aortic dissection - Felner

Question 1

Two types of aortic dissection and how serious they are

Answer 1

1. proximal to left subclavian artery (BP different); surgical emergency
2. distal to LSCA… getting that blood to the left subclavian artery so not as severe

Question 2

define dissection

Answer 2

• Tear of intimal portion of blood vessel that causes vulnerability to open the whole aorta… blood goes down intima instead of lumen and we lose a lot of blood

Question 3

define transection

Answer 3

• shearing aorta right at ligamentum arteriosum… DISSECTING BOTH INTIMA AND MEDIA

Question 4

Name symptoms/signs

Answer 4

• tearing chest pain thru to back (max intensity at onset… no radiation)

Type 1 has arm BP differences

Cold leg/stroke/MI/tamponade

Question 5

What is the best test for aortic dissection.. what’s drawback

Answer 5

• MRI, but can’t be done in emergency

So we do TEE

Question 6

finding on aortic dissection for CXR?

TEE?

Answer 6

• widened mediastinum

- aortic dissection

Question 7

cardiac complications of aortic dissection

Answer 7

1. aortic regurgitation (acute and severe)

2. pericardial effusion (tamponade)

Question 8

therapy for aortic dissection medically and surgically

Answer 8

medical:

• beta blocker: decrease sehear stress
• nitroprusside: decrease blood pressure if > 100 (rapid acting)