aortic dissection

Question 1

what is aortic dissection

Answer 1

Formation of a false lumen between the tunica intima and tunica media of the aorta - severe medical emergency

Question 2

Aetiology

Answer 2

• Rupture in aorta leads to decreased blood flow to organs.
• Medical emergency as it can lead to full-thickness tearig due to weakening of aortic wall leading to complete rupture.
• False lumen: area within tunica media where blood pools.
• Occurs due to hypertension, coarction of aorta, genetic connective tissue disorders.

Question 3

Type A (proximal)

Answer 3

• False lumen seen on imaging
• Ascending aorta, radial-radial delay
• Rupture causes blood to leak into pericardial sac - cardiac temponade

Question 4

Type B (distal)

Answer 4

• Radio-femoaral delay
• All dissections EXCEPT ascending aorta
• Occlusion of major aortic branch leads to end-organ ischemia

Question 5

Complications

Answer 5

• Pericardial temponade
• Haemmorhaging
• Compressing branching arteries

Question 6

Risk factors

Answer 6

• Preexisting aortic aneurysm
• Elderly, male, hypertension
• Use of amphetamines or cocain

Question 7

Signs

Answer 7

• Sudden sharp pain radiating to upper back and shoulders
• Weak pulse
• BP unequal in both arms, aortic regurgitation murmur

Question 8

Investigations

Answer 8

CT Angiography

• Shows true and false lumen, effect on organ perfusion

Question 9

Management Type A (proximal)

Answer 9

Emergency surgical repair: open lap or TEVAR

Question 10

management Type B (distal)

Answer 10

• Beta blockers (e.g. bisoprolol)
  
  • Decreases BP velocity and LV contraction