Aortic dissection Flashcards
What is aortic dissection?
A break or tear in the inner lining of the aorta, allowing blood to flow between the layers of the wall of the aorta
What layers of the aorta does blood flow between in aortic dissection?
Between the intima and media layers of the aorta
What is the stanford system of classification for aortic dissection?
Type A - affects the ascending aorta, before the brachiocephalic artery
Type B - affects the descending aorta, after the left subclavian artery
What is the DeBakey system of classification for aortic dissection?
Type I - begins in the ascending aorta, and involved at the least the aortic arch
Type II - isolated to the ascending aorta
Type IIIa - begins in the descending aorta, and involves only the section above the diaphragm
Type IIIb - begins in the descending aorta, and involves the aorta below the diaphragm
What are the risk factors for aortic dissection?
Biscuspid aortic valve
Coarctation of the aorta
Aortic valve replacement
Coronary bypass graft
Ehlers-Danlos syndrome
Marfan’s syndrome
HTN
What is the presentation of aortic dissection?
Ripping or tearing chest pain
Syncope
Radio-radial or radio-femoral delay
Difference in blood pressure between two arma
Hypertension
What investigations are performed in suspected aortic dissection?
ECG
FBC
U&Es
Group and save, and crossmatch
CXR
What is the gold standard investigation for diagnosis of aortic dissection?
Contrast-enhanced CT angiogram
What is the management of aortic dissection?
IV labetalol if BP is 100-120 (high pressures are associated with extension of the dissection)
Urgent surgical repair
- Open surgery with replacement of ascending aorta for type A
- Thoracic endovascular aortic repair for type B
What are the complications of aortic dissection?
MI
Stroke
Paraplegia
Cardiac tamponade
Aortic valve regurgitation
Death
