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Flashcards in 11 17 2014 Aortic Dissection Deck (12)
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What are the risk factors for aortic dissection?

-Chronic HTN
-cystic medial degeneration = Marfan or Ehlers- Danlos syndrome ( CT disorders)
-traumatic insult to aorta


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


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


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


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


Treatment for Type A aortic dissection

- beta blockers ( decrease HR and contractility)
- Vasodilators (sodium nitroprusside)-- rapidly reduces blood pressure

Early SURGICAL correction!
-synthetic aortic graft


Treatment for uncomplicated Type B aortic dissection

* early surgery does not improve outcome in patients

If gets worse -- catheter-based repair with endovascular stent grafts is successful in specific stable patients


Symptoms of thoracic aortic aneurysms

- compress trachea or mainstream bronchus
= cough, dyspnea, pneumonia

- Compression of esophagus
= dysphagia

-Involvement of the recurrent laryngeal
= hoarseness


Symptoms of ascending aorta

dilate aortic ring = aortic regurgitation and symptoms of heart failure


Symptoms of abdominal aorta

pulsating mass
abdominal or back pain
nonspecific gastrointestinal symptoms


Ascending aortic aneurysm is associated with what conditions?

HTN, Marfan syndrome, Loeys-Dietz syndrom, and Ehlers-Danlos syndrome ( CT disorders)


aneurysms of the descending aorta and abdominal aorta are related to what disease

- genetic predisposition
- local vessel inflammation