Aortic Dissection

Question 1

association of aortic dissection

Answer 1

hypertension: the most important risk factor

trauma

bicuspid aortic valve

collagens: Marfan’s syndrome, Ehlers-Danlos syndrome

Turner’s and Noonan’s syndrome

pregnancy

syphilis

Question 2

features of aortic dissection

Answer 2

• chest/back pain

typically severe and ‘sharp’, ‘tearing’ in nature

pain is typically maximal at onset

classically chest pain is more common in type A dissection and upper back pain is more common in type B dissection. However, there is considerable overlap and both chest and back pain are present in many patients

• pulse deficit
  weak or absent carotid, brachial, or femoral pulse
  variation (>20 mmHg) in systolic blood pressure between the arms
• aortic regurgitation
• hypertension
• other features may result from the involvement of specific arteries. For example:
  coronary arteries → angina
  spinal arteries → paraplegia
  distal aorta → limb ischaemia
• the majority of patients have no or non-specific ECG changes. In a minority of patients, ST-segment elevation may be seen in the inferior leads

Question 3

• weak or absent carotid, brachial, or femoral pulse
• variation in arm BP

what does this indicate

Answer 3

In aortic dissection, a pulse deficit may be seen:
weak or absent carotid, brachial, or femoral pulse
variation in arm BP

Question 4

The initial management of dissections of the descending thoracic aorta is with…..

if it doesn’t work then surgery can be looked at

Answer 4

blood pressure control