Aortic Dissection

Question 1

Risk Factors/Association?

Answer 1

HTN (70%)

Genetic e.g. Marfans

Question 2

Clinical features?

Answer 2

Tearing, sudden onset chest pain (painless 10%) (retrosternal anterior or back pain posterior)
Hypertension or Hypotension
A blood pressure difference (in each arm) greater than 20 mm Hg
Neurologic deficits (20%)

Question 3

Diagnostic investigations?

Answer 3

CXR
CT angiography of thoracic aorta
MRI angiography

Question 4

CXR signs?

Answer 4

Widened mediastinum
Abnormal aortic knob
Ring sign
Tracheal/oesophageal deviation

Question 5

Stanford classification?

Answer 5

Type A: Ascending aorta (can also be descending - but anterior chest pain)
Type B: Descending aorta

Question 6

Mx of Type A?

Answer 6

surgical management

but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Question 7

Mx of Type B?

Answer 7

Reduce BP: Labetalol IV to prevent progression