Aortic Dissection Flashcards
What is an aortic dissection?
Tear in the tunica intima of the wall of the aorta
What is the pathophysiology of aortic dissection?
Tear in the tunica intima
Blood flows into tunica media
Forms a false lumen
False lumen propagates proximally + distally
Distal occlusion blocks flow through aortic arch
What are risk factors for aortic dissection?
HTN Smoking Marfan's syndrome Ehlers-Danlos syndrome FHx
What are the symptoms of aortic dissection?
Chest pain through to back
Dizziness
Nausea
What are signs of aortic dissection?
Hypotension
Tachycardia
Different BP in each arm
What are the two classification systems of aortic dissection?
Stanford
DeBakey
What is the Stanford classification?
Type A
- involves ascending aorta
- proximal to L subclavian artery
Type B
- distal to L subclavian artery
- does not involve ascending aorta
What is the DeBakey classification?
Type 1
- originates in ascending aorta
- involves ascending aorta + arch
Type 2
- confined to ascending aorta
Type 3a
- originates distal to L subclavian artery
- extends distally to diaphragm
Type 3b
- originates distal to L subclavian artery
- extends beyond diaphragm
What investigations should be done in a suspected aortic dissection?
ECG
Bloods
- FBC
- U+Es
- troponin
- Group + save / crossmatch
CXR
CT angiogram
What can a CXR show in aortic dissection?
Widened mediastinum
+/- aortic knuckle
How is aortic dissection managed initially?
ABCDE
- keep haemodynamically stable
Keep BP below 110 systolic
How is Stanford type A aortic dissection managed?
Surgical management
How is Stanford type B aortic dissection managed?
Medical management
- IV labetalol
- analgesia
What is the follow up of an aortic dissection?
Anti-hypertensives
CT angiogram
- 1 month
- 3 month
- 6 month
- 12 months
- annually
What are the complications of aortic dissection?
Pericardial tamponade
Aortic incompetence = aortic regurg
