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Flashcards in Aortic dissection Deck (12)
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1
Q

What is aortic dissection

A

Blood enters between intimacy and media layers of aorta

2
Q

Which part of the aorta is most commonly affected

A

Ascending and aortic arch

3
Q

What are the two classification systems

A

Stanford and Debakey

4
Q

Explain the Stanford classification system

A

Type A - ascending aorta before brachiocephalic artery
Type B - descending aorta, after left subclavian artery

5
Q

Explain the Debakey classification system

A

Type I – begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
Type II – isolated to the ascending aorta
Type IIIa – begins in the descending aorta and involves only the section above the diaphragm
Type IIIb – begins in the descending aorta and involves the aorta below the diaphragm

6
Q

What are risk factors

A

Those of PAD
HTN especially
Conditions affecting the aorta - bicuspid aortic valve, coarctation, aortic valve replacement, CABG
Conditions affecting connective tissues - Ehlers-Danlos syndrome, Marfans

7
Q

What is the typical presentation

A

Sudden onset severe ripping or tearing chest pain

8
Q

What other features may suggest aortic dissection

A

HTN
Differences in blood pressure between arms >20mmHg
Radial pulse deficit
Diastolic murmur
Focal neuro deficit
Chest AND abdo pain
Collapse
Hypotension

9
Q

What investigations would you do

A

ECG and CXR to exclude other causes
CT angiogram
MRI angiogram for greater detail

10
Q

What is treatment of type A

A

Open surgery to remove the section of the aorta with the defect in the wall and replace it with a synthetic graft

11
Q

What is the management of type B

A

Thoracic endovascular aortic repair
Catheter inserted via the femoral artery inserting a stent graft into the affected section of the descending aorta

12
Q

What are the complications of dissection

A

MI
Stroke
Paraplegia
Cardiac tamponade
AV regurgitation
Death