Aortic dissection Flashcards
What is aortic dissection?
Aortic dissection is a rare but serious cause of chest pain.
What is the pathophysiology of aortic dissection?
It involves a tear in the tunica intima of the wall of the aorta.
What is the most important risk factor for aortic dissection?
Hypertension.
What are some associations with aortic dissection?
Trauma, bicuspid aortic valve, Marfan’s syndrome, Ehlers-Danlos syndrome, Turner’s syndrome, Noonan’s syndrome, pregnancy, and syphilis.
What are the typical features of aortic dissection?
Chest/back pain, typically severe and ‘sharp’, ‘tearing’ in nature.
How does the pain present in aortic dissection?
Pain is typically maximal at onset.
What is the difference in pain presentation between type A and type B aortic dissection?
Chest pain is more common in type A dissection, while upper back pain is more common in type B dissection.
What are some physical exam findings in aortic dissection?
Pulse deficit, weak or absent carotid, brachial, or femoral pulse, and variation in systolic blood pressure between the arms.
What are some potential complications of aortic dissection?
Coronary arteries may lead to angina, spinal arteries may cause paraplegia, and distal aorta may result in limb ischaemia.
What ECG changes may be seen in aortic dissection?
The majority of patients have no or non-specific ECG changes; however, ST-segment elevation may be seen in the inferior leads in a minority of patients.
What are the types in the Stanford classification of aortic dissection?
Type A - ascending aorta (2/3 of cases); Type B - descending aorta, distal to left subclavian origin (1/3 of cases).
What are the types in the DeBakey classification of aortic dissection?
Type I - originates in ascending aorta and propagates; Type II - originates in and is confined to ascending aorta; Type III - originates in descending aorta.
What is the Stanford classification for aortic dissection?
Type A - ascending aorta, 2/3 of cases
Type B - descending aorta, distal to left subclavian origin, 1/3 of cases
What is the DeBakey classification for aortic dissection?
Type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
Type II - originates in and is confined to the ascending aorta
Type III - originates in descending aorta, rarely extends proximally but will extend distally
What is the investigation of choice for aortic dissection?
CT angiography of the chest, abdomen and pelvis is the investigation of choice.
Suitable for stable patients and for planning surgery; a false lumen is a key finding in diagnosing aortic dissection.
What is a key finding on a chest x-ray for aortic dissection?
Widened mediastinum
What is the management for Type A aortic dissection?
Surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention.
What is the management for Type B aortic dissection?
Conservative management, bed rest, and reduce blood pressure IV labetalol to prevent progression.
Endovascular repair of type B aortic dissection may have a role in the future.
What are complications of backward tear in aortic dissection?
Aortic incompetence/regurgitation and myocardial infarction (MI) with inferior pattern often seen due to right coronary involvement.
What are complications of forward tear in aortic dissection?
Unequal arm pulses and blood pressure, stroke, and renal failure.
What is the role of transoesophageal echocardiography (TOE) in aortic dissection?
More suitable for unstable patients who are too risky to take to CT scanner.
