Aortic Dissection

Question 1

What is the Stanford classification for aortic dissection?

Answer 1

Type A and type B

Question 2

What is Type A aortic dissection?

Answer 2

Involves the ascending aorta, before the brachiocephalic artery. Associated with chest pain and requires rapid surgical intervention.

Question 3

What is type B aortic dissection?

Answer 3

Involves the descending aorta post-subclavian artery on the aortic arch and typically presents with back pain. Managed with watchful waiting or thoracic endovascular repair via the femoral.

Question 4

What is the DeBakey classification of aortic dissection?

Answer 4

Type 1
Type 2
Type 3A
Type 3B

Question 5

What is Type 1 aortic dissection in Be Bakey’s?

Answer 5

Involves the ascending aorta and can extend to the whole aorta

Question 6

What is Type 2 aortic dissection in De Bakey’s?

Answer 6

Only involves the aortic arch

Question 7

What is Type 3A aortic dissection in Be Bakey’s?

Answer 7

Descending aorta above the diaphragm

Question 8

What is Type 3B aortic dissection in Be Bakey’s?

Answer 8

Descending aorta below the diaphragm

Question 9

How does aortic dissection present?

Answer 9

Radial pulse is higher in one arm, typically 20 mmHg

Radio-radial delay

Radio-femoral delay

Diastolic murmur due to aortic regurgitation

Syncope

Focal neurological deficits such as paraplegia

Question 10

What are the complications with aortic dissection?

Answer 10

Stroke
Aortic regurgitation
MI
Paraplegia
Cardiac tamponade

Question 11

Which medication should be avoided with aortic dissection?

Answer 11

Thrombolytics due to reducing clot formation and increasing the risk of rupture

Question 12

How is aortic dissection diagnosed?

Answer 12

CXR
CT angiogram or mRI angiogram

Question 13

What are the risk factors for aortic dissection?

Answer 13

Male
Smoker
Hypertension
Connective tissue disorder
Cocaine use
Bicuspid aortic valve
CABG
Aortic valve replacement

Question 14

What is the initial management of aortic dissection?

Answer 14

Resuscitation
Blood pressure regulation, ith beta blockers
Cardiac monitoring

Question 15

Which imaging type is used where proximal dissection is suspected?

Answer 15

Trans-thoracic echocardiograpy is ideal for ascending aorta dissection

Question 16

What will ECG show for aortic dissection?

Answer 16

ST depression due to ischaemia or left ventiruclar hypertrophy but may be normal

Question 17

How does proximal aortic dissection present?

Answer 17

Chest pain
Radio-radial delay
inferior ST elevation on ECG
Aortic regurgitation

Question 18

What to do for Type A aortic dissection?

Answer 18

IV labetalol and surgery for ascending aorta

Question 19

What to do for type B dissection?

Answer 19

IV lbaetalol only

Question 20

What causes radio-radial delay?

Answer 20

Ascending aorta occlusion

Question 21

What causes radiofemoral delay?

Answer 21

Type B dissectiontion

Question 22

What Must be present in ruptured AA?

Answer 22

Pulsatilele mass

Question 23

What is the most common association for aortic dissection?

Answer 23

Hypertension

Question 24

Which bedside test is most suggestive of aortic dissection?

Answer 24

Bilateral blood pressure measurements with difference of over 20mmHg on each arm

Question 25

How to manage patients in hypovolaemic shock with aortic dissection

Answer 25

Emergency vascular surgical review -> patients are stable enough for CT scan

Question 26

How to differentiate between aortic dissection and ruptured aneurysm?

Answer 26

Aortic dissections commonly present with severe chest pain that is often described as tearing in nature with new diastolic murmur. Ruptured abdominal aortic aneurysm would usually present with abdominal or back pain as opposed to chest pain. Also, there may be features of shock (e.g. presyncope, cool peripheries, low blood pressure) and a pulsatile, expansile mass on examination of the abdomen

Question 27

What is a a key finding for CT angiogram?

Answer 27

False lumen

Question 28

How does dissection involving spinal arteries present?

Answer 28

Paraplegia

Question 29

How is ECG affected in dissection?

Answer 29

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 30

Which limb tends to be affected in dissection?r

Answer 30

Right leg which is further from ventricle

Question 31

What does aortic dissection show on imaging?

Answer 31

A false lumen is a key finding suggestive of aortic dissection on CT angiography