Aortic Dissection

Question 1

What features may a patient with aortic dissection have?

Answer 1

1. Features of Marfan syndrome

2. Features of Ehlers-Danlos syndrome

Question 2

What is a Type A aortic dissection?

Answer 2

• 70%

- Ascending aorta

Question 3

What is a Type B aortic dissection?

Answer 3

• 30%

- Descending aorta

Question 4

How is a type A aortic dissection managed?

Answer 4

need surgery

Question 5

What is a type 1 aortic dissection?

Answer 5

ascending and descending aorta

Question 6

What is a type II aortic dissection?

Answer 6

ascending aorta only

Question 7

What is a type IIIa aortic dissection?

Answer 7

descending aorta only (above diaphragm)

Question 8

What is a type IIIb aortic dissection?

Answer 8

descending aorta only (above and blow the diaphragm)

Question 9

What are RF for aortic dissection?

Answer 9

1. Hypertension
2. Cholesterol
3. Smoking
4. Crack cocaine
5. Coarcation of aorta (congenital)
6. Male

Question 10

How does an aortic dissection differ from AAA?

Answer 10

Above where a AAA happens

Question 11

What is the patho of aortic dissection?

Answer 11

where a tear in aortic intima flows blood to flow into a new false channel in between the inner and outer layers of the tunica media

Question 12

What is the key symptoms for aortic dissection?

Answer 12

acute severe chest pain – radiating to back tearing

Question 13

What are the other symptoms specific to?

Answer 13

by blockages to braches of aorta

Question 14

What are the symptoms of aortic dissection if the carotid artery is blocked?

Answer 14

• blackout

- dysphasia

Question 15

What are the symptoms of aortic dissection if the coronary artery is blocked?

Answer 15

angina

Question 16

What are the symptoms of aortic dissection if the subclavian artery is blocked?

Answer 16

LOC (subclavian steal syndrome)

Question 17

What are the symptoms of aortic dissection if the renal artery is blocked?

Answer 17

anuria, renal failure

Question 18

What are the signs of aortic dissection?

Answer 18

1. Hypertension
2. Left/right blood pressure differential (>50%)
3. Diastolic murmur-indicating aortic incompetence (aortic regurg)
4. Murmur on back – left scapula
5. Signs of connective tissue disease

Question 19

What murmur is usually heard in aortic dissection?

Answer 19

aortic regurgitation

Question 20

What are DDx for aortic dissection?

Answer 20

1. ACS
2. Pericarditis
3. Aortic aneurysm
4. MSK pain
5. PE
6. Mediastinal tumour

Question 21

What are possible complications of aortic dissection?

Answer 21

1. Cardiac tamponade
2. Aortic incompetence
3. MI
4. Aneurysmal degeneration/rupture
5. Regional ischaemia
6. Left arm ischaemia/subclavian steal syndrome
7. Endoleak

Question 22

What is the gold standard Ix for aortic dissection?

Answer 22

CT angiogram

Question 23

What other imaging Ix are done for aortic dissection?

Answer 23

1. ECG
2. ECHO
3. CXR
4. CT

Question 24

What would ECG show?

Answer 24

ST segment depression can occur – check signs of infraction – downstream effect of AD

Question 25

What would echo show?

Answer 25

- intimal flap in acute or chronic dissection | - two lumen can be seen in chronic dissection

Question 26

What would CXR show?

Answer 26

- widened mediastinum - loss of aortic knuckle - globular heart

Question 27

What bloods are done and what would they show?

Answer 27

1. Troponin: negative 2. Renal function tests: elevated creatinine + urea 3. LFTs: elevated AST and ALT 4. Lactate 5. FBC: reduced or normal rbc and anaemia in haemorrhage 6. CRP: can be elevated 7. Creatine kinase: elevated 8. Procalcitonin: raised in infection

Question 28

What other Ix are done?

Answer 28

- Group and save: for surgery | - Blood gas: metabolic acidosis

Question 29

How do you manage a haemodynamically unstable suspected aortic dissection?

Answer 29

Advanced life support with haemodynamic support + opiod analgesia

Question 30

How do you treat an acute TYPE A + B aortic dissection?

Answer 30

1. Beta-blocker or non-dihydropyridine CCB 2. opiod analgesia and vasodilator 3. open surgery or endovascular repair

Question 31

How do you manage ongoing chronic aortic dissection?

Answer 31

Beta blocker + lifestyle advice + risk factor management and additional antihypertensive therapy

Question 32

What is the prognosis of aortic dissection?

Answer 32

Left untreated, the natural history of proximal acute aortic dissection is of false channel rupture with fatal exsanguination in 50% to 60% of patients within 24 hours

Question 33

What is the 5 year survival after thoracic endovascular aortic repair (TEVAR)?

Answer 33

for acute type B aortic dissection is 81%