Aortic Dissection

Question 1

ESSENCE

Answer 1

Break or tear forms in inner layer of aorta, allowing blood to flow between layers (enters between intima and media layers)

Question 2

AETIOLOGY

Risk factors

Answer 2

• Same as peripheral arterial disease
• Hypertension
• Conditions/procedures that affect aorta
  
  • Bicuspid aortic valve
  • Coarctation of aorta
  • Aortic valve replacement
  • CABG
• Conditions that affect connective tissues
  
  • Ehlers-Danlos syndrome
  • Marfans syndrome

Question 3

CLINICAL FEATURES

Presentation

Answer 3

• Sudden onset, severe ripping or tearing chest pain
  
  • Anterior if ascending aorta, back if descending
• Hypertension
• Differences in BP between arms
• Radial pulse deficit
• Diastolic murmur
• Focal neurological deficit
• Chest and abdominal pain
• Collapse (syncope)
• Hypotension as dissection progresses

Question 4

Is murmur systolic or diastolic

Answer 4

Diastolic

Question 5

INVESTIGATIONS

First line

Answer 5

• 1) CT angiogram - confirm diagnosis
• ECG and x-ray to exclude other cause
• MRI angiogram - greater detail but takes longer

Question 6

COMPLICATIONS

Answer 6

• Myocardial infarction
• Stroke
• Paraplegia (motor or sensory impairment in legs)
• Cardiac tamponade
• Aortic valve regurgitation
• Death

Question 7

MANAGEMENT

General

Answer 7

• Analgesia
• Beta blockers - control blood pressure and heart rate
• Surgical intervention
  
  • Type A - open surgery (midline sternotomy)
  • Type B - endovascular aortic repair (TEVAR)

Question 8

CLASSIFICATION

Answer 8

• Stanford system
  
  • A - ascending aorta before brachiocephalic artery
  • B - descending aorta, after left subclavian artery