Dissecting Aortic Aneurysm

Question 1

(1) *Ascending Aorta is the portion of Aorta that starts at the Aortic valve and ends at the start of the brachiocephalic trunk.

(2) *Aortic arch starts at the brachiocephalic trunk and ends just distal the left subclavian artery.

(3) *Descending aorta starts just after the left subclavian artery and ends at the diaphragm.

(4) *Abdominal aorta starts at the diaphragm and ends at the branch point of the iliac arteries.

Answer 1

*Anatomy: Dissecting Aortic Aneurysm

Question 2

3 layers in the Aorta:

Answer 2

*The intima, media, and adventitia

Question 3

is a spontaneous or traumatic tear in the intimal layer of the aorta causing dissection of the inner and middle walls of the
aorta.

Blood entering the tear may propagate the dissection into the abdominal aorta, carotids, subclavian, or lower extremity arteries.

may occlude major aortic branches leading to ischemia of the brain, kidney, upper extremity, or lower extremities.

Spontaneous dissections are highly associated with hypertension, connective tissue disorders (Marfan syndrome), bicuspid aortic valve, pregnancy, and coarctation of the aorta.

Answer 3

Aortic dissection

Question 4

dissection involves the arch of the aorta proximal to the left
subclavian artery.

Answer 4

Type A dissection

Question 5

dissection occurs in the proximal descending aorta.

Answer 5

Type B dissection

Question 6

(1) *Sudden severe chest pain radiating to the back, often described as ripping or tearing px.
(2) Hypertension
(3) Syncope
(4) Paralysis of lower extremities
(5) Diminished or unequal peripheral pulses
(6) *Possible diastolic murmur of Aortic Regurgitation

Answer 6

Symptoms/Physical Findings: Dissecting Aortic Aneurysm

Question 7

(1) *CXR: May reveal abnormal aortic contour or WIDENED
MEDIASTIMUM.
(2) *CT scan with IV contrast is imaging gold standard

Answer 7

Labs/Studies/EKG: Dissecting Aortic Aneurysm

Question 8

BP Goal for Aortic Dissection’s

Answer 8

lower blood pressure to SBP of 100-120 and lower HR to
<80.

Question 9

Type A aortic dissections require

Answer 9

emergent surgery.

Question 10

Type B aortic dissections do not require

Answer 10

emergent surgery unless blood flow is lost to extremities or other organs.

Question 11

(1) The goal is to lower blood pressure to SBP of 100-120 and HR to <80.
(2) Type A aortic dissections require emergent surgery.
(3) Type B aortic dissections do not require emergent surgery unless blood flow is lost to extremities or other organs.
(4) ABCs, IV, O2 if saturation < 94%, Monitor.
(5) Beta blockers are the mainstay of therapy.
(a) Metoprolol 5 mg IV, or 50-100 mg orally
(b) Labetalol 5-10 mg IV q 30 minutes to goal, or 100 mg q 6 hours orally.
(6) Pain control with Morphine 4-8 mg IV.
(7) Long-term management can use regular antihypertensive medications and beta blockers such as ACEI, ARB, and Diuretics.
(8) Smoking cessation
(9) Surgery is the definitive therapy for Type A dissections.

Answer 11

Treatment: Dissecting Aortic Aneurysm

Question 12

(1) Blood pressure and HR control
(2) Pain control to assist in decreasing blood pressure.
(3) ABCs
(4) MEDEVAC to higher level of care

Answer 12

Initial Care: Dissecting Aortic Aneurysm

Question 13

Untreated type A dissection has a mortality rate of

Answer 13

1% at 72 hours and
90% at 3 months if unrepaired.