Aortic Dissection

Question 1

Aortic Dissection: Define

Answer 1

Tear in inside of aorta - causes blood flow between layers of the wall - forcing (media) layers apart

Question 2

Aortic Dissection: Aetiology

Answer 2

Hypotension (#1)
Atherosclerosis
Trauma
Marfans Syndrome

Question 3

Aortic Dissection: Type A

Aortic Dissection: Type B

Answer 3

Type A: Ascending (2/3 cases)

Type B: Descending (1/3 cases)

Question 4

Aortic Dissection: Symptoms

Answer 4

Chest pain (tearing & radiates to back)
Syncope/collapse
Breathlessness
Difficulty to speak 
Loss of vision 
***sign = Inferior ST elevation***

Question 5

Aortic Dissection: Signs

Answer 5

Inferior ST elevation
Raised/reduced BP
Absent/reduced Peripheral Pulses
Pulmonary Oedema 
Aortic Regurgitation -> Early diastolic murmur

Question 6

Aortic Dissection: Investigation

Answer 6

MRI
ECG - inferior ST elevation 
ECHO 
CT
CXR - widened mediastinum 
Trans-Oesophageal ECHO = TOE

Question 7

Aortic Dissection: Treatment

Answer 7

Type A: Ascending: Aortic root replacement surgery - optimal long term treatment
Type B: Descending: BP control, Beta blocker, Sodium Nitroprusside
Bed rest
Cosnervative management
Acute Operative mortality <25%
In neonates - give IV prostaglandins to maintain open Patent Ductus Arteriosus until performing surgery