Aortic Dissection Flashcards

1
Q

What is aortic dissection?

A

A tear in the wall of the aorta, the walls are then forced apart by blood.
Comes in Acute & chronic forms

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2
Q

What causes aortic dissection?

A
  • Trauma
  • Cardiac Surgery
  • Marfan’s Syndrome
  • Congenital Bicuspid AV
  • Atherosclerosis
  • Hypertension
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3
Q

What are the risk factors for aortic dissection?

A

Trauma - Smoking - Hypercholesterolaemia - Hypertension - Pregnancy - Cocaine use - Arteritis

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4
Q

What are the symptoms of Aortic Dissection?

A
  • Severe tearing chest pain radiating to the back (location varies based on location/spread of tear)
  • Collapse due to tamponade/Acute AR/External rupture
  • Pleuritic Chest Pain due to cardiac tamponade and/or haemothorax from an external rupture
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5
Q

What are the clinical signs of aortic dissection?

A
  • reduced or absent peripheral pulses
  • BP mismatch between limbs
  • AR murmur (sort early diastolic)
  • Hyper/Hypotension
  • Pulmonary Oedema
  • Inferior ST elevation
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6
Q

How do we investigate a case of Aortic Dissection?

A

CXR: Can show mediastinal widening - pleural effusion - Loss of aortic knob - tracheal deviation. A -ve CXR doesnt rule out AD

CTA/MRA: MRA is the best and can confirm the diagnosis

TOE: The most common way to confirm the diagnosis

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7
Q

How do we classify Aortic dissection?

A

Stanford:
A = Asc. Aorta involved - treat Surgically
B = Asc. aorta excluded - Treat medically

Debakey:
1 = Propagates from Asc. Aorta
2 = Stays in Asc. Aorta
3 = Starts in Desc. Aorta and can move

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8
Q

How do we medically treat Aortic Dissection?

A

With Strict BP control:
CCBs - Beta Blockers - Sodium Nitroprusside (vasodilator)

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9
Q

How do we surgically treat Aortic Dissection?

A

Surgically replacing the valve and/or a section of the aorta.

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