Aortic dissection

Question 1

What is an aortic dissection?

Answer 1

• tear in the wall of the aorta
• tear starts from the intima, goes into the media

Question 2

Commonest aetiology of aortic dissection

Answer 2

• HTN, then degenerative changes, then damage to aortic media
• connective tissue disorder (Marfan’s, Ehlers-Danlos)
• atherosclerosis
• congenital conditions
  
  • coarctation of the aorta
  • bicuspid aortic valves
  • PDA
• infection
• trauma- post cardiac surgery
• ateritis

Question 3

Peak incidence of aortic dissection?

Answer 3

• 50-65 yo
• more common in males
• 20-40 yo with connective tissue disorders

Question 4

Clinical features of aortic dissection?

Answer 4

• sudden onset tearing chest pain
• radiates to the back
• HTN in 75-85% patients
• syncope
• Mesenteric or limb ischaemia – complicated aortic dissection, if blood flow to organs is compromised

Question 5

Investigations for aortic dissection?

Answer 5

• CT angiography = gold standard
• CXR - pleural cap
• TEE
• ECG
• bloods: lactate (ischaemic gut, shock), lipase (pancreatitis), trops (MI), group + hold

Question 6

Explain this image

Answer 6

LEFT: Type A dissection with clear intimaflap seen within the aortic arch.

RIGHT: Type B dissection. Entry point distal to left subclavian artery.

Question 7

How is aortic dissection classified?

Answer 7

• STANFORD CLASSIFICATION
• type A = ascending aorta involved
  
  • chances of rupture are much higher, treat with surgery
• type B = does not affect the ascending aorta
  
  • can be managed conservatively
    
    • pain relief
    • BP management, lifestyle modification etc

Question 8

Complications of aortic dissection

Answer 8

• Mesenteric ischaemia or limb ischaemia – complicated aortic dissection, if blood flow to organs is compromised
• Heart failure or CVA – due to aortic regurgitation
• death, lol

Question 9

What is a true lumen vs false lumen?

Answer 9

• true lumen = the normal passageway of blood
• false lumen = newly created passageway
  
  • forms in the wall as a result of rupture

Question 10

Management of aortic dissection

Answer 10

• ABC, IV cannulas, bloods, fluids
• Referral to cardiovascular surgeon
• Type A = mergency operation
• Type B = can be managed conservatively with BP control, pain relief