual worsening intensity

Question 12

How is an aortic dissection diagnosed?

Answer 12

Gold standard = TOE (transoesophageal echocardiogram), then classify as A or B
or
CT angiogram (if haemodynamically stable)

If Chest XR shows widened mediastinum of greater than 8cm be suspicious

Question 13

What would imaging of an aortic dissection show?

Answer 13

Intimal flap
False lumen
Rupture/leak

Question 14

what are surgical options for aortic dissection?

Answer 14

Open repair (typically A: proximal to left subclavian artery)

EVAR (typically B: distal to left subclavian artery)

Question 15

If patient with aortic dissection is hypotensive, what should be considered?

Answer 15

IV fluid
Blood transfusion
Adrenaline

Question 16

What are the options for medical prevention of an aortic dissection?

Answer 16

1) Special beta-blocker: Esmolol or labetolol

2) Vasodilator: sodium nitroprusside

Question 17

What is the purpose of Esmolol as medical prevention of aortic dissection?

Answer 17

Beta blocker and partial alpha-blocker
Lowers blood pressure and prevents tachycardia

Question 18

What is the target systolic blood pressure for aortic dissection prevention?

Answer 18

100-120
(with heart rate around 60 bpm)

Question 19

What are some complications of an aortic dissection?

Answer 19

Cardiac tamponade
Aortic insufficiency (regurgitation)
Pre-renal AKI
Stroke