Aortic Dissection

Question 1

What is dissection?

Answer 1

Tear in the intimal layer of the aortic wall, causing blood to flow between and splitting apart the tunica intima and media.

Question 2

What is the classification and what are the types?

Answer 2

DeBakey

Type I

• originates in the ascending aorta and propagates at least to the aortic arch
• They are typically seen in patients under 65yrs and carry the highest mortality, quoted at 1% per hour in the acute setting

Type II

• confined to the ascending aorta
• Classically in elderly patients with atherosclerotic disease and hypertension

Type III

• originates distal to the subclavian artery in the descending aorta
• Further subdivided into IIIa which extends distally to the diaphragm and IIIb which extends beyond the diaphragm into the abdominal aorta

Question 3

Clinical features:

Answer 3

Tearing chest pain

tachycardia, hypotension*, new aortic regurgitation murmur, or signs of end-organ hypoperfusion

Question 4

Differentials:

Answer 4

MI

Pulmonary embolism

Pericarditis

Question 5

Ix:

Answer 5

Basic bloods

CT angio

Question 6

Management:

Answer 6

Type A (debakey 1 and 2) : Urgent surgery: replacement aortic arch etc

Type B (debakey 3): medical management: HTN treatment