Aortic Dissection

Question 1

Where does blood track in an aortic dissection?

Answer 1

Between layers of the media

Question 2

Where do aortic dissections most commonly originate?

Answer 2

The aortic root or just distal to the left subclavian artery

Question 3

What are the risk factors for aortic dissection?

Answer 3

• Hypertension
• Atherosclerotic disease
• Marfan’s/Ehler’s-Danlos
• Bicuspid aortic valve
• Coarctation
• Smoking
• FHx

Question 4

What are likely history/examination findings in someone wih aortic dissection?

Answer 4

• Tearing chest pain/interscapular pain
• BP differs between arms/legs
• Diastolic murmur
• Rare - paraplegia, abdominal pain, limb pain/pallor (EO ischaemia)

Question 5

What investigations are important in someone with suspected aortic dissection?

Answer 5

• CT chest/abdo/pelvis
• ECG, cardiac enzymes (exclude ACS)
• CXR (exclude pulmonary causes)
• UECs (renal function may be compromised)

Question 6

What are the principles of management of aortic dissection?

Answer 6

• Oxygen and opioid analgesia
• Reduce stress on vessel wall - beta-blockade (labeta/esmo/metoprolol)
• Surgical intervention - stenting