Aortic Dissection Flashcards
What is aortic dissection?
Damage to the intima allows blood to collect between the layers of the aorta.
What are the consequences?
Can lead to obstruction of the true lumen especially if no outlet for blood flow.
Can block small vessels and cause local problems- Coronary Arteries, Carotids
Pathophysiology- how many phases?
Two
Describe phase 1
Pain and pulse loss
Phase 2?
Rupture
Into Pericardium
Mediastinum
Pleura
Consequence of rupture into the pericardium?
Cardiac Tamponade.
Symptoms?
Sharp tearing Pain
Sudden onset and at maximal intensity
Pain migrates
Syncope
What problems are associated with dissection?
Myocardial Ischaemia- Angina
Aortic Regurgitation
Heart Failure
High risk factors?
Male 50-70 Years Hypertension Marfan's Syndrome Smoking
Investigations?
ECG- shows Ischaemia
CT
MRI
Doppler
What do we need to establish
Site of dissection
Extent of dissection
Any small vessel involvement
Treatment?
Surgery Morphine IV fluids Blood transfusion Beta Blockers Lower blood pressure
Why beta blockers?
Lower the heart rate and strength of contraction
Reduce the rate of dilation
Why is Marfans associated?
Marfans causes dilation of the Aorta and can lead to Aortic Regurgitation
How can the risk of AD be minimised in Marfans?
- periodic aortic diameter screening
- Limit extreme strenuous exercise
- Lifelong beta blockers
- prophylactic aortic graft.
