Aortic dissection

Question 1

Aortic dissection?

Answer 1

A condition where a tear in the aortic intima allows blood to surge into the aortic wall, causing a split between the inner and outer tunica media, creating a false lumen.

Question 2

Aortic dissection types?

Answer 2

Type A: ascending aorta (most common), Type B: descending aorta (distal to the left subclavian artery).

Question 3

Aortic dissection Aetiology?

Answer 3

Usually preceded by degenerative changes in the smooth muscle of the aortic media. expansion of the false lumen can lead to obstruction of the subclavian, carotid, coeliac and renal arteries.

Question 4

Aortic dissection risk factors (8)?

Answer 4

Hypertension, aortic atherosclerosis, connective tissue disease, congenital cardiac abnormalities, aortitis, iatrogenic, trauma, crack cocaine.

Question 5

Aortic dissection epidemiology?

Answer 5

males 40-60yrs.

Question 6

Aortic dissection general symptoms?

Answer 6

sudden central tearing pain, may radiate to back between shoulder blades. Other symptoms are caused by obstruction to branches of the aorta.

Question 7

Aortic dissection carotid obstruction symptoms?

Answer 7

hemiparesis, dysphasia, blackout

Question 8

Aortic dissection coronary artery obstruction symptoms?

Answer 8

chest pain (angina or MI)

Question 9

Aortic dissection subclavion obstruction symptoms?

Answer 9

ataxia, loss of consciousness.

Question 10

Aortic dissection anterior spinal artery obstruction symptoms?

Answer 10

paraplegia

Question 11

Aortic dissection coeliac axis symtpoms

Answer 11

severe abdominal pain (due to ischaemic bowel)

Question 12

Aortic dissection renal artery obstruction symptoms?

Answer 12

anuria, renal failure.

Question 13

Aortic dissection signs?

Answer 13

Murmour below the left scapula, descending to abdomen,

hypertension,

BP difference between 2 arms >20mm Hg,

wide pulse pressure,

Signs of aortic regurgitation (high volume collapsing pulse, early diastolic murmour over aortic mass),

there may be palpable abdo mass.

Question 14

Aortic dissection impact of hypotension?

Answer 14

Hypotension may suggest tamponade; check for pulsas paradoxus (abnormally large decrease in systolic blood pressure and pulsewave amplitude during inspiration). This may indicate, tamponade, pericarditis, chronic sleep apnoea, obstructive lung disease.

Question 15

Aortic dissection investigations (6)?

Answer 15

Bloods (FBC, cross match, check renal function, clotting screen)

CXR (shows widened mediastinum),

ECG (often normal)

CT thorax (shows false lumen)

echocardiography,

cardiac catheterisation and aortography.