aortic dissection

Question 1

what is aortic dissection?

Answer 1

1. aortic dissection is a tear in the intimal layer of the aortic wall,
2. causing blood to flow between and split apart the tunica intima and media

Question 2

what is the classification of aortic dissections and how is it classified?

Answer 2

1. type 1 - ascending aorta to the the aortic arch
   - highest mortality and <65 years
2. type 2 - confined to ascending aorta
   - elderly with atherosclerotic disease
3. type 3 - distal to the subclavian artery in the descending aorta
   3a - to diaphragm
   3b - to the abdominal aorta

Question 3

stanford classification

Answer 3

1. group A - debakey type 1 AND 2 ( ascending aorta and aortic arch)
2. group B - dont involve ascending aorta - debakey type III

Question 4

risk factors

Answer 4

1. hypertension
2. atherosclerosis
3. connective tissue - marfan’s/ehler’s-danlos

Question 5

clinical syns

Answer 5

1. severe tearing pain radiating to the back

2. tachycardia, hypotension and aortic regurgitation murmur

Question 6

First line Ix

Answer 6

Chest CT scan

Question 7

Ix

Answer 7

1. baseline bloods
2. crossmatch
3. abg
4. ecg

Question 8

Mx of type A dissections

Answer 8

1. managed surgically - remove ascending aorta and replace with synthetic graft

Question 9

Mx of type B dissections

Answer 9

1. Medeical mnagement - mx hypertension with IV labetalol