Thoracic Aortic dissection

Question 1

Define Aortic dissection

Answer 1

Separation of lamiar planes of the media of the vessel to form a channel within the vessel wall. Blood enters the space and continues to cause separation of layers proximally to distally

Question 2

What are some of the causes of aortic dissection?

Answer 2

HTN
Atherosclerosis
Marfan's syndrome
Ehler's Danlos syndrome
Vitamin C deficiency

Question 3

How does an aortic dissection present?

Answer 3

Sudden onset of tearing chest pain that radiates to the back
Tachycardia
HTN
Unequal arm pulses
Unequal arm BP
*If propagates distally, may have hemiplegia/anuria
*If propagates proximally, may have aortic regurgitation

Question 4

How can aortic dissections be classified?

Answer 4

Stanford classification
Type A - 70%. Proximal. Involves ascending aorta +/- descending. Usually require surgery, higher mortality
Type B - 30%. Distal. Involves descending aorta only (distal to left SC artery). Best managed conservatively

Question 5

What investigations can be done in a patient with suspected Aortic dissection?

Answer 5

Bloods - FBC, U+Es, Cross match, Clotting, Amylase
ECG - excludes MI
Trans-oesophageal echo - can be used in unstable patients
CT/MRI - If patient is stable enough

Question 6

What is the management of a patient with an aortic dissection?

Answer 6

Resusitate
Investigate
Treat - Analgesia, ↓Systolic BP to 100-110
Type A - Open repair
Type B - Conservative - Surgery if persistent pain/complications. Thoracic Endovascular Aortic Repair if uncomplication