Aortic dissection

Question 1

Definition/pathophysiology of aortic dissection

Answer 1

A tear in the intima layer of the aorta leading to blood flowing between the layers of the media, forcing them apart.

Question 2

Part of aorta most commonly affected

Answer 2

Ascending aorta - 65%
Aortic arch - 10%
Descending thoracic aorta - 20%

Question 3

Risk factors for aortic dissection (6)

Answer 3

1. Male sex
2. Age
3. Thoracic aortic aneurysm
4. Genetic conditions (Marfan, Turner, Ehlers-Danlos, biscuspid aortic valve)
5. Hypertension
6. Chest trauma/cardiac surgery

Question 4

Symptoms of aortic dissection (4)

Answer 4

1. Sudden onset tearing chest pain, migrating downwards
2. Symptoms of heart failure (7%)
3. Syncope (9%)
4. Stroke (6%)

Question 5

Signs of aortic dissection (4)

Answer 5

1. Hypertension or hypotension (grave prognostic indicator)
2. Murmur (aortic regurgitation due to dilation/detachment of valve)
3. Asymmetrical pulses
4. Signs of complications (e.g. Beck’s triad, heart failure)

Question 6

Investigations for aortic dissection (4). Which is the gold standard?

Answer 6

1. CXR
2. CT (gold standard)
3. Echo (TOE better)
4. MRI

Question 7

Sign of aortic dissection on CXR

Answer 7

Widening of mediastinum

Question 8

Management of aortic dissection

Answer 8

1. Anti-hypertensives

2. Surgery (if involving aortic arch), endovascular aneurysm repair

Question 9

Complications of aortic dissection

Answer 9

1. Pericardial tamponade
2. Heart failure
3. Rupture of aorta

Question 10

Percentage mortality of aortic dissection + most common cause of death

Answer 10

40% mortality, most commonly due to pericardial tamponade