Aortic Dissection

Question 1

Define aortic dissection

What are the two types?

Answer 1

Tear in the intima of the aorta -> blood enters false lumen between intima and media

Type A – ascending aorta
Type B – descending aorta distal to L subclavian

Question 2

What are the causes/risk factors of aortic dissection?

Answer 2

• Hypertension
• Atherosclerosis
• Connective tissue disease e.g. Marfan’s, Ehlers-Danlos
• Congenital cardiac abnormalities e.g. aortic coarctation
• Aortitis
• Iatrogenic e.g. angiography
• Trauma
• Crack cocaine

Question 3

What are the symptoms of aortic dissection?

Answer 3

• Sudden onset tearing pain radiating to the back

Carotid
• Syncope
• Hemiparesis

Coronary
• Chest pain
• SOB

Subclavian
• Altered mental status/LOC
• Ataxia

Anterior spinal
• Paraplegia

Coeliac
• Severe abdominal pain

Renal
• Anuria

Question 4

What are the signs of aortic dissection?

Answer 4

• Hypertension
• Hypotension – tamponade or shock
• BP discrepancy >20mmHg
• pulsus paradoxus

Aortic regurgitation
• Wide pulse pressure
• Collapsing pulse
• Early diastolic murmur

Question 5

What investigations are carried out for aortic dissection?

Answer 5

• ECG - ST segment depression may occur with acute dissection; ST elevation occurs rarely
• chest x-ray - may show widened mediastinum
• cardiac enzymes - cardiac enzymes usually negative
• computed tomography angiography - intimal flap
• renal function tests - elevated creatinine and urea
• liver function tests - elevated aspartate transaminase and alanine transaminase
• lactate - elevated or normal
• full blood count - reduced or normal
• D-dimer - positive