Aortic Dissection

Question 1

What is an aortic dissection?

Answer 1

Caused by a tear in the tunica intima.

With each heartbeat it causes blood to be forced through this tear and it ends up causing more tearing.

This causes a true lumen (between the tunica intima layers) and a false lumen (between the tunica intima and media)

Question 2

What can cause aortic dissection?

Answer 2

•	Chronic HTN
•	Connective tissue disease
o	Marfan’s syndrome
o	Ehlers-Danlos syndrome
•	Aneurysm 
•	Trauma to chest

Question 3

How can an aortic dissection symptomatically present?

Answer 3

• Tearing chest pain of sudden onset
• Radiating to the back
• HTN
• Hypotension as the dissection becomes more severe
• Sweating
• Nausea
• SOB
• Weakness
• Syncope
• Pale

Question 4

How can an aortic dissection clinically present?

Answer 4

• Weak/absent carotid, brachial or femoral pulse
• Variation (>20mmHg) in systolic BP between arms
• Aortic regurgitation
• HTN
• Cardiac tamponade
• Neurological deficits

Question 5

What is Stanford A?

Answer 5

An aortic dissection involving the ascending aorta

Question 6

What is Stanford B?

Answer 6

An aortic dissection involving the descending aorta after the left subclavian artery origin

Question 7

How do you diagnose aortic dissection?

Answer 7

• Transoesophageal echocardiogram
• CT with contrast
• Magnetic resonance angiogram (MRA)

Question 8

How do you manage aortic dissection Stanford A?

Answer 8

• Urgent vascular repair and surgical repair

* BP controlled to 100-120mmHg until surgery

Question 9

How do you manage aortic dissection Stanford B?

Answer 9

• Beta blockers for HTN (labetalol)

Question 10

What are the clinical signs that suggest cardiac tamponade?

Answer 10

• Hypotension
• Muffled heart sounds
• Raised JVP