Aortic dissection (zero to finals) Flashcards
What is aortic dissection?
Refers to when a break or tear forms in the inner layer of the aorta, allowing blood to flow between the layers of the wall of the aorta.
What are the 3 layers of the aorta?
Adventitia
Media
Intima
What layers of the aorta does blood enter in aortic dissection?
With aortic dissection, blood enters between the intima and media layers of the aorta.
A false lumen full of blood is formed within the wall of the aorta. Intramural refers to within the walls of the blood vessel.
What are the risk factors for aortic dissection?
Age, male sex, smoking, hypertension, poor diet, reduced physical activity and raised cholesterol.
Shares the same risk factors as PVD (peripheral vascular disease).
What is a large risk factor for aortic dissection?
Hypertension
Dissection can be triggered by events that temporarily cause a dramatic increase in blood pressure, such as heavy weightlifting or the use of cocaine.
What cardiac procedures can increase aortic dissection risk?
Bicuspid aortic valve
Coarctation of the aorta
Aortic valve replacement
Coronary artery bypass graft (CABG)
What conditions can increase aortic dissection risk?
Ehlers-Danlos Syndrome
Marfan’s Syndrome
What is the typical presentation for a patient with aortic dissection?
A man aged around 60 with a background of hypertension, presenting with a sudden onset tearing chest pain, has aortic dissection.
Marfan’s and Ehlers-Danlos syndrome are worth remembering as risk factors
What is the main feature of aortic dissection?
A sudden onset, severe, “ripping” or “tearing” chest pain.
The pain may be in the anterior chest when the ascending aorta is affected, or the back if the descending aorta is affected.
What are other potential features of aortic dissection as opposed to just sudden “tearing” chest pain?
Hypertension
Differences in blood pressure between the arms (more than a 20mmHg difference is significant)
Radial pulse deficit (the radial pulse in one arm is decreased or absent and does not match the apex beat)
Diastolic murmur
Focal neurological deficit (e.g., limb weakness or paraesthesia)
Chest and abdominal pain
Collapse (syncope)
Hypotension as the dissection progresses
What is the usual initial investigation for aortic dissection?
CT angiogram is usually the initial investigation to confirm the diagnosis and can generally be performed very quickly.
What imaging investigation can provide further detail and can help plan management for aortic dissection?
MRI angiogram
Why are ECG’s and CXR’s done in aortic dissection?
Often used to exclude other causes (such as myocardial infarction), although they may be normal and falsely reassuring.
Is aortic dissection considered a surgical emergency?
Yes, requires immediate involvement of experienced seniors, vascular surgeons, anaesthetists and intensive care teams.
There is a very high mortality.
How can aortic dissection be managed?
Analgesia (e.g., morphine) is required to manage the pain.
Blood pressure and heart rate need to be well controlled to reduce the stress on the aortic walls. This usually involves beta-blockers.
Surgical intervention from the vascular team will depend on the type of aortic dissection.
