Aortic dissection

Question 1

Aortic dissection, what is it

Answer 1

• occurs when the tunica intima of the aorta gets ripped off -> high pressure blood flow goes between the tunica intima and tunica media -> leads to an increase in the outside diameter of the aorta, creating a “false lumen”

Question 2

Aortic dissection: E

Answer 2

• chronic hypertension:
  Chronic HTN either caused by stress, increased blood volume like in pregnancy, coartaction (narrowing of the blood vessels
• weakened aortic wall: due to Marfan’s syndrome, Ehler’s Denbos syndrome, or decreased blood flow in vasa vasorum
• aneurysms -> aortic dissection: weak walls can lead to out pouching of the blood vessels, or a break in the tunica intima -> both weaken the wall further
• Bicuspid aortic valve
• chest trauma

Question 3

Aortic dissection: Locations

Answer 3

• the first 10cm closest to the heart is the most common place

Question 4

Aortic dissection: Symptoms

Answer 4

• tearing angina
• nausea
• syncope
• dyspnoea
• different blood pressure in the periphery
• limb ischemia

Question 5

Aortic dissection: complications

Answer 5

Mostly related to where the blood in the false lumen flows

• Pericardial tamponade: blood flows back up to the aorta and enters the pericardial space -> filling it with blood -> causing pericardial tamponade (life-threatening situation)
• bleeds into the mediastinum: blood in the false lumen creates a whole in the tunica externa -> blood goes in the mediastinum: causing a rapid death as the blood quickly leaves the vascular system
• blood goes back to true lumen: best situation
• compression of renal artery or subclavian arteries: blood continues to go between the tunica media and intimate -> compresses the renal/subclavian arteries -> causing a decreased blood flow to the kidneys and arms

Question 6

Aortic dissection: Diagnosis

Answer 6

• history, based on symptoms
• ECG
• CXR
• Echo
• MRI
• Angio

Question 7

Aortic dissection: Classification, the 2 types

Answer 7

• DeBakey and Standford classifications:
  .I: ascending aorta and descending (Type A standford)
  .II: ascending only (Type A standford)
  .III: descending aorta only, commencing after the origin of the left subclavian artery (= Stanford B)

Question 8

Aortic dissection: Treatment

Answer 8

• ABS resuscitation
• keep systolic BP at 100
• Esmolol, labetalol
• Calcium Channel Blocker
• Surgery (artificial graft)