Aortic dissection Flashcards
What is an aortic dissection?
- tear in the tunica intima of the wall of the aorta
What are the associations of an aortic dissection?
- hypertension: the most important risk factor
- trauma
- bicuspid aortic valve
- collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
- Turner’s and Noonan’s syndrome
- pregnancy
- syphilis
What are the features of an aortic dissection?
- chest pain: typically severe, radiates through to the back and ‘tearing’ in nature
- aortic regurgitation
- hypertension
- other features may result from the involvement of specific arteries. For example coronary arteries → angina, spinal arteries → paraplegia, distal aorta → limb ischaemia
- the majority of patients have no or non-specific ECG changes.
- In a minority of patients, ST-segment elevation may be seen in the inferior leads
What is the Stanford classification of an aortic dissection?Stanford classification?
Stanford classification
Type A - ascending aorta, 2/3 of cases
Type B - descending aorta, distal to left subclavian origin, 1/3 of cases
What is the DeBakey classification?
type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
type II - originates in and is confined to the ascending aorta
type III - originates in descending aorta, rarely extends proximally but will extend distally
How do you manage Type A dissections?
Surgical management
- blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
What is the management of Type B dissections?
Conservative management
- bed rest
- reduce blood pressure: IV labetalol to prevent progression
What are the complications of a backward tear?
- Aortic incompetence/regurgitation
- MI: inferior pattern often seen due to right coronary involvement
What are the complications of a forward tear?
- unequal arm pulses and BP
- stroke
- renal failure
