Dissections

Question 1

How is acute aortic dissection defined

Answer 1

within the past 14 days

Question 2

Define Stanford type A dissection

Answer 2

involves the ascending aorta

Question 3

Define Stanford type B dissection

Answer 3

those that do not involve the ascending aorta

Question 4

Define Debakey class I dissection

Answer 4

ascending aorta thru the arch and into the descending

Question 5

Define Debakey class II dissection

Answer 5

limited to the ascending aorta

Question 6

Define Debakey class III dissection

Answer 6

descending aorta

Question 7

What is the imaging study of choice for a dissection

Answer 7

CTA

Question 8

What imaging can be done to substitute for a contrast allergy to dx dissection

Answer 8

transesophageal echocardiography

Question 9

Why is pharmacologic tx important

Answer 9

decrease blood pressure and reduce left ventricular ejection

Question 10

What is the goal systolic blood pressure for patients with a dissection

Answer 10

120mmHg

Question 11

What is the drug of choice to tx HTN in patients with a dissection

Answer 11

nitroprusside

Question 12

How should Stanford A or DeBakey class I and II dissections be treated

Answer 12

surgically

Question 13

How should Stanford B and DeBakey 3 dissections be treated

Answer 13

aggressive medical management of uncomplicated dissections; complicated- surgical

Question 14

What defines a complicated dissection

Answer 14

1. suspicion of leak or rupture 2. visceral, renal, spinal or peripheral malperfusion 3. dilation 4. HTN despite medical tx 5. persistent pain

Question 15

What is the MC catastrophic event involving the aorta

Answer 15

dissection

Question 16

What layers of the aorta are affected by dissections

Answer 16

intima and media

Question 17

Is a dissection involving the intima considered a true or false lumen

Answer 17

TRUE

Question 18

Is a dissection involving the media considered a true or false lumen

Answer 18

FALSE

Question 19

Define an intramural hematoma

Answer 19

hemorrhage from the vaso-vasoum causing blood to collect within the media (intima remains intact)

Question 20

Define penetrating aortic ulcer

Answer 20

deep ulcers that borrow into the aortic wall and allow blood to enter the media

Question 21

True or false: intramural hematomas and penetrating aortic ulcers weaken the aortic wall making it prone to rupture

Answer 21

TRUE

Question 22

What causes malperfusion syndrome of the aorta

Answer 22

false lumen compresses the true lumen causing ischemia

Question 23

malperfusion can cause what type of cardiac regurgitation

Answer 23

acute valvular regurgitation