Cardiology\ Aortic Dissection

Question 1

What is the pathophysiology of aortic dissection?

Answer 1

• A tear in the intima causes the intima to separate from the media and/or adventita.

Question 2

What are the risk factors for aortic dissection?

Answer 2

• Hypertension
• atherosclerosis
• preexisting aortic aneurysm
• vasculitis
• collagen vascular disorders
• family history of dissection
• bicuspid aortic valve
• aortic coarctation
• Turner syndrome
• coronary artery bypass graft surgery
• previous aortic valve replacement
• cardiac catheterization
• trauma
• cocaine use

Question 3

What trauma classically can cause dissection?

Answer 3

• Rapid deceleration from a motor vehicle accident

Question 4

What are the clinical manifestations of aortic dissection?

Answer 4

• Sharp
• tearing chest or back pain
• weak or absent carotid, brachial, or femoral pulses
• more than 20 mm Hg difference in systolic BP between the right and left arms

Question 5

What are the complications of aortic dissection?

Answer 5

• Aortic insufficiency
• myocardial infarction
• tamponade
• hemothorax
• stroke
• Horner syndrome (from compression of the cervical sympathetic ganglion)
• vocal cord paralysis (from compression of the left recurrent laryngeal nerve)

Question 6

What imaging findings can be seen with aortic dissection?

Answer 6

• Mediastinal widening on chest x-ray
• two distinct aortic lumens and an intimal flap on chest CT scan with intravenous (IV) contrast or MRI
• transesophageal echocardiogram confirming a true and false lumen

Question 7

What is the management of aortic dissection involving the ascending aorta?

Answer 7

Emergent surgery due to high risk of complications

• mortality rate is 1-2% per hour

Question 8

What is the management of aortic dissection involving the descending aorta?

Answer 8

IV beta-blockers to reduce heart rate and BP (and, thus, vascular stress)