Aortic Dissection

Question 1

What is aortic dissection?

Answer 1

A condition where a tear in the aortic intima allows blood to surge into the aortic wall, causing a split between the inner and outer tunica media, and creating a false lumen.

Question 2

What are risk factors for development of aortic dissection?

Answer 2

• typically occurs in male over 50
• Hypertension
• atherosclerotic aneurysmal disease
• smoking, use of amphetamines and cocaine
• Genetic syndromes (tissue disease)
  
  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • coarcitation (narrowing of aorta)
  • bicuspid aortic valve
  • annulo-aortic ectasia
• dilation of the proximal ascending aorta
• family history of aortic aneurysm or dissection

Question 3

What is the aetiology of aortic dissection?

Answer 3

Normally develops due to high pressure

• stress related? increased plasma volume (e.g. pregnancy)
  
  • creates stress on the vessel wall leading to tear of tunica intima (more likely in congentical vascular abnormalitites)
• might also be due to trauma

Question 4

What are symptoms of someone with an Aortic Dissection?

Answer 4

• Sudden and severe tearing/ripping painLocation
  
  • Anterior chest (ascending) or back (descending) –> aortic arch and root –> decreased bloof flow do coronary arteries)
  • Interscapular or retrosternal pain (descending aorta)
  • Neck and jaw (aortic arch affected –> into great vessels)
  • Abdomen or periumbilical, colicky pain
    
    • Character: migrates as the dissected wall propagates caudally
• Confusion, agitation

Question 5

What are signs of aortic dissection on examination?

Answer 5

• Hyper/Hypotension (blood loss/cardiac tamponade)
• different BP in different limbs
• Heart murmor due to aortic regurgitation in proximal dissection

Question 6

What would be appropriate investigations when suspecting an aortic dissection?

Answer 6

• ECG to exclude other causes of severe chest pain
• CXR in low-moderate risk
  
  • widened mediastinum with increased cardiothroacic ratio
• CT/MRI angio in high risk patients or
  
  • if CXT abnormal
  • otherwise unexplained hypotension

Question 7

What is the epidemiology of aortic dissection?

Answer 7

The worldwide incidence of aortic dissection is 0.5 to 2.95 cases per 100,000 people annually

• normally men over 50

Question 8

Which parts of the aorta are most commonly affected by aortic dissection?