Aortic Dissection

Question 1

Define aortic dissection

Answer 1

• Tear in intima aortic lining
• Column of blood enters aortic wall under pressure
• Forms haemotoma and separates intima & adventitia
• = false lumen

Question 2

Where do aortic dissection comonly occur in the aorta?

Answer 2

Commonly 2-3cm from aortic valve

Question 3

What are the symptoms of aortic dissection?

Answer 3

Symptoms

• Tearing chest pain radiating to back
• Hemiplegia
• Paraplegia
• Mesenteric/limb ischaemia

Question 4

What are the clinical signs of aortic dissection?

Answer 4

• Shock
• Aortic regurgitation (if aortic valve involved)
• Unequal pulses
• BP unilateral

Question 5

INVESTIGATIONS: Aortic Dissection

Answer 5

Imaging

• ECG
• CXR = widened mediastinum
• Echocardiography

Question 6

MANAGEMENT: Aortic Dissection

Answer 6

• Type A - Involving ascending aorta*
• Surgery -replacement affected aorta cardiopulmonary bypass
• Type B - begins subclavian artery*
• Medical treatment for HTN
• May require surgery if distal ischaemia

Question 7

What is the main risk factor for aortic dissection?

Answer 7

Chronic Hypertension

Question 8

What are the main complications from aortic dissection?

Answer 8

• Sudden death
• Stroke
• Mesenteric infarction
• Ischaemic limb paralysis