aortic dissection

Question 1

define aortic dissection

Answer 1

Aortic dissection is a tear in the tunica intima in the aorta, causing serious chest pain

Question 2

Stanford classification

Answer 2

type A - ascending aorta, 2/3 of cases
type B - descending aorta, distal to left subclavian origin, 1/3 of cases

Question 3

DeBakey classification

Answer 3

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

Question 4

risk factors

Answer 4

hypertension: the most important risk factor
trauma
Aneurysm’s
Connective Tissue Disorders: Marfan’s syndrome, Ehlers-Danlos syndrome
Turner’s and Noonan’s syndrome
pregnancy
Syphilis

Question 5

pathology

Answer 5

Tear in the tunica intima of the wall of the aorta then high pressure blood tunnels through intima into media

Question 6

clinical manifestations

Answer 6

Intra arm blood pressure differential
Hypertension
Aortic regurgitation - diastolic murmur
Absent peripheral pulses
Chest pain - tearing through to back

*A false lumen (area between intima and media where blood can pool) is a key suggestive finding

Question 7

findings on chest Xray

Answer 7

Chest radiography may be normal or have a several findings suggestive of aortic dissection, such as:

Widened mediastinum: > 8.0-8.8 cm at the level of the aortic knob on portable anteroposterior chest films
Double aortic contour
Irregular aortic contour
Inward displacement of atherosclerotic calcification (>1 cm from the aortic margin)

Depending on the aetiology there may also be signs of peri-aortic or mediastinal haematoma, such as deviation of mediastinal structures, oesophageal or tracheal deviation to the right and inferior displacement of the left main bronchus.

Question 8

CT Angio

Answer 8

False lumen is a finding suggestive of aortic dissection

Question 9

management sanford A and stanford B

Answer 9

a - Involves ascending aortic arch so require open surgery immediately upon diagnosis - 10-25% mortality

b - Limited to descending aorta and medical therapy is preferred:
IV beta blockers - to reduce BP
Opioid analgesia