aortic dissection and tamponade Flashcards
what is the pathophysiology of aortic dissection ?
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
what are the classification of aortic dissection ?
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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
what are the risk factors for aortic dissection ?
anything that increases the stress on the aortic wall hypertension cocaine direct trauma weight lifting coartication of the aorta
what genetic factors may pose a risk for the development of aortic dissection ?
marfans syndrome
Ehlers Danlos syndrome
Turner syndrome
bicuspid aortic valve disease
what othet inflammatory disorders may pose a risk for the development of aortic dissection ?
vasculitis - giant cell arteritis, takayasu arteritis, rheumatoid artheritis, syphilitic aortitis
what are the symptoms of aortic dissection ?
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
what are the signs of aortic dissection ?
pulse deficit
diastolic murmur or bruit
radio-radial delay ( loss of synchronicity of radial pulses )
what are the complications of aortic dissection ?
acute aortic regurgitation myocardial ischameia pericardial effusion (haemopericardium) heart failure stroke limb ischaemia
how do you make a diagnosis of aortic dissection ?
CT aortic angiogram ( diagnostic)
TOE
MRI
how would you make a diagnosis using each imaging modality ?
TOE - intimal flap
Spiral CT - double lumen, intimal flap
MRI - double lumen , intimal flap
what shape would a false lumen take in comparison to a true lumen ?
a false lumen is cresenteric
a true lumen is round or oval
true lumen - round or oval
what is the general treatment for aortic dissection?
manage in high dependency unit
analgesia - give IV morphine
BP control
what is the management for type A dissection ?
surgical emergency
excision of the intimal tear and reconstruction of the aorta with synthetic graft
what is the management for type B dissection and when to consider surgery ?
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
what is the pericardium ?
a double layered fibro-serous sac that envelopes the heart
what are the causes of pericarditis ?
RHIM :
radiotherapy
hemopericardium
infections, inflammatory, idiopathic
metabolic disease ( uraemic, hypothyroidism )
Malignancy
what is the nature of pericardial pain ?
often confused by pleuritic chest pain
worse on lying flat improves on leaning forward
relieved by leaning forward
what are the clinical features of pericarditis ?
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
what investigations would be required with pericarditis?
ECG
Chest X-ray
Blood test
echo
what is the treatment of pericarditis ?
analgesia with NSAIDs, colchicine and exercise restriction in most cases
treat the underlying cause
what is the management if there is significant pericardial effusion ?
peri-cardiocentesis
when does tamponade happen?
extreme pericardial effusion affecting the cardiac output
what are the clinical features of tamponade ?
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
what is pulsus paradoxus?
as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase seen in cardiac tamponade
what is the treatment for tamponade ?
emergency pericardiocentesis
emergency pericardial window
what is the most common cause of constrictive pericarditits ?
TB
what is the most sensitive diagnostic tool in constrictive pericarditis ?
CT , MRT
what is the main differential diagnosis in constrictive pericarditis ?
restrictive cardiomyopathy
what may be the cause of adhesive pericarditis ?
may be due to rheumatic fever
what are the ECG changes in pericarditis ?
saddle shaped ST elevation
what does the chest x ray look like in complicated pericarditis ?
globular heart outline if there is pericardial effusion
what is the most sensitive diagnostic tool in constrictive pericarditis ?
pericardial knock ( CT and MRT )
what is the clinical scenario that should raise your suspicion for a diagnosis of aortic dissection ?
1- acute chest pain plus a simultaneous neurological event
2- acute chest pain with a simultaneous peripheral disease
what type of murmur is associated with aortic dissection ?
diastolic murmur
aortic regurgitation
what is the definitive investigation for the diagnosis of aortic dissection ?
CT aortic angiogram
what are thee indications for surgery ffor aortic ddisseection type B ?
marfans syndrome
worsening pain
expansion
what is cconstrictive pericarditis a result of ?
loss of elasticity of the pericardium
what is the blood supply off the pericardium ?
internal mammary arteries
what is dressler syndrome ?
is a type of pericarditis that happens post MI
what are the causes of pericardial effusion ?
same as pericarditis
what is the best non invasive diagnostic tool for tamponade ?
echho
if we have recurrent pericardial effusion what is the management ?
pleuropericardial window
