aortic dissection and tamponade

Question 1

what is the pathophysiology of aortic dissection ?

Answer 1

disruption of the middle layer of the wall of the aorta due to bleeding within ( tunica media), results in the formation of a false lumen

Question 2

what are the classification of aortic dissection ?

Answer 2

~~~
debakey I debakey II ( together are stanford A)
debakey II ( stanford B)

stanford A is in the ascending aorta
Stanford B is in the descending aorta

Question 3

what are the risk factors for aortic dissection ?

Answer 3

anything that increases the stress on the aortic wall 
hypertension 
cocaine 
direct trauma 
weight lifting 
coartication of the aorta

Question 4

what genetic factors may pose a risk for the development of aortic dissection ?

Answer 4

marfans syndrome
Ehlers Danlos syndrome
Turner syndrome
bicuspid aortic valve disease

Question 5

what othet inflammatory disorders may pose a risk for the development of aortic dissection ?

Answer 5

vasculitis - giant cell arteritis, takayasu arteritis, rheumatoid artheritis, syphilitic aortitis

Question 6

what are the symptoms of aortic dissection ?

Answer 6

typically severe tearing pain in the chest or the back
abrupt onset and maximal at onset
with type A - retrosternal
with type B - inter-scapular

Question 7

what are the signs of aortic dissection ?

Answer 7

pulse deficit
diastolic murmur or bruit
radio-radial delay ( loss of synchronicity of radial pulses )

Question 8

what are the complications of aortic dissection ?

Answer 8

acute aortic regurgitation 
myocardial ischameia 
pericardial effusion (haemopericardium)
heart failure 
stroke
limb ischaemia

Question 9

how do you make a diagnosis of aortic dissection ?

Answer 9

CT aortic angiogram ( diagnostic)
TOE
MRI

Question 10

how would you make a diagnosis using each imaging modality ?

Answer 10

TOE - intimal flap
Spiral CT - double lumen, intimal flap
MRI - double lumen , intimal flap

Question 11

what shape would a false lumen take in comparison to a true lumen ?

Answer 11

a false lumen is cresenteric
a true lumen is round or oval

true lumen - round or oval

Question 12

what is the general treatment for aortic dissection?

Answer 12

manage in high dependency unit
analgesia - give IV morphine
BP control

Question 13

what is the management for type A dissection ?

Answer 13

surgical emergency
excision of the intimal tear and reconstruction of the aorta with synthetic graft

Question 14

what is the management for type B dissection and when to consider surgery ?

Answer 14

initially medical therapy with tight blood pressure control and serial imaging 

consider surgery if there is ongoing pain
or if the patient has marfan’s syndrome

Question 15

what is the pericardium ?

Answer 15

a double layered fibro-serous sac that envelopes the heart

Question 16

what are the causes of pericarditis ?

Answer 16

RHIM :
radiotherapy
hemopericardium
infections, inflammatory, idiopathic
metabolic disease ( uraemic, hypothyroidism )
Malignancy

Question 17

what is the nature of pericardial pain ?

Answer 17

often confused by pleuritic chest pain
worse on lying flat improves on leaning forward

relieved by leaning forward

Question 18

what are the clinical features of pericarditis ?

Answer 18

1- pericardial friction rub , a rough scratching noise not associated with the cardiac cycle accentuated by leaning forward
2- signs of pericardial effusion
signs of underlying cause

Question 19

what investigations would be required with pericarditis?

Answer 19

ECG
Chest X-ray
Blood test
echo

Question 20

what is the treatment of pericarditis ?

Answer 20

analgesia with NSAIDs, colchicine and exercise restriction in most cases
treat the underlying cause

Question 21

what is the management if there is significant pericardial effusion ?

Answer 21

peri-cardiocentesis

Question 22

when does tamponade happen?

Answer 22

extreme pericardial effusion affecting the cardiac output

Question 23

what are the clinical features of tamponade ?

Answer 23

1- beck’s triad = raised JVP+ hypotension+quiet heart sounds
2- kussmaul’s sign
3- pulsus paradoxus
4- increased cardiac dullness
5- cold clammy peripheries

Question 24

what is pulsus paradoxus?

Answer 24

as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase seen in cardiac tamponade

Question 25

what is the treatment for tamponade ?

Answer 25

emergency pericardiocentesis

emergency pericardial window

Question 26

what is the most common cause of constrictive pericarditits ?

Answer 26

TB

Question 27

what is the most sensitive diagnostic tool in constrictive pericarditis ?

Answer 27

CT , MRT

Question 28

what is the main differential diagnosis in constrictive pericarditis ?

Answer 28

restrictive cardiomyopathy

Question 29

what may be the cause of adhesive pericarditis ?

Answer 29

may be due to rheumatic fever

Question 30

what are the ECG changes in pericarditis ?

Answer 30

saddle shaped ST elevation

Question 31

what does the chest x ray look like in complicated pericarditis ?

Answer 31

globular heart outline if there is pericardial effusion

Question 32

what is the most sensitive diagnostic tool in constrictive pericarditis ?

Answer 32

pericardial knock ( CT and MRT )

Question 33

what is the clinical scenario that should raise your suspicion for a diagnosis of aortic dissection ?

Answer 33

1- acute chest pain plus a simultaneous neurological event
2- acute chest pain with a simultaneous peripheral disease

Question 34

what type of murmur is associated with aortic dissection ?

Answer 34

diastolic murmur
aortic regurgitation

Question 35

what is the definitive investigation for the diagnosis of aortic dissection ?

Answer 35

CT aortic angiogram

Question 36

what are thee indications for surgery ffor aortic ddisseection type B ?

Answer 36

marfans syndrome
worsening pain
expansion

Question 37

what is cconstrictive pericarditis a result of ?

Answer 37

loss of elasticity of the pericardium

Question 38

what is the blood supply off the pericardium ?

Answer 38

internal mammary arteries

Question 39

what is dressler syndrome ?

Answer 39

is a type of pericarditis that happens post MI

Question 40

what are the causes of pericardial effusion ?

Answer 40

same as pericarditis

Question 41

what is the best non invasive diagnostic tool for tamponade ?

Answer 41

echho

Question 42

if we have recurrent pericardial effusion what is the management ?

Answer 42

pleuropericardial window