Aortic Dissection

Question 1

What is an aortic dissection?

Answer 1

• Tear of the tunica intima letting luminal blood under high pressure into tunica media - Creates a second lumen

Question 2

Type A aortic dissections involve

Answer 2

Ascending aorta and/or arch (and commonly more of the aorta)

Question 3

Type B dissections involve

Answer 3

Descending aorta alone

Question 4

Type A vs. Type B

Answer 4

Type A is more common and more serious

Question 5

Progression

Answer 5

intermittent go proximally or distally

Question 6

are dissections unique to the aorta?

Answer 6

no! they can occur in other arteries

Question 7

Epidemiology

Answer 7

uncommon late middle age males blacks

Question 8

Associated with…

Answer 8

HTN Marfan Syndrome or late pregnancy (younger pts)

Question 9

Pathogenesis

Answer 9

1. starts with intimal tear —-caused by trauma or surgery or something not obvious 2. dissection of hemorrhage into lumen?

Question 10

motor vehicle accidents with deceleration can cause

Answer 10

intimal tear at the ligamentum arteriosum

Question 11

rupture of vasa vasorum in some cases..

Answer 11

may cause hemorrhage in wall and dissection of this hemorrhage into the lumen may be the next step

Question 12

vasa vasorum

Answer 12

arteries within artery

Question 13

medial dissection commonly associated with..

Answer 13

cystic medial degeneration

Question 14

Type A symptoms

Answer 14

sudden severe sharp “tearing” chest pain ***Anteriorly** moving as the dissection progresses arm pain and weakness if subclavian artery compromised altered mental status (if carotid is hit) collapse (if it ruptures) lack of pain is uncommon

Question 15

Type B symptoms

Answer 15

sudden severe sharp “tearing chest pain ***Between the scapula**** moving as the dissection progresses rest of symptoms may be same as Type A

Question 16

Complications

Answer 16

rupture (commonly into pericardium; less often into pleural cavity) occlusion of aortic branches aortic valve regurgitation death

Question 17

Diagnosis

Answer 17

requires imaging with transesophageal echocardiogram, computerized tomography, or magnetic resonance imaging

Question 18

Treatment includes

Answer 18

reducing BP to low normal –beta-blockers and vasodilator therapy TYPE A –surgery

Question 19

When would type B require surgery?

Answer 19

only if: a rupture is impending, major aortic branches are compromised, or dissection is progressing

Question 20

Aortic dissection

Answer 20

medical or sometimes surgical EMERGENCY!

Question 21

Type A aortic dissections involve

Answer 21

ascending aorta and/or arch (and commonly more of the aorta)

Question 22

Type B dissections involve

Answer 22

descending aorta alone

Question 23

Type A vs. Type B

Answer 23

Type A is more common and more serious

Question 24

Progression

Answer 24

intermittent go proximally or distally

Question 25

are dissections unique to the aorta?

Answer 25

no! they can occur in other arteries

Question 26

Epidemiology

Answer 26

uncommon late middle age males blacks

Question 27

Associated with…

Answer 27

HTN Marfan Syndrome or late pregnancy (younger pts)

Question 28

Pathogenesis

Answer 28

1. starts with intimal tear —-caused by trauma or surgery or something not obvious 2. dissection of hemorrhage into lumen?

Question 29

motor vehicle accidents with deceleration can cause

Answer 29

intimal tear at the ligamentum arteriosum

Question 30

rupture of vasa vasorum in some cases..

Answer 30

may cause hemorrhage in wall and dissection of this hemorrhage into the lumen may be the next step

Question 31

vasa vasorum

Answer 31

arteries within artery

Question 32

medial dissection commonly associated with..

Answer 32

cystic medial degeneration

Question 33

Type A symptoms

Answer 33

sudden severe sharp “tearing” chest pain ***Anteriorly** moving as the dissection progresses arm pain and weakness if subclavian artery compromised altered mental status (if carotid is hit) collapse (if it ruptures) lack of pain is uncommon

Question 34

Type B symptoms

Answer 34

sudden severe sharp “tearing chest pain ***Between the scapula**** moving as the dissection progresses rest of symptoms may be same as Type A

Question 35

Complications

Answer 35

rupture (commonly into pericardium; less often into pleural cavity) occlusion of aortic branches aortic valve regurgitation death

Question 36

Diagnosis

Answer 36

requires imaging with transesophageal echocardiogram, computerized tomography, or magnetic resonance imaging

Question 37

Treatment includes

Answer 37

reducing BP to low normal –beta-blockers and vasodilator therapy TYPE A –surgery

Question 38

When would type B require surgery?

Answer 38

only if: a rupture is impending, major aortic branches are compromised, or dissection is progressing

Question 39

Aortic dissection

Answer 39

medical or sometimes surgical EMERGENCY!