Aortic Dissection Flashcards
Aortic dissection
Tear in tunica intima of wall of aorta - commonly arch or ascending aorta.
Common place for tear
Right lateral area of the ascending aorta is the most common site of a tear of the intima layer, as this is under the most stress from blood exiting the heart.
RF Aortic Dissection
Hypertension
Heavy Weightlifting
Cocaine
Bicuspid aortic valve
Coarctation of the aorta
Aortic valve replacement
Coronary artery bypass graft (CABG)
Ehlers Danlos
Marfans
Pregnancy
Syphilis
Symptoms AD
Ripping or tearing chest pain that may migrate overtime - maximal at onset.
Differences in blood pressure between the arms (>20mmHg)
Radial pulse deficit (the radial pulse in one arm is decreased or absent and does not match the apex beat)
Diastolic murmur
Focal neurological deficit (e.g., limb weakness or paraesthesia)
Chest and abdominal pain
Syncope
Hypotension as the dissection progresses
Ix AD
CT Angiogram - quick and effective - false lumen finding
TOE - for unstable patients
ECG and Cxr can be falsely reassuring - normal or slight ST + Widened mediastinum.
Caution with MI and AD
Myocardial infarction can occur in combination with aortic dissection, and treatment of the myocardial infarction (e.g., thrombolysis) can cause fatal progression of the aortic dissection.
Type A
affects the ascending aorta, before the brachiocephalic artery -
severe chest pain and may exhibit signs of aortic regurgitation or cardiac tamponade due to involvement of the aortic valve or pericardium
problems with neck and jaw.
Type B
affects the descending aorta, after the left subclavian artery - sudden onset of severe back pain and can involve spinal arteries, leading to neurological deficits such as paraplegia
Type I
begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
Type II
isolated to the ascending aorta
Type III
begins in the descending aorta and extends to just above or below diaphragm
Treatment
Analgesia
Beta blockers - blood pressure and HR control - IV labetalol
Surgery
Treatment Type B
Beginning intravenous labetalol and monitoring is the correct management for an uncomplicated Stanford Type B aortic dissection in a hemodynamically stable patient - not if renal involvement
Complications
Myocardial infarction
Stroke - especially if subclavian involvement.
Paraplegia (motor or sensory impairment in the legs)
Cardiac tamponade
Aortic valve regurgitation
Death
Classification systems in AD
Stanford Types A or B - most commonly used
DeBakey Types I,II,III
