Aortic Dissection Flashcards
Define Aortic Dissection
An aortic dissection is a tear in the intimal layer of the aortic wall, causing blood to flow between and splitting apart the tunica intima and media.
Aortic dissection risk factors
- Hypertension (BIG risk)
- Hyperlipidaemia
- Male gender
- Connective tissue disorders (Marfan’s syndrome or Ehler’s-Danlos syndrome) - younger patients
- Biscuspid aortic valve
Aortic dissection Sx
- sudden onset severe tearing chest pain, radiating to the back
Aortic dissection clinical signs
- Tachycardia
- Hypotension - due to hypovolaemia from blood loss
- Radio-radial delay
- Radio-femoral delay
- Radial pulse deficit (not matching apex beat)
- Diastolic murmur
- Blood pressure differential >20mmHg between arms
- Syncope
Aortic dissection complications
- Death due to internal haemorrhage
- Aortic Rupture
- Aortic Regurgitation
- End organ damage (renal or cardiac failure)
- Cardiac tamponade
- Stroke
- Limb ischaemia
- Mesenteric ischaemia
Most common location of aortic dissection
Ascending aorta and aortic arch
Two classifications of aortic dissection
- Stanford
- DeBakey
Stanford classifications
- Type A - A dissection occurs at the ascending aorta before the Brachiocephalic artery
- Type B - A dissection occurs at the descending aorta after the left subclavian artery
DeBakey classifications
- Type I – starts in the ascending aorta and involves at least to the aortic arch
- Type II – Isolated to the ascending aorta
- Type IIIa – starts at descending aorta and stops before the diaphragm
- Type IIIb - starts at the descending aorta and travels pass the diaphragm
what is the 1st line imaging used to confirm Dx aortic dissection
CT angiogram
what Ix can be used to exclude other causes
- ECG
- TOE - Transoesophageal Echo
- CXR
- Bedside USS
Other than CT angiogram, what imagin is used to provide greater detail of the aortic dissection
MRI angiogram
Stable Stanford Type B Aortic Dissection Mx
occuring at the descending aorta
Medical Mx Gold standard
- IV labetalol - rapidly lower the SBP, pulse pressure, and pulse rate to minimise stress
- IV morphine - for pain relief
Stanfrod Type A aortic dissection clinical signs
- Aortic regurg
- Diastolic murmur
- Cardiac Tamponade signs (hypotension, raised JVP, muffled heart sound)
- Stroke, Syncope (carotid artery involvement)
Type A Aortic Dissection Mx
Urgent surgery
when is endovascular repair indicated in Type B AD
For the formation of an aneurysm with med Mx
