Aortic Dissection

Question 1

What is Aortic dissection? (2 points)

Answer 1

1. Tear in Tunica Intima layer of Aortic wall
2. Causing blood to flow between Tunica Intima + Media

Question 2

What is the difference between Acute + Chronic Aortic dissection?

Answer 2

• Acute: Dx within 14 days
• Chronic: Dx after 14 days

Question 3

What are the different classification system of Aortic Dissection? (2 things)

Answer 3

1. Stanford classification
2. DeBakey classification

Question 4

What is the Stanford classification of Aortic dissection?

Answer 4

• Type A: affects ascending aorta (before brachiocephalic artery)
• Type B: affects descending aorta (after left subclavian artery)

Question 5

Which Stanford Classification Aortic Dissection is more common?

Answer 5

Type A (2/3 of cases)

Question 6

What is the DeBakey classification of Aortic dissection?

Answer 6

• Type 1: Originates in Ascending aorta, involves at least aortic arch (if not whole aorta)
• Type 2: Confined to Ascending aorta
• Type 3: Originates in Descending aorta (after Subclavian artery)

Question 7

Who is Type 1 DeBakey Aortic Dissection usually seen in?

Answer 7

Under 65 year olds

Question 8

Which DeBakey Aortic dissection type has the highest mortality?

Answer 8

Type 1

Question 9

Who is Type 2 DeBakey Aortic dissection usually seen in?

Answer 9

Elderly w Atherosclerotic disease + HTN

Question 10

What are the RF for Aortic Dissection? (5 things)

Answer 10

1. HTN
2. Atherosclerotic disease
3. Male
4. CT disorders (e.g Marfans / Ehler’s Danlos)
5. Bicuspid aortic valve

Question 11

What is the general rule about Aortic Dissection RF? (2 things)

Answer 11

1. Younger pts often associated w CT disorders
2. Older pts often have underlying HTN / atherosclerosis

Question 12

Why is Aortic Dissection a tricky Dx?

Answer 12

Difficult to spot, often missed

Question 13

What are the CF of Aortic Dissection? (4 things)

Answer 13

1. Chest pain (tearing / ripping) (severe)
2. Aortic regurg
3. HTN
4. CF specific to certain arteries

Question 14

Where does the Chest pain radiate to in Aortic dissection?

Answer 14

Radiates to back

Question 15

What CF is specific to Aortic dissection in Coronary arteries?

Answer 15

Angina

Question 16

What CF is specific to Aortic dissection in Spinal arteries?

Answer 16

Paraplegia

Question 17

What CF is specific to Aortic dissection in Distal aorta?

Answer 17

Limb ischaemia

Question 18

What investigations should you quickly do to exclude other causes of Chest pain (aka MI)? (2 things)

Answer 18

1. ECG
2. CXR

Question 19

What is a problem about Dx MI in sus Aortic dissection? (2 points)

Answer 19

1. MI can occur in combination with Aortic dissection
2. Tx of MI (aka thrombolysis) –> causes fatal progression of Aortic dissection

Question 20

What is the GOLD standard investigation to confirm Dx of Aortic dissection?

Answer 20

CT angiogram

Question 21

What investigation can you do after confirming Aortic dissection Dx with CTA?

Answer 21

MRI angiogram

Question 22

What is the use of MRI angiogram in Aortic dissection? (2 things)

Answer 22

1. Provides more detail
2. Helps plan management

Question 23

What are some DDx that present similarly to Aortic Dissection (4 things)

Answer 23

1. MI
2. PE
3. Pericarditis
4. MSK back pain

Question 24

How can you differentiate between MI and Aortic dissection? (3 things)

Answer 24

MI will have:
1. “Crushing” chest pain
2. CF of cardiac ischaemia on ECG
3. Raised Troponin

Question 25

How can you differentiate between PE and Aortic dissection? (3 things)

Answer 25

PE wil have: 1. Dyspnoea 2. Hypoxia on ABG 3. CTPA / V/Q scan confirms Dx

Question 26

How can you differentiate between Pericarditis and Aortic dissection? (3 things)

Answer 26

Pericarditis will have: 1. “Pleuritic” chest pain 2. ST elevation on ECG 3. Pericardial rub @ ausc

Question 27

How can you differentiate between MSK back pain and Aortic dissection? (2 things)

Answer 27

MSK back pain will have: 1. Tender to palpation of chest wall / paraspinal muscles 2. NO systemic signs of shock

Question 28

What are the Mx options for Aortic dissection? (3 things)

Answer 28

1. Analgesia (e.g morphine) 2. Beta blockers (for BP + HR control to reduce stress on aortic walls) 3. Surgery

Question 29

What does the Surgery for Aortic dissection depend on?

Answer 29

Type of aortic dissection

Question 30

What are the Surgical Mx options for Type A Aortic dissection? (3 steps)

Answer 30

Open surgery (midline sternotomy) 1. Remove section of aorta w defect 2. Replace section with synthetic graft 3. Potentially replace Aortic valve

Question 31

What are the Surgical Mx options for Type B Aortic dissection? (2 steps)

Answer 31

Thoracic EndoVascular Aortic Repair (TEVAR) 1. Insert catheter via femoral artery 2. Insert stent graft into affected section of Descending aorta

Question 32

What will complication cases of Type B Aortic dissection require?

Answer 32

Open surgery

Question 33

What are the complications of Aortic dissection? (6 things)

Answer 33

1. MI 2. Stroke 3. Paraplegia (motor / sensory impairment in legs) 4. Cardiac tamponade 5. Aortic regurg 6. Death