Aortic Dissection

Question 1

What is an aortic dissection.

Answer 1

Blood tracks through a breach in intima creating parallel true and false lumens.

Question 2

What are the two types of aortic dissection.

Answer 2

Type A.

Type B.

Question 3

Where do type A aortic dissections usually occur.

Answer 3

They involve the ascending aorta.

It involves the aortic arch and aortic valve.

Question 4

Where do type B aortic dissections usually occur.

Answer 4

They involve the descending aorta. They start at the origin of the left subclavian artery.

Question 5

What are major risk factor for aortic dissections. (2)

Answer 5

Chronic Hypertension.

Aortic disease.

Question 6

What are the symptoms of aortic dissections. (7)

Answer 6

Tearing chest pain radiating to the back, and down the arms.
Hemiplegia (carotid artery).
Paraplegia (spinal artery).
Mesenteric ischaemia (leading to an acute abdomen).
Limb ischaemia.
AKI.
Collapse.

Question 7

What are the physical signs of aortic dissections. (5)

Answer 7

Shock. 
Aortic regurgitation if aortic valve involved. 
Coronary ischaemia. 
Cardiac Tamponade. 
Unequal pulses or BP unilaterally.

Question 8

What is usually the first stage of an aortic dissection.

Answer 8

Tear in the intima.

Question 9

What type of aortic dissection is De Bakey type 2.

Answer 9

It is a subtype of a type A aortic dissection.

It is a dissection that extends to the abdominal aorta.

Question 10

What type of aortic dissection is De Bakey type 1.

Answer 10

It is a subtype of a type A aortic dissection.

It is localized to the ascending aorta.

Question 11

What is another name for a type B aortic dissection.

Answer 11

De Bakey type 3.

Question 12

What predisposes you to developing an aortic dissection. (3)

Answer 12

Patients with autoimmune rheumatic disorders, Marfan’s and Ehlers-Danlos syndromes.

Question 13

What other condition may the symptoms of aortic dissection mimic.

Answer 13

MI.

Question 14

How is the pain described in aortic dissection.

Answer 14

Tearing in nature.

Question 15

What are the neurological symptoms present in aortic dissection due to.

Answer 15

They are secondary to loss of blood supply to the spinal cord.

Question 16

What sort of clinical findings may be apparent in patients with distally extending aortic dissections. (4)

Answer 16

AKI.
Acute lower limb ischaemia.
Visceral Ischaemia.
Peripheral pulses may be absent.

Question 17

What is the finding on CXR if aortic dissection occurs. (2)

Answer 17

Widened mediastinum.

Distortion of the aortic ‘knuckle’.

Question 18

What factors may predispose to aortic dissection. (10)

Answer 18

Hypertension (in 80%).
Aortic atherosclerosis.
Non-specific aortic aneurysm.
Aortic coarctation.
Collagen disorders (eg Marfan’s, Ehlers-Danlos).
Fibromuscular dysplasia.
Previous aortic surgery (eg CABG, aortic valve replacement).
Pregnancy (usually third trimester).
Trauma.
Iatrogenic (eg cardiac catheterisation, intra-aortic balloon pumping).

Question 19

At what age is aortic dissection most common.

Answer 19

60-70 years old.

Question 20

What is the usually cause of aortic dissection in younger patients. (3)

Answer 20

Pregnancy.
Trauma.
Marfan’s syndrome.

Question 21

Are women and men equally affected by aortic dissections.

Answer 21

No, men are twice as frequently affected as women.

Question 22

What type of aortic dissection accounts for 2/3rds (approximately 70%) of cases.

Answer 22

Type A.

They frequently extend into the descending aorta.

Question 23

In aortic dissection, occlusion of what artery causes hemiplegia.

Answer 23

Carotid artery.

Question 24

In aortic dissection, occlusion of what artery causes paraplegia.

Answer 24

Spinal artery.