Aortic Dissection

Question 1

Define aortic dissection.

Answer 1

Aortic dissection describes the condition when a separation has occurred in aortic wall intima, causing blood flow into a new false channel composed of the inner and outer layers of the media.

Question 2

Explain the aetiology/risk factors of aortic dissection.

Answer 2

Aortic dissection results from an intimal tear that extends into the media of the aortic wall. Cystic medial degeneration predisposes to intimal disruption and is characterised by elastin, collagen, and smooth muscle breakdown in the lamina media. Bleeding from the vasa vasorum can also lead to this condition.

Marfan and Ehlers-Danlos increases the risk of aortic dissection.

Question 3

Summarise the epidemiology of aortic dissection.

Answer 3

The worldwide incidence of aortic dissection is 0.5 to 2.95 cases per 100,000 people annually.

Question 4

Recognise the presenting symptoms of aortic dissection.

Answer 4

Acute severe chest pain
Interscapular and lower pain

Question 5

Recognise the signs of aortic dissection on physical examination.

Answer 5

Left/right blood pressure differential
Pulse deficit
Diastolic murmur
Hypertension

Question 6

Identify appropriate investigations for aortic dissection and interpret the results.

Answer 6

ECG
CXR
Cardiac enzymes
CT angiography
Renal function tests
Liver function tests
Lactate
FBC