Condition- Aortic Dissection Flashcards

1
Q

What is an aortic dissection?

A

A condition where a tear in the aortic intima allows blood to surge into the aortic wall, causing a split between the inner and outer tunica media, creating a false lumen

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2
Q

What are the two classifications of aortic dissection and which is the most common?

A
  1. Type A: ASCENDING Aorta: Most common (70%)
  2. Type B: DESCENDING Aorta: Less common (30%) Distal to the subclavian artery
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3
Q

Descirbe the pathophysiology of aortic dissection

A
  1. An intimal tear is the initial event
  2. Subsequent degeneration of the medial layer of the aortic wall
  3. Blood then passes through the media, propagating distally or proximally and creating a false lumen
  4. As the dissection propagates, flow through the false lumen can occlude flow through branches of the aorta
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4
Q

List some risk factors for developing Aortic Dissection. What is the main RF?

A
  • HYPERTENSION-often poorly controlled
  • Aortic Atherosclerosis
  • Smoking
  • Usually in their 50s
  • Iatrogenic- angioplasty etc.
  • Younger patients may have:
    • Connective-tissue disorder (SLE, Marfan’s, Ehlers-Danlos)
    • Recent history of heavy lifting
    • cocaine use
    • Congenital cardiac abnormalities
  • FHx of aortic aneurysms, dissection, or a connective-tissue disorder
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5
Q

Describe the chest pain experienced by someone with aortic dissection

A
  • S: Central
  • O: Acute onset
  • C: TEARING or RIPPING chest pain
  • R: May radiate to the back in between the shoulder blades
  • S: severe
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6
Q

Describe some of the other symptoms that may be experienced dependent on which branches of the aorta are obstructed.

* Go through the different branches and think about what could happen if they were occluded

A
  • Carotid: Hemiparesis, dysphasia, syncope
  • Coronary: Chest Pain (MI)
  • Subclavian: Ataxia, loss of consciousness
  • Anterior Spinal: paraplegia
  • Coeliac: Abdo pain
  • Renal: Anuria, renal failure
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7
Q

List some of the signs of Aortic Dissection on physical examination

A
  • Distolic Murmur on the back below left scapula (crescendo pattern)
  • Blood pressure differences >20mmHg between two arms
  • Wide pulse pressure
  • Hypertension
  • Signs of aortic regurgitation:
    • High volume collapsing pulse
    • Early DBP over aortic area
  • May be palpable abdo mass
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8
Q

A difference in blood pressure greater than xmmHg between the two arms is suggestive of aortic dissection?

A

20mmHg

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9
Q

Why might you get hypotension in a patient with aortic dissection. How could you check for this

A

Hypotension may suggest tamponade

Check for pulsus paradoxus = abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

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10
Q

Which investigations could you order for someone with suspected aortic dissection? What is the GOLD STANDARD + FIRST LINE investigation?

A
  1. CT and Echocardiography- can visualise intimal flap
  2. ECG- to rule ou Myocardial Ischaemia. Should be normal. If MI get ST elevation or ST depression+ T inversion
  3. Bloods
    • FBC- anaemia
    • X-match
    • U&Es: renal function
    • LFTs: clotting screen too
    • Lactate: indicates malperfusion
    • Cardiac enzymes: to rule out MI
  4. CXR
    • Rule out pulmonary causes. May also see widened mediatinum
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