Aortic Dissection

Question 1

Type A

Answer 1

Involving the aortic arch and aortic valve proximal to the left subclavian artery origin
Involves the ascending aorta

Question 2

Type B

Answer 2

Involving the descending thoracic aorta distal to the left subclavian artery origin

Question 3

Pathophysiology

Answer 3

Tear in the intima of the aortic wall, which then results to degeneration of the medial layer. Blood passes through the media, creating a false lumen

Question 4

Causes

Answer 4

Inherited conditions, bicuspid aortic valve, aortic atherosclerosis, inflammatory conditions, trauma, infections, iatrogenic causes (e.g. cardiac surgery)

Question 5

Clinical Presentation

Answer 5

Severe, central, tearing chest pain, radiating to the back
Left/right BP differential
Diastolic murmur - aortic incompetence
Hypotension
Shock

Question 6

ECG

Answer 6

ST depression

Question 7

Type A Management

Answer 7

Local resuscitation
Antihypertensives
Surgery - arch replacement; possibly repair/replacement of the aortic valve

Question 8

Type B Management

Answer 8

Local resuscitation
Antihypertensives
If complicated, surgical/endovascular intervention is required