Aortic dissection

Question 1

define aortic dissection?

Answer 1

a condition where a tear in theaortic intimaallows blood to surge into the aortic wall, causing a split between the inner and outer tunica media, creating afalse lumen

Question 2

how to classify aortic dissection?

Answer 2

• ascending aortic dissection (this is common)

- descending aortic dissection

Question 3

what is the aetiology of an aortic dissection?

Answer 3

• aortic dissections are preceded by degenerative changes in the smooth muscle of the aortic media

Question 4

what are common risk factors for an aortic dissection?

Answer 4

• hypertension
• aortic atherosclerosis
• connective tissue disease eg. marfans
• congenital cardiac abnormalities
• iatrogenic causes (angiography)
• trauma
• crack cocaine

Question 5

what is a dangerous effect of aortic dissection?

Answer 5

• the expansion of the false lumen might result in obstruction of the subclavian, carotid, coeliac and renal arteries.

Question 6

what is the main presenting complaint of aortic dissection?

Answer 6

• sudden central tearing pain radiating to the back in between the shoulder blades.

Question 7

what are the other symptoms of aortic dissection if it obstructs other branches of the aorta?

Answer 7

• carotid artery: hemiparesis, dysphasia, blackout
• coronary artery: chest pain
• subclavian artery : ataxia, loss of consciousness
• anterior spinal artery: paraplegia
• coeliac artery : severe abdominal pain
• renal artery :anuria, renal failure

Question 8

how to recognise aortic dissection on physical examination?

Answer 8

• murmur on the back
• hypertension
• blood pressure difference between the arms is more than 20mmHg
• wide pulse pressure
• unequal arm pulses
• there could be a palpable abdominal mass
• there might be signs of aortic regurgitation

Question 9

what might hypotension in aortic dissection suggest?

Answer 9

this suggests cardiac tamponade

Question 10

what is pulsus paradoxus?

Answer 10

abnormally large decrease insystolic blood pressureandpulse wave amplitudeduringinspiration

Question 11

what might pulsus paradoxus indicate?

Answer 11

• tamponade
• pericarditis
• chronic sleep apnoea
• obstructive lung disease

Question 12

what are the appropriate investigations for aortic dissection?

Answer 12

• bloods
• chest xray
• ECG
• CT thorax
• echo
• Cardiac catheterisation and aortography

Question 13

what bloods should be taken for aortic dissection?

Answer 13

• FBC
• x-match 10 units of blood
• Us and Es
• clotting screen

Question 14

what might be seen on a chest x-ray of aortic dissection?

Answer 14

• widened mediastinum

Question 15

what might be seen on a ECG of aortic dissection?

Answer 15

• its often normal
• if the ostia is damaged you might get
• left ventricular hypertrophy or inferior MI

Question 16

what might be seen on a CT thorax?

Answer 16

• it could show the false lumen