Diagnosis of Aortic Disection

Question 1

The primary event in aortic deisection is

Answer 1

A tear in the aortic intima

Question 2

propagation of the disection can occur

Answer 2

Both distal and proximal to the initial tear

Question 3

The most importan predisposing factor for acute aortic disection is

Answer 3

HTN

Question 4

Predisposing factors for aortic disection

Answer 4

Preexisting aortic aneurysm

Inflammatory disease

Disorders of collagen

biscuspid aortic valve

aortic coarctation

turner syndrom

CABG

Aortic valve replacement

Crack Cocaine

Question 5

Classification systems of aortic disections

Answer 5

DeBakey and Daily (Stanford)

Question 6

Daily calssifications

Most common system used

Answer 6

ascending aorta - Type A

all other - Type B

Question 7

DeBakey system of classification is base on what

Answer 7

The origin of the tear

Question 8

DeBakey Type 1 disection

Answer 8

ascending aorta to aortic arch

Question 9

DeBakey type 2 disection

Answer 9

originating in and confined to the aortic arch

Question 10

Debakey type 3

Answer 10

originating in the descending aorta and extending distally and or proximally

Question 11

Ascending aortic disection are 2x more common the descending disection?

T/F

Answer 11

True

Question 12

Where is the most common site of aortic dissection

Answer 12

Right lateral wall of the Ascending aorta

Question 13

Varients of aortic dissection

Answer 13

Intimal tear without hematoma

aortic intramural hematoma

penetrating athrosclerotic ulcer

Question 14

Typical presentation of aortic disection

Answer 14

sever sharpe or tearing posterior chest or back pain

with radiation to any where in th thorax or abd

can be associated with:

CVA, MI, Heart failure,

Question 15

Chest pain is more common with what type of Daliy calssification

Answer 15

type A

ascending aorta

Question 16

HTN is more common in what type of disection?

Answer 16

Type B

distal dissection

Question 17

Ascending disection can induce the following

Answer 17

Aortic insufficiency causing a decrescendo murmur

hypotension, HF ( in 1/2 -2/3 of these disections)

AMI, cardiac tamponade, hemothorax, CVA and > 20 mmHg BP difference in the arms

Question 18

Clinical manifestations of Type B dissection

Answer 18

Chest or back pain- 86 %

abrupt onset - 89 %

migrating pain - 25 %

hypertension - 69 %

hypotensive shock - 3 %

pulse deficit - 21 %

Question 19

DIagnosis of aortic dissection clinically

Answer 19

Abrupt onset of thoracic or abd pain
that is sharp and tearing

medialstinal or aortic wideing of CXR

Variation in BP in the ext by >20 mmHg

Question 20

STANDARD CT scan disadvantages

Answer 20

intimal flap is seen in less than 75% of cases

site of entry is rarely ID

Question 21

TEE sensitivity for thoracic disection is

Answer 21

97-99%

Question 22

TEE findings include

Answer 22

Intimal disection flap

ture and false lumens

thrombosis of false lumen

Question 23

Prefered methods for evaluating an aortic disection

Answer 23

MRI, CT, multiplane TEE