Aortic Dissection

Question 1

What is dissection?

Answer 1

Separation of layers within the aortic wall - there is a tear in the aortic intima - leads to blood in the intima and media

Question 2

What classification is used for dissection?

Answer 2

The DeBakey classification - look at PPP

Question 3

Symptoms:

What do patient describe the chest pain as?

What do the following sites of the pain suggest the dissection is?:

• Anterior chest pain
• Neck or jaw pain
• Intra-scapular pain

Answer 3

A tearing or ripping pain

(1) Anterior chest pain - anterior arch or aortic root
(2) Neck or jaw pain - aortic arch involvement and extension into the great vessels
(3) Intra-scapular pain - descending aorta

Question 4

Signs:

What sign may you notice on pulses?

What are some signs of aortic regurg?

If the vessel was to burst within the pericardial sac, you would get cardiac tamponade. What signs suggest this?

D-DIMERS CAN BE RAISED IN DISSECTION SO WORTH TESTING FOR

Answer 4

Radio-radial delay

Bounding pulses
Wide pulse pressure
Diastolic murmurs

Muffled heart sounds
Hypotension
Pulsus paradoxus

Question 5

Inv:

CXR:
- What is seen with a ascending dissection/A?

CT/CT angiography is confirmatory alongside MRI.

What is an aorta specific imaging that is not used as much anymore?

Answer 5

Mediastinal mass

Aortography

Question 6

Management:

What is the only way to manage this?

Where are they taken to straight away?

What is given to dilate the artery?

Answer 6

Surgery

ICU

Vasodilators - Sidum nitroprusside
Beta-blockers - slows demand on heart - ESMOLOL

Question 7

Management:

Endovascualr stent graft - look up on YT

What are some complications of this operation?

Answer 7

Migration

Endo-leaks and perforation