Cardiology - A Deadly Mimic - Aortic Dissection

Question 1

Explain the newer, Stanford classification of aortic dissection.

Answer 1

Type A:
- involvement of ascending aorta

Type B:
- not involving ascending aorta

Question 2

Explain what type of aortic dissection may mimic STEMI on 12-lead, and why this occurs.

Answer 2

Type A aortic dissections may dissect around the ostia (openings) of the coronary arteries. In doing so, they may prevent adequate blood flow to the myocardium, producing ischemic chest pain and ST segment elevation.

Question 3

In what condition should aortic dissection be considered, though it is often not?

A. STEMI
B. Stroke
C. AMS

Answer 3

B. Stroke

Due to decreased cerebral blood flow, aortic dissection should be included on list of differential Dx for stroke

Question 4

AMI occurs in roughly ___ % of Type I aortic dissections.

Answer 4

1-2%

Question 5

Early type ____ dissections produce anterior chest pain similar to an MI.

A. A
B. B

Answer 5

A. type A

Question 6

Type A aortic dissection may begin to produce back/posterior chest pain as it moves _____.

A. up the ascending aorta
B. down the descending aorta

Answer 6

B. down the descending aorta

Question 7

Explain the differences in pain (onset, maximum pain occurrence, description) associated with AD vs. MI

Answer 7

AD onset: abrupt
MI onset: slow onset

AD maximum pain: peaks early
MI maximum pain: peaks later

AD pain description: sharp/tearing/ripping
MI pain description: pressure

Remember, it takes time for ischemia to develop in the MI and eventually produce pain. For the AD, it may take time for the dissection to produce pain, but when it does, it HURTS!!!

Question 8

T/F: Pulse deficits between arms greater than 20 mmHg are often found in aortic dissection.

Answer 8

False! It only occurs in 20-30% of patients

Question 9

T/F: Widening pulse pressure is often found in AD.

Answer 9

True