Aortic Dissection Flashcards
(15 cards)
What is an aortic dissection?
- when a break or tear forms in the tunica intima of the aorta
- blood entered between intima + media layers of aorta forming a false lumen
Most common location of aortic dissection
Right lateral area of ascending aorta
Classification systems of aortic dissection
Stanford system
DeBakey system
Stanford system of aortic dissection
- type A: affects ascending aorta before brachiocephalic artery
- type B: affects descending aorta after left subclavian artery
DeBakey system of aortic dissection
- type I: begins in ascending aorta involves aortic arch
- type II: isolated to ascending aorta
- type IIIa: begins in descending aorta above diaphragm
- type IIIb: begins in descending aorta below diaphragm
Risk factor of aortic dissection
- male
- smoking
- hypertension most common
- Hyperlipidaemia
- cocaine use
- heavy weight lifting
- bicuspid aortic valve
- Marfan’s + Elhers-Danlos
Conditions or procedures that increase risk of aortic dissection
- bicuspid aortic valve
- coarctation of aorta
- aortic valve replacement
- CABG
- Marfan’s + Ehlers Danlos syndrome
Presentation of aortic dissection
- sudden onset, severe, ripping chest pain
- anterior pain if ascending aorta
- posterior pain if descending aorta
- collapse
- radial pulse deficit
- new aortic regurgitation murmur (early diastolic murmur)
Diagnosis of aortic dissection
CT angiogram TAP (first line)
MRI angiogram
Management of aortic dissection
- IV morphine
- BP+HR well controlled - B blockers
- type A: open surgery + replacement of synthetic graft
- type B: thoracic endovascular aortic repair
Complications of aortic dissection
- MI
- stroke
- paraplegia
- cardiac tamponade
- aortic valve regurgitation
- death
Layers of arterial wall
Tunica intima
Tunica media
Tunica externa/adventitia
What is the key findings in CT angiography in aortic dissection?
False lumen
What investigation is used if patient is unstable for CT in suspected aortic dissection?
Transoesophageal echocardiography
What is the most significant risk factor of aortic dissection?
Hypertension
