Aortic Dissection Flashcards
(26 cards)
What is an aortic dissection?
Tear in the tunica intima in wall of aorta
What is the biggest RF for aortic dissection?
HTN
List 6 risk factors other than HTN for aortic dissection
Trauma
Bicuspid aortic valce
CTD: Marfan’s, EDS
Turner’s + Noonan’s
Pregnancy
Syphillis
Recall 2 ways in which aortic dissection can be classified and what these entail
Stanford classification
Type A: ASCENDING aorta (2/3 cases)
Type B: DESCENDING aorta (1/3 cases)
De Bakey classification
Type 1 originates in ASCENDING aorta, EXTENDs to arch + possibly beyond
Type 2: confined to ASCENDING aorta
Type 3: originates in DESCENDING aorta
What is the main symptom of aortic dissection?
Tearing chest/ back pain
Maximal at onset
Describe classic pain in type A and B dissection?
Type A: Chest pain more common
Type B: Upper back pain more common
(overlap + often both present)
What signs may be found in aortic dissection?
Pulse deficit
Aortic regurgitation
HTN
What pulse deficit is seen in aortic dissection?
Weak/ absent carotid, brachial or femoral pulse
Variation >20mmHg in SBP between arms
List 3 features caused by involvement of specific arteries in aortic dissection
Coronary arteries: Angina
Spinal arteries: Paraplegia
Distal aorta: limb ischaemia
What ECG changes are seen in aortic dissection?
Majority: none/ non-specific changes
Minority: ST elevation in inferior leads
What would be seen on CXR in aortic dissection?
Widened mediastinum
How should aortic dissection be imaged?
Stable: CT CAP (Ix of choice)- false lumen
Unstable: Transoesophageal echo
Describe management of Type A aortic dissection
Surgical emergency: refer to surgeons
Meanwhile: control BP + analgesia
What is used to control BP in Type A aortic dissection?
IV Labetalol
If AR/ CI: Verapamil/ Diltiazem
Then vasodilate: Sodium nitroprusside
Why must B-blockers be avoided in aortic regurgitation?
B-blockers can inhibit compensatory tachycardia.
What analgesia is given in aortic dissection?
Morphine sulfate
To reduce pain + stress that increases HTN + tachycardia
What surgical intervention is performed in Type A aortic dissection?
Open surgery: replacement of dissection with graft
In which type of aortic dissection is emergency surgery not indicated?
Descending
Describe management of Type B aortic dissection
Conservative: watchful waiting + medication unless complications occur
B-blocker to reduce BP + prevent progression
+/- ARB/ ACEi
Lifestyle: avoid contact sports, smoking cessation
When is surgical repair of type B aortic dissection performed?
Electively: Open replacement + graft implantation/ endovascular aortic stent implantation
If complications arise: open
Name 5 complications of type A aortic dissections
MI (coronary artery occlusion; inferior pattern often seen due to RCA involvement)
Aortic regurgitation
Cardiac tamponade
Pericarditis
Stroke (extension of dissection into carotids)
Name 2 complications of both type A and B aortic dissections
Aortic rupture + acute blood loss
Arterial occlusion followed by ischaemia of downstream organs
What occurs secondary to ischaemia of the celiac trunk/ superior/ inferior mesenteric artery?
Acute abdomen
Ischaemic colitis
What occurs secondary to ischaemia of the renal arteries?
Acute renal failure
