Cardio- Aortic Dissection

Question 1

WHat is an aortic dissection

Answer 1

breech in the intergrity of aortic wall/tear in the intima which allows blood into the intima-media space creating a false lumen

Question 2

What is the most important risk factor for aortic dissection as well as other risk factors

Answer 2

HTN

vasculitis(syphillis, takayasu arteritis)
connective tissue disorders
coartation of aorta
third trimester pregnancies
sudden decellerating injuries
bicuspid aortic valves(seen in turner syndrome)
aortic aneurysms

Question 3

clinical features of an aortic dissection

Answer 3

chest pain radiating to back
HTN
asymmetric bp in arms/wide pulse pressure
syncope
features of aortic regurg (new onset diastolic murmur in 30%)

rupture into pleura-> dyspnea
peritoneum->hypotension shock
pericardium-> cardiac tamponade

Question 4

What is the gold standard for investigating a potential aortic dissection

Answer 4

CT angiogram

Question 5

Investigations done for a suspected aortic dissection?

Answer 5

radiological vs ecg vs bloodwork

ecg on all patients (left ventricular hypertrophy due to htn and ischaemic changes in inferior leads)

CT angio indicated for stable patients

transesophageal echo

if unstable -> cxr, transthoracic echo

bloods-> lactate to r/o ischaemic gut, amylase to r/o pancreatitis, troponin to r/o MI

Question 6

Stamford A vs Stamford B Aortic dissection

Answer 6

STamford A-> ascending aorta only(requires Sx)

stamford B-> any not involving ascending aorta (can be managed conservatively