Thoracic Aortic Disection Flashcards
What is an aortic dissection?
A tear in the tunica intima allows blood to pool between the intima and the media
What is the name for the collection of blood seen in an aortic dissection?
The false lumen
The true lumen is the regular lumen of the blood vessel
Where do aortic dissections most commonly occur?
The thoracic aorta
Where are type A dissections found?
The ascending aorta
Where are type B dissections found?
The descending aorta
Which is more common type A or type B dissections?
Type A (70%)
All patients with type A dissections should be considered for surgery
What are some risk factors for aortic dissection?
As with risk factors for aneurysm it is things that weaken the vessel wall:
- Marfans, Ehlers Danlos
- HTN
- Aneurysms themselves can weaken the wall
What are some complications of aortic dissection?
This depends on where the blood in the false lumen flows and the degree of obstruction of the true lumen. As the false lumen extends branches are occluded sequentially.
Pericardial tamponade- if flows into the pericardial space
Renal Artery Occlusion
Arm Pain due to Subclavian artery occlusion
Aortic valve incompetence
Inferior MIs
Cardiac Arrest
What are some symptoms of aortic dissections?
Tearing chest pain
Radiation to the back
Arm Pain
Not passing any urine
What are some signs of aortic dissection?
Unequal radial pulses
Anuria
Unequal BP between arms
Pallor and coldness of the upper arms- if limb ischaemia
Hypotension and Tachycardia if significant blood loss
What investigations should be done for a suspected aortic dissection?
CXR- Widened Aorta
CT Thorax
Transesophageal Echo (TOE)
ECG- Risk of pericardial tamponade and inferior MI if false lumen moves proximally
What is the management of thoracic aortic dissections?
Transfer to ITU
Surgical intervention
Blood pressure control- between 100-110
