Aortic dissection

Question 1

Types of aortic dissection acc to stanford classification

Answer 1

A- ascending 2/3
B- descending 1/3

Question 2

RFs for aortic dissection

Answer 2

CT disorders
HTN
Atherosclerosis
Male
50-70 yo
Abrupt, severe increase in BP
Aortic aneurysm
Bicuspid AV

Question 3

Definition of aortic aneurysm

Answer 3

Tear in intiaml layer of arotic wall-> creates a false lumen through which blood can collect and occlud the true lumen and therefore blood flow

Question 4

Where does anterograde aortic dissection propagate towards

Answer 4

iliac arteries

Question 5

Where does retrograde aortic dissection propagate towards

Answer 5

AV

Question 6

Clin f of aortic dissection

Answer 6

Sudden severe CP- tearing to back - sharp, tearing
sharp abdo pain
signs of decreased perfusion to end organs

Question 7

Examination findings in aortic dissection

Answer 7

Pulse deficit
Asymmetric BP
decreased breath sounds
HTN/hypotension
tachycardia
diastolic murmur
tamponade sings- pulsus paradoxus, muffled heart sounds, increased JVP

Question 8

A pulse deficit is likely seen in which type of aortic dissection

Answer 8

A

Question 9

Investigations to order for suspected aortic dissection

Answer 9

ECG, ABG
FBC, UEC, LFTS, coags, group and hold
Troponin, d-dimer, CTA of whole aorta +/- MRA + echo

Question 10

Expected findings on CXR for aortic dissection

Answer 10

Widened mediastinum >8cm
Double/irregular aortic contour
Inwards displacement of artherosclerotic calcification
Pleural effusion, hemothorax

Question 11

Expected findings on CTA for aortic dissection

Answer 11

False/ double lumen
Entry tear
Evidence of aortic dilation
Evidence of malperfusion

Question 12

When to use a CTA in pt with suspected aortic dissection

Answer 12

Stable, surgery planning

Question 13

WHen to use a TOE in pt with suspected aortic dissection

Answer 13

Unstable

Question 14

DDX of aortic dissection

Answer 14

ACS
Cardiac tamponade
pericarditis
PTX
PE
Esophageal rupture
MSK pain

Question 15

General mng of aortic dissection

Answer 15

BP control- at 100-120 with IV betablockers
high flow oxygen
IV access
Analgesia - morphine preferred
continuous monitoring

Question 16

Agents for BP control in aortic dissection

Answer 16

1. IV labetalol
2. IV CCBS
3. IV infusion nitrates / vasodilators

Question 17

Mng of type A aortic dissection

Answer 17

Open surgical repair - removal of aortic and stent insertion +/- AV repair

Question 18

Mng of type B aortic dissection

Answer 18

Cx: TEVAR in acute phase
uncom: endovascular intervention in hyperacute phase

Question 19

What complications of type B aortic dissection indicate need for TEVAR

Answer 19

aortic rupture
impending rupture, rapidly expanding
malperfusion
ongoing pain
refractory HTN