Aortic Dissection

Question 1

What is an aortic dissection?

Answer 1

A breach in the integrity of the aortic wall allows arterial blood to enter the media, which is then split into two layers, creating a ‘false lumen’ alongside the existing or ‘true lumen’.

Question 2

What are the complications of aortic dissection

Answer 2

Rupture into the left pleural space or pericardium with fatal consequences.

Question 3

What are the risk factors for aortic dissection?

Answer 3

HTN, aortic disease, collagen disorders, trauma

Question 4

What are the different types of dissection?

Answer 4

Type A - involves the ascending aorta. Accounts for 2/3 of cases and frequently extend into descending aorta.

Type B - descending aorta, distal to left subclavian origin, and accounts for 1/3 of cases

Question 5

What are the clinical features of aortic dissection?

Answer 5

• Anterior chest pain - ascending aorta
• Intrascapular pain - descending aorta
• Tearing pain, sudden onset
• Collapse
• Hypertension
• Asymmetry of pulses
• Signs of aortic regurgitation

Question 6

What are complications of occlusion of aortic branches?

Answer 6

Coronary - MI
Carotid - Stroke
Paraplegia - Spinal
Mesenteric infarction with an acute abdomen - coeliac and superior mesenteric
Distal aorta - acute limb ischaemia

Question 7

How is a type A dissection managed?

Answer 7

Surgical management to replace ascending aorta. Blood pressure should be controlled to a target systolic of 100-120 mmHg.

Question 8

How is a type B dissection managed?

Answer 8

Conservative management. Bed rest. Reduce blood pressure with IV labetalol - duce the force of the ejection of blood from the LV.