Aortic dissection

Question 1

Aortic dissection define

Answer 1

Walls of aorta intimate split-blood flows the new gap (inner/outer layer of media)-can continue to branches of the aorta
70% ascending aorta, and 30%-other part of aorta

acute within 14 days

Question 2

Aortic dissection aetiology risk factor

Answer 2

Aetiology-Initial tear in which blood flows into

Predisposed to tear-
Over 50, Hypertension
family history of aneurysm, soft tissue diseases
Recent weightlifting, cocaine

Soft tissue genetic issues
Marfans/ Ehler-Danlos/Bicuspid Aortic valve (possibly also a result of abnormal Soft tissue)

Aortic atherosclerosis +dilation/inflam/infection/trauma

or can result from surgery handling of aorta (rare)

Question 3

Aortic dissection epidemology

Answer 3

RARE -max 2.5 per 100000 people

Question 4

Aortic dissection presentation

Answer 4

Tearing back in the chest (that can also go to the back) -quite specific
Can be anterior chest, retroscapular, lower back -migrates as time passes

can present many ways-stable or hypovaleamic shock, and tons more

small amount have syncope
70% ascending aorta, and 30%-other part of aorta

acute within 14 days

The pain and Hx is the most characteristic

Can be: signs of shock, heart failure, tamponade
Limbs can be depressed/weak/in pain/parasthesia (usually means involves paracostal vessels)

Blood pressure difference between upper and lower limbs

Question 5

Aortic dissection investigations

Answer 5

Exclude other things-
ECG (MI), Bloods (Cardiac enzymes, Pneumonia)
Chest xray (pneumonia)

Low D-dimer but can help differential -PE

check CRP, elastin degradation products

DIAGNOSIS-
transoesophageal echo-UNSTABLE
CT angio-stable

cxr-unspecific

Chest CT
central displacement of the intimal flap, calcification, or separation of intimal layers are definitive signs of aortic dissection

Question 6

Aortic dissection Differential

Answer 6

Chest pain emergency-MI (pain central/crushing. previous angina/risk factors)(ACS),
Pericarditis (pleuritic painn)),
Aortic aneurysm (asympto,
Lungs- Pulmonary oedema (SOB, DVT/risk factors, hypoxia), Pneumonia
MSK problem (palpate-pain)

Question 7

Management of Aortic dissection

Answer 7

ascending- more common- need surgical help and mainting bp <120

Descending-less common-main management is BP and rest (IV labetolol)

monitor complications- Aortic REGURG -classic
Forward tear