Aortic Dissection

Question 1

what is the definition of aortic dissection

Answer 1

a tear in the aortic intima allows blood to surge into the aortic wall
this causes a split between the inner and outer tunica media forming a false lumen

Question 2

what is the aetiology of aortic dissection

Answer 2

degenerative changes to the smooth muscle of the aortic media

Question 3

what are common causes and predisposing factors of aortic dissection

Answer 3

HTN
aortic atherosclerosis
CTD (marfans)
congenital cardiac abnormalities (aortic coarctation)
aortitis
iatrogenic (angiography/angioplasty)
crack cocaine
trauma

Question 4

what are the two types of aortic dissection

Answer 4

type A (ascending-common)
type B (descending-distal to left subclavian artery)

Question 5

what is the risk associated with the formation of a false lumen in aortic dissection

Answer 5

false lumen can occlude other arteries

Question 6

what is the epidemiology of aortic dissection

Answer 6

males between 40-60yrs

Question 7

what character of chest pain is associated with aortic dissection

Answer 7

sudden central ‘tearing’

Question 8

what would be observed with carotid obstruction

Answer 8

hemiparesis
dysphasia
syncope

Question 9

what would be observed with coronary artery obstruction

Answer 9

chest pain (angina-like)

Question 10

what would be observed with subclavian obstruction

Answer 10

ataxia (cerebellar damage)

loss of consciousness

Question 11

what would be observed with anterior spinal obstruction

Answer 11

paraplegia (paralysis of lower body)

Question 12

what would be observed with coeliac obstruction

Answer 12

severe abdominal pain

Question 13

what would be observed with renal artery obstruction

Answer 13

anuria (failure of urine production)

renal failure

Question 14

what would be the examination findings in aortic dissection

Answer 14

murmur below left scapular, descending to abdomen
HTN, >20mmHg BP discrepency between arms, wide PP
aortic insufficiency: collapsing pulse, early diastolic murmur in aortic area, unequal arm pulses

Question 15

what are the investigations for aortic dissection

Answer 15

1 ECG (first line investigation to exclude MI)
2 CT-Thorax (gold standard investigation for diagnosis -false lumen)
3 CXR (widened mediastinum)
4 bloods
-FBC (anaemia may be present in haemorrhage)
-cardiac enzymes to exclude MI

Question 16

when is aortic dissection considered acute

Answer 16

<14 days old

Question 17

what does a weakened aortic wall, particularly the lamina media increase risk of

Answer 17

aneurysm formation

Question 18

what does anterior tearing pain indicate

Answer 18

dissection of the ascending aorta

Question 19

what does interscapular pain indicate

Answer 19

dissection of the descending aorta

Question 20

what might be see on an ECG in acute dissection

Answer 20

ST depression

Question 21

what is the deadly triad in aortic dissection

Answer 21

hypotension/shock (not syncope), lack of chest/back pain, branch vessel involvement