Aortic Dissection

Question 1

What is aortic dissection?

Answer 1

A tear in the inner layer of the aorta causing blood to rush through the tear, splitting the layers of the aorta + comprising blood flow

Question 2

Aortic dissection risk factors

Answer 2

Smoking
Hypertension
Cocaine use
Connective tissue disorders
Atherosclerosis
Previous heart or aortic valve surgery
Bicuspid aortic valves
Pregnancy
Blunt trauma

Question 3

Presentation of aortic dissection

Answer 3

• sudden onset tearing/ripping chest pain
• radiation to interscapular area
• dyspnoea
• syncope
• abdominal pain
• radial pulse deficit
• blood pressure difference in arms

Question 4

Investigations of aortic dissection

Answer 4

• ECG + chest X ray to rule out other causes
• CT angiogram initially
• MRI angiogram for more detail

Question 5

Management of aortic dissection

Answer 5

• surgical intervention
• analgesia
• B blockers to reduce HR + BP

Question 6

Complications of aortic dissection

Answer 6

MI
Stroke
Paraplegia
Cardiac tamponade
Aortic regurgitation
Death

Question 7

What are the two classification systems of aortic dissection

Answer 7

The Stanford system
The DeBakey system

Question 8

Stanford system classification of aortic dissection

Answer 8

type A: affects ascending aorta, before brachiocephalic artery
type B: affects the descending aorta, after the left subclavian artery

Question 9

DeBakey system classification of aortic dissection

Answer 9

• type I: begins in ascending aorta + involves at least the aortic arch, if not the whole aorta
• type II: ascending aorta ONLY
• type IIa: in descending aorta which is above the diaphragm only
• type IIb: in descending aorta + involves aorta below diaphragm