Diagnosis of Aortic Disection Flashcards

1
Q

The primary event in aortic deisection is

A

A tear in the aortic intima

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2
Q

propagation of the disection can occur

A

Both distal and proximal to the initial tear

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3
Q

The most importan predisposing factor for acute aortic disection is

A

HTN

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4
Q

Predisposing factors for aortic disection

A

Preexisting aortic aneurysm

Inflammatory disease

Disorders of collagen

biscuspid aortic valve

aortic coarctation

turner syndrom

CABG

Aortic valve replacement

Crack Cocaine

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5
Q

Classification systems of aortic disections

A

DeBakey and Daily (Stanford)

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6
Q

Daily calssifications

Most common system used

A

ascending aorta - Type A

all other - Type B

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7
Q

DeBakey system of classification is base on what

A

The origin of the tear

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8
Q

DeBakey Type 1 disection

A

ascending aorta to aortic arch

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9
Q

DeBakey type 2 disection

A

originating in and confined to the aortic arch

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10
Q

Debakey type 3

A

originating in the descending aorta and extending distally and or proximally

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11
Q

Ascending aortic disection are 2x more common the descending disection?

T/F

A

True

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12
Q

Where is the most common site of aortic dissection

A

Right lateral wall of the Ascending aorta

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13
Q

Varients of aortic dissection

A

Intimal tear without hematoma

aortic intramural hematoma

penetrating athrosclerotic ulcer

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14
Q

Typical presentation of aortic disection

A

sever sharpe or tearing posterior chest or back pain

with radiation to any where in th thorax or abd

can be associated with:

CVA, MI, Heart failure,

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15
Q

Chest pain is more common with what type of Daliy calssification

A

type A

ascending aorta

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16
Q

HTN is more common in what type of disection?

A

Type B

distal dissection

17
Q

Ascending disection can induce the following

A

Aortic insufficiency causing a decrescendo murmur

hypotension, HF ( in 1/2 -2/3 of these disections)

AMI, cardiac tamponade, hemothorax, CVA and > 20 mmHg BP difference in the arms

18
Q

Clinical manifestations of Type B dissection

A

Chest or back pain- 86 %

abrupt onset - 89 %

migrating pain - 25 %

hypertension - 69 %

hypotensive shock - 3 %

pulse deficit - 21 %

19
Q

DIagnosis of aortic dissection clinically

A

Abrupt onset of thoracic or abd pain
that is sharp and tearing

medialstinal or aortic wideing of CXR

Variation in BP in the ext by >20 mmHg

20
Q

STANDARD CT scan disadvantages

A

intimal flap is seen in less than 75% of cases

site of entry is rarely ID

21
Q

TEE sensitivity for thoracic disection is

A

97-99%

22
Q

TEE findings include

A

Intimal disection flap

ture and false lumens

thrombosis of false lumen

23
Q

Prefered methods for evaluating an aortic disection

A

MRI, CT, multiplane TEE