Aortic Dissection Flashcards
Aortic dissection epidemiology
Affects males 40-60 years w/ HTN (5000-10000 cases each year)
Affects <40years w/ aortic valve disease/CT disorder/pregnancy (vascular remodelling)
What is aortic dissection?
Blood separates the laminar places of the media to form a blood filled channel
Rupture through the TA is catastrophic
Ass. To aortic dilation
Etiology of aortic dissection
HTN/disorganised ECM ass. To ischemia
Medial Ht of vaso vasorum
Degenerative changes
LO medial SM/pregnancy/Marfans/arterial cannulation
Pathogenesis AD
Intimal tear and blood flow under sys P- dissects through media leading to hematoma
Intramural Hm due to rupture of VV in defective media leading to intimal tear/propagation of cleavage plane by flowing blood
Morphology AD
Cystic medial degeneration
Lacunae formation due to elastic fibre degeneration
Risk factors for AD
HTN/aortic dilation/turner syndrome
Marfans/family history/bicuspid aortic valve/congenital HD (noonans syndrome- alteration in MR/clotting/stature/facial features)
Features of AD
Usually occurs at ascending aorta (sharp jagged tear)
Extension can be retrograde towards the heart/anterograde toward Iliac and femoral Aa
AD can re enter lumen in chronic cases
Classification
De bakey- asc. Ao beyond arch/asc. Ao/desc. Ao/desc. Ao beyond diaphragm (1/2/3a/3b)
Stanford- A asc. Ao/B- desc. Ao
Clinical manifestations and Tx
Acute pain between scapula/anterior chest
Surgical plication/antihypertensives
Complications AD
Rupture into ms/p/p/p
Rupture through false channel
Cardiac/pericardial tamponade (» fluid «_space;vent filling- hemodynamic compromise)
Aortic insufficiency/exsanguination/ischemia and obstruction/congestive HF
Site of tear
Asc Ao mainly ruptures in intrapericardium
Aortic arch mainly ruptures in intrapericardium/LHS pleura
Desc Ao mainly ruptures in LHS pleura
