Aortic Dissection Flashcards
What is aortic dissection?
Tear in the tunica intima of aorta, allowing blood to surge into the aortic wall, creating a false lumen
What are the two types of aortic dissection?
- Type A – ascending aorta (more common)
* Type B – descending aorta
List 5 causes of aortic dissection
- HTN
- Atherosclerosis
- Congenital – aortic coarctation, Marfan’s, SLE
- Iatrogenic – angioplasty
- Crack cocaine use
How would aortic dissection present?
Sudden onset tearing pain down the back
Can have associated symptoms based on blockage of other arteries:
- Carotid - neurological signs e.g. hemiparesis, dysphasia, LOC
- Subclavian - ataxia, LOC
- Renal - anuria, renal failure
What would you find on examination in aortic dissection?
Radio-radial delay
BP discrepancy between arms >20mmHg
Hypertension
Signs of aortic insufficiency – same as aortic regurgitation e.g. ejection-systolic murmur, collapsing pulse
Why would hypotension be concerning if a patient had aortic dissection?
May indicate tamponade - bad prognosis
How would you investigate aortic dissection?
Bloods – FBC, X-match, clotting, U+Es
CXR – widened mediastinum
ECG – often normal, rule out other causes
CT thorax – visualise false lumen
Echo – transoesophageal has high specificity
Cardiac catheterisation + aortography
What 4 steps would you take to manage acute aortic dissection?
- Urgent CT thorax
- Resus
- Blood transfusion
- ITU
How would you manage Type A aortic dissection?
- emergency surgery - insert tube graft to replace affected area
How would you manage Type B aortic dissection?
- Conservative management – IV nitroprusside (vasodilator) ± IV β-blocker to control BP
- Surgery if recurrent/progression
What are 6 possible complications of aortic dissection?
- Rupture
- Tamponade
- MI
- Organ ischaemia
- Pulmonary oedema
- Syncope
Which type has a better prognosis?
Type B
