Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AIP Chest pain > Aortic dissection > Flashcards

Aortic dissection Flashcards

1
Q

How common is aortic dissection in comparison to abdominal aortic aneurysm rupture?

A

3x as common (but still rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiology of aortic dissection?

A
  • tear in the tunica intima of the wall of the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 3 possibilities as to how blood enters the tunica media of the aorta in aortic dissection?

A
  1. atherosclerotic ulcer leading to intimal tear
  2. Disruption of vasa vasorum causing intramural haematoma
  3. De novo intimal tear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 5 possible things that can occur following aortic dissection (i.e. blood flow into the tunica media)?

A
  1. Extension up or down
  2. Rupture
  3. Vessel branch occlusion
  4. Aortic regurgitation
  5. Pericardial effusion/ tamponade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 7 conditions associated with aortic dissection?

A
  1. Hypertension
  2. Trauma
  3. Bicuspid aortic valve
  4. Collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
  5. Turner’s and Noonan’s syndrome
  6. Pregnancy
  7. Syphilis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most important risk factor for aortic dissection?

A

hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 5 clinical features of aortic dissection?

A
  1. Chest pain: typically severe, radiates through to back and ‘tearing’ in nature
  2. Pulse deficit: weak or absent carotid, brachial, or femoral
  3. Variation (>20 mmHg) in systolic BP between the arms
  4. Aortic regurgitation (early diastolic decrescendo murmur, eponymous clinical signs)
  5. Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the nature of the chest pain of aortic dissection?

A
  • severe
  • typically ripping or tearing in nature
  • occurs suddenly and maximal at onset
  • retrosternal or interscapular
  • migrating, may go down the back

(but pain not always present)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can the location of pain in aortic dissection suggest the part of the affected aorta?

A

retrosternal chest pain: anterior dissection

interscapular pain: descending aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 3 possible features of aortic dissection which may occur due to the involvement of specific branching arteries?

A
  1. Coronary arteries: angina
  2. Spinal arteries: paraplegia/paraesthesias
  3. Distal aorta: limb ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should you remember about when to consider a diagnosis of aortic dissection, due to the frequency of atypical presentations of this condition?

A
  • consider aortic dissection if there is a combination of chest/ back pain and new or evolving neurological deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What may ECG show in aortic dissection? 4 possibilities

A
  1. majority have no or non-specific ECG changes
  2. in minority of patients, ST segment elevation may be seen in inferior leads (right coronary artery dissection)
  3. Pericarditis changes
  4. Electrical alternans (tamponade)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 2 types of classification for aortic dissection?

A
  1. Stanford classification
  2. DeBakey classification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 2 types of aortic dissection according to the Stanford classification?

A
  1. Type A: ascending aorta
  2. Type B: descending aorta, distal to left subclavian origin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the relative proportions of cases of Type A vs Type B aortic dissections (Stanford classification)?

A
  • type A: 2/3
  • type B: 1/3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 types of aortic dissection according to the DeBakey classification?

A
  1. Type I: originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
  2. Type II: originates in and is confined to the ascending aorta
  3. Type III: originates in descending aorta, rarely extends proximally but will extend distally
17
Q

What should you do if a patient with suspected aortic dissection is hypo (rather than hyper-) tensive?

A

ensure not due to upper limb discrepancy caused by an occluded vessel - check BP in arm with best radial pulse

18
Q

What is a key bedside test to perform in suspected aortic dissection?

A

ECG

19
Q

What are 5 key blood tests to perform in suspected aortic dissection?

A
  1. FBC: leukocytosis likely
  2. Creatine Kinase: elevates with renal artery involvement
  3. Troponin - can cause myocardial ischaemia
  4. D-dimer: if negative dissection very unlikely, not sufficient to rule out
  5. Cross-match
20
Q

What are 5 types of imaging that can be performed in suspected aortic dissection?

A
  1. CXR
  2. Echocardiography: Transthoracic or Traonoesophageal (TOE)
  3. Helical CT/ CT angiography
  4. Aortography
  5. MRI/MRA
21
Q

What are 8 possible findings on a CXR for aortic dissection?

A
  1. normal in 11-16%
  2. widened mediastinum (56-63%)
  3. abnormal aortic contour (48%)
  4. aortic knuckle double calcium sign >5mm (14%)
  5. pleural effusion (L>R)
  6. Tracheal shift
  7. Left apical cap
  8. Deviated NGT
22
Q

What type of echocardiography is more sensitive and specific for aortic dissection?

A

transoesophageal

23
Q

What are 4 disadvantages of transoesophageal echocardiography for imaging aortic dissection?

A
  1. Operator-dependent
  2. Need sedation
  3. Less available
  4. Upper ascending aorta and arch not well visualised
24
Q

When is it useful to perform echo for suspected aortic dissection?

A

unstable patients who are too risky to take to CT scanner, and in ICU/perioperatively

25
Q

Which imaging method is the method of choice for aortic dissection?

A

CT angiography of chest, abdomen and pelvis

26
Q

What is the key finding on CT angiography suggesting aortic dissection?

A

false lumen

27
Q

What was the previous gold standard imaging for aortic dissection (replaced now by MRI/CT/echo)?

A

aortography

28
Q

What are the pros vs cons of MRI/MRA to diagnose aortic dissection?

A

excellent sensitivity and specificity but low availability

29
Q

What are the 3 emergency priorities in aortic dissection?

A
  1. control BP
  2. control bleeding
  3. fluid resuscitation
30
Q

What are 8 aspects of the immediate management of aortic dissection?

A
  1. give oxygen
  2. wide bore IV access (Swan sheath)
  3. invasive monitoring
  4. warn blood bank (cross match 6 units + need for other products)
  5. correct coagulopathy
  6. contorl HR and BP (aim for HR 60-80 an BP 100-120)
  7. IV beta blocker (propranolol, esmolol or labetalol) + vasodilators (e.g. GTN, labetalol, SNP)
  8. call cardiothoracic surgeon
31
Q

What are the 2 types of IV drugs you should give as part of the immediate management of aortic dissection and in what order?

A
  1. IV beta blocker: propranolol, esmolol, labetalol
  2. Vasodilators: GTN, labetalol, SNP

start beta blocker first to avoid increased aortic wall stress from reflex tachycardia

32
Q

What are 4 indications for surgery for aortic dissection?

A
  1. Persistent pain
  2. Type A (Stanford)
  3. Branch occlusion
  4. Leak
  5. Continued extension despite optimal medical management
33
Q

What must be achieved while awaiting surgical intervention for Type A aortic dissection?

A

blood pressure should be controlled to target systolic of 100-120 mmHg

34
Q

What is the management of Type B aortic dissection (Stanford)?

A

conservative management; bed rest, reduce BP with IV labetalol to prevent progression

35
Q

What are 6 possible complications of aortic dissection?

A
  1. aortic rupture
  2. aortic regurgitation
  3. acute myocardial infarction
  4. cardiac tamponade
  5. end-organ ischaemia (brain, limbs, spine, renal, gut, liver)
  6. death
36
Q

What type of management might be possible for type B aortic dissection in the future?

A

endovascular repair

AIP Chest pain (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions