12 Aortic Dissection and Related Aortic Syndromes Flashcards
examples of acute aortic syndromes
aortic dissection
penetrating atherosclerotic ulcer
intramural hematoma
aortic aneurysmal leakage
ruptured abdominal aortic aneurysm
the most common cardiovascular complication of Marfan’s syndrome
aortic root disease and type A dissection (ascending aorta)
remarks on acute aortic syndromes
acute aortic syndromes occur in the setting of chronic hypertension and other factors that lead to degeneration of the media of the aortic wall
chronic cocaine or amphetamine use accelerates atherosclerosis and increase the risk for dissection
remarks on aortic dissection
aortic dissection occurs after a violation of the intima allows blood to ender the media and dissect between the intimal and adventitial layers
the 2 most common intimal tear sites in aortic dissection
- sinotubular juction at the start of the ascending aorta (50-65%)
- just beyond the left subclavian artery at the junction between the ascending and descending aorta (20-30%)
2 systems of classifying aortic dissections
- Standford classification
- DeBakey classification
Describe Standford classification
Type A: any involvement of the ascending aorta
- more commonly presents with anterior chest pain
Type B: restricted to only the descending aorta
- more commonly presents with abdominal pain
Describe DeBakey classification
Type 1: simultaneously involves the ascending aorta, the arch, and the descending aorta
Type 2: involves only the ascending aorta
Type 3: involves only the descending aorta
remarks on aortic intramural hematoma
- it results from infarction of the aortic media, usually from injury to the vasa vasorum
- this often appears as a crescent on CT
- an intramural hematoma may resolve spontaneously or may lead to dissection
classic presentation of aortic dissection
abrupt and severe pain in the chest that radiates to an area between the scapulae and may be accompanied by a feeling of impending doom
dissection that may present as a classic stroke
dissection in or near a carotid artery
dissection that may lead to cardiac tamponade
a proximal dissection to the aortic root may lead to cardiac tamponade
and is generally fatal
remarks on blood pressure difference in aortic dissectio
a blood pressure difference >20 mm Hg between arms is independently associated with aortic dissection
however, 19% of ED patients without dissection also have this clinical finding
Category 1 features of aortic dissection as per the Aortic Dissection Detection Risk Score (ADDRS)
“Underlying Condition”
Marfan’s syndrome
Family history of aortic disease
Aortic valvular disease
Recent aortic manipulation
Thoracic aortic aneurysm
Category 2 features of aortic dissection as per the Aortic Dissection Detection Risk Score (ADDRS)
Chest/back/abdominal Pain”
Abrupt onset
Severe in intesneity
Ripping or tearing