general

Question 1

definition

Answer 1

catastrophic tear of tunica intima letting luminal blood under high pressure into tunica media…

tunnels a second lumen

Question 2

definition

Answer 2

catastrophic tear of tunica intima letting luminal blood under high pressure into tunica media…

tunnels a second lumen

Question 3

Type A aortic dissections involve

Answer 3

ascending aorta and/or arch (and commonly more of the aorta)

Question 4

Type B dissections involve

Answer 4

descending aorta alone

Question 5

Type A vs. Type B

Answer 5

Type A is more common and more serious

Question 6

Progression

Answer 6

intermittent

go proximally or distally

Question 7

are dissections unique to the aorta?

Answer 7

no! they can occur in other arteries

Question 8

Epidemiology

Answer 8

uncommon
late middle age
males
blacks

Question 9

Associated with…

Answer 9

HTN

Marfan Syndrome or late pregnancy (younger pts)

Question 10

Pathogenesis

Answer 10

1. starts with intimal tear
   - —caused by trauma or surgery or something not obvious
2. dissection of hemorrhage into lumen?

Question 11

motor vehicle accidents with deceleration can cause

Answer 11

intimal tear at the ligamentum arteriosum

Question 12

rupture of vasa vasorum in some cases..

Answer 12

may cause hemorrhage in wall and dissection of this hemorrhage into the lumen may be the next step

Question 13

vasa vasorum

Answer 13

arteries within artery

Question 14

medial dissection commonly associated with..

Answer 14

cystic medial degeneration

Question 15

Type A symptoms

Answer 15

sudden severe sharp “tearing” chest pain
*Anteriorly
moving as the dissection progresses

arm pain and weakness if subclavian artery compromised

altered mental status (if carotid is hit)

collapse (if it ruptures)

lack of pain is uncommon

Question 16

Type B symptoms

Answer 16

sudden severe sharp “tearing chest pain
Between the scapula*
moving as the dissection progresses

rest of symptoms may be same as Type A

Question 17

Complications

Answer 17

rupture (commonly into pericardium; less often into pleural cavity)

occlusion of aortic branches

aortic valve regurgitation

death

Question 18

Diagnosis

Answer 18

requires imaging with transesophageal echocardiogram, computerized tomography, or magnetic resonance imaging

Question 19

Treatment includes

Answer 19

reducing BP to low normal
–beta-blockers and vasodilator therapy

TYPE A
–surgery

Question 20

When would type B require surgery?

Answer 20

only if:
a rupture is impending,
major aortic branches are compromised, or
dissection is progressing

Question 21

Aortic dissection

Answer 21

medical or sometimes surgical EMERGENCY!

Question 22

Type A aortic dissections involve

Answer 22

ascending aorta and/or arch (and commonly more of the aorta)

Question 23

Type B dissections involve

Answer 23

descending aorta alone

Question 24

Type A vs. Type B

Answer 24

Type A is more common and more serious

Question 25

Progression

Answer 25

intermittent

go proximally or distally

Question 26

are dissections unique to the aorta?

Answer 26

no! they can occur in other arteries

Question 27

Epidemiology

Answer 27

uncommon
late middle age
males
blacks

Question 28

Associated with…

Answer 28

HTN

Marfan Syndrome or late pregnancy (younger pts)

Question 29

Pathogenesis

Answer 29

1. starts with intimal tear
   - —caused by trauma or surgery or something not obvious
2. dissection of hemorrhage into lumen?

Question 30

motor vehicle accidents with deceleration can cause

Answer 30

intimal tear at the ligamentum arteriosum

Question 31

rupture of vasa vasorum in some cases..

Answer 31

may cause hemorrhage in wall and dissection of this hemorrhage into the lumen may be the next step

Question 32

vasa vasorum

Answer 32

arteries within artery

Question 33

medial dissection commonly associated with..

Answer 33

cystic medial degeneration

Question 34

Type A symptoms

Answer 34

sudden severe sharp “tearing” chest pain
*Anteriorly
moving as the dissection progresses

arm pain and weakness if subclavian artery compromised

altered mental status (if carotid is hit)

collapse (if it ruptures)

lack of pain is uncommon

Question 35

Type B symptoms

Answer 35

sudden severe sharp “tearing chest pain
Between the scapula*
moving as the dissection progresses

rest of symptoms may be same as Type A

Question 36

Complications

Answer 36

rupture (commonly into pericardium; less often into pleural cavity)

occlusion of aortic branches

aortic valve regurgitation

death

Question 37

Diagnosis

Answer 37

requires imaging with transesophageal echocardiogram, computerized tomography, or magnetic resonance imaging

Question 38

Treatment includes

Answer 38

reducing BP to low normal
–beta-blockers and vasodilator therapy

TYPE A
–surgery

Question 39

When would type B require surgery?

Answer 39

only if:
a rupture is impending,
major aortic branches are compromised, or
dissection is progressing

Question 40

Aortic dissection

Answer 40

medical or sometimes surgical EMERGENCY!