Aortic Dissection Flashcards
What is an Aortic Aneurysm?
Weakening in the layers of the aorta
Aortic aneurysms are often asymptomatic and may cause chest pain, back pain, or a pulsating feeling in the stomach.
What characterizes an Aortic Dissection?
Tear in the tunica intima of the wall of the aorta
Aortic dissection is a serious condition that can lead to aortic rupture.
What is an Aortic Rupture?
Complete tare of the aorta
Aortic rupture is a life-threatening emergency.
List the risk factors for Aortic Dissection.
- Male
- Age
- Smoking
- Hypertension
- Trauma
- CT disorders (e.g., ED syndrome, Marfan’s)
- Genetic conditions (e.g., Turner’s, Noonan’s syndrome)
- Pregnancy
- Syphilis
- Atherosclerosis
Understanding these risk factors is crucial for early detection and prevention.
What are the symptoms of Aortic Dissection?
- Sharp/tearing chest/back pain (maximal at onset)
- Radial-radial delay
- Pulse deficit
- Systolic variation in arms (20mmHg)
- NEW MURMUR - Aortic regurgitation
- Hypertension
- Angina (if coronary arteries involved)
- Paraplegia (if spinal arteries involved)
- Limb ischaemia (if distal aorta involved)
Symptoms can vary based on which arteries are affected.
What 2 classification systems are used in aortic dissection?
1) Stanford Classification
2) DeBakey Classification
What are the classifications of Stanford system?
Stanford classification:
* Type A = ascending aorta
* Type B = descending aorta
These classifications help guide treatment decisions.
What are the classifications of DeBakey system?
DeBakey classification:
* 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 investigations are used for Aortic Dissection?
- CXR/FAST scan
- **CT Angiography of the Aorta = diagnostic **
- Transoesophageal echocardiography (TOE)
Investigations depend on the stability of the patient.
What is the initial management for an acutely unwell patient with Aortic Dissection?
A-E Management
* X-match
* Fluid resuscitate
* Control BP
* Control HR
Immediate management is critical to stabilize the patient.
What is the management for Type A Aortic Dissection (DB I & II)?
Surgery for aortic repair
Type A dissections are considered surgical emergencies.
What is the management for Type B Aortic Dissection (DB IIIa and IIIb)?
Conservative management (bed rest) and reduce BP with IV Metoprolol/Labetalol
Type B dissections may not require immediate surgery.
What long-term management is required after Aortic Dissection?
Antihypertensive medications and CT monitoring
Long-term follow-up is essential to prevent complications.
List complications of Aortic Dissection.
- Aortic incompetence/regurgitation
- Myocardial infarction
- Stroke
- Renal failure
Complications can arise from both backward and forward tears.
True or False: Patients with an Aortic Aneurysm are at high risk for Aortic Dissection.
True
Aortic aneurysms can predispose individuals to dissection.
