Flashcards in 11 17 2014 Aortic Dissection Deck (12)
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1
What are the risk factors for aortic dissection?
-Chronic HTN
-Aging
-cystic medial degeneration = Marfan or Ehlers- Danlos syndrome ( CT disorders)
-traumatic insult to aorta
2
Class A vs. Class B anatomy
Class A involves the proximal aorta ( ascending --> aortic arch) regardless of where the tear originated.
Class B involves the deciding aorta
3
Aortic Dissection
Blood from aorta passes through a tear in the intima into the medial layer and spreads along the artery
Another postulate origin is rupture of vasa vasorum with hemorrhage into the media
4
Etiology of Aortic Dissection
Common in 6th and 7th decades and occur more frequently in men
* most common in ascending thoracic aorta ( 65%)
Proximal aortic involvement tends to be more devastating because of the potential for extension into the coronary and arch vessels
5
Clinical presentation
1. pain
2. associated symptoms
severe tearing or ripping quality in the anterior chest or between the scapula ( radiates to back)
Pain can radiate along the aorta or anywhere in the thorax or abdomen
- painless tear is possible but uncommon
2. HTN due to the pain or the decrease in renal flow -- increase RAAS
Type A can have aortic regurgitation.
Leakage from type A = cardiac tamponade
6
Treatment for Type A aortic dissection
REDUCE SYSTOLIC BP
- beta blockers ( decrease HR and contractility)
- Vasodilators (sodium nitroprusside)-- rapidly reduces blood pressure
Early SURGICAL correction!
-synthetic aortic graft
7
Treatment for uncomplicated Type B aortic dissection
MEDICATION
* early surgery does not improve outcome in patients
If gets worse -- catheter-based repair with endovascular stent grafts is successful in specific stable patients
8
Symptoms of thoracic aortic aneurysms
- compress trachea or mainstream bronchus
= cough, dyspnea, pneumonia
- Compression of esophagus
= dysphagia
-Involvement of the recurrent laryngeal
= hoarseness
9
Symptoms of ascending aorta
dilate aortic ring = aortic regurgitation and symptoms of heart failure
10
Symptoms of abdominal aorta
pulsating mass
abdominal or back pain
nonspecific gastrointestinal symptoms
11
Ascending aortic aneurysm is associated with what conditions?
HTN, Marfan syndrome, Loeys-Dietz syndrom, and Ehlers-Danlos syndrome ( CT disorders)
12
