Aortic dissection Flashcards
Pathophysiology?
Tear in the tunica intima of the wall of the aorta
Associations?
- hypertension: the most important risk factor
- trauma
- bicuspid aortic valve
- collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
- Turner’s and Noonan’s syndrome
- pregnancy
- syphilis
Symptoms and signs?
- chest pain: typically severe, radiates through to the back and ‘tearing’ in nature
- aortic regurgitation
- hypertension
- other features may result from the involvement of specific arteries. For example coronary arteries → angina, spinal arteries → paraplegia, distal aorta → limb ischaemia
ECG changes?
Majority of patients have no or non-specific ECG changes. In a minority of patients, ST-segment elevation may be seen in the inferior leads
What 2 classification systems are there?
Stanford classification and Debakey classifcation
What is Stanford classification criteria?
- Type A - ascending aorta, 2/3 of cases
- Type B - descending aorta, distal to left subclavian origin, 1/3 of cases
What is DeBakey classification criteria?
- Type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
- Type II - originates in and is confined to the ascending aorta
- Type III - originates in descending aorta, rarely extends proximally but will extend distally
Management is based off which classification?
Stanford Classification
Management for Type A?
Surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention
Management for Type B?
- conservative management
- bed rest
- reduce blood pressure with IV labetalol to prevent progression
Complications of a backward tear?
- aortic incompetence/regurgitation
* MI: inferior pattern often seen due to right coronary involvement
Complications of a forward tear?
- unequal arm pulses and BP
- stroke
- renal failure
