Aortic Dissection Flashcards
What is an aortic dissection?
tear in the innermost layer of the aorta (intimate)
Most aortic dissections are ascending or descending?
ascending
Ascending aortic dissections have a high….
mortality
What is the most important predisposing factor to an aortic dissection?
HTN
What disorder has a higher likelihood of developing an aortic dissection?
Marfans
What will chest pain be like?
sudden onset, severe, tearing/ripping/knife like in chest and upper back
What are some other s/s of dissections?
N/V
Where will the chest pain be in an ascending dissection?
anterior chest
Where will pain be in aortic arch dissection?
neck/jaw
Where will pain be in a descending dissection?
intrascapular pain
What will pulses be like?
decreased, variation in pulse btw. r. and l. arm**
What is the classic CXR finding?
widened mediastinum but 10% may have normal CXR
What is the test of choice?
CT scan w. contrast
What is the gold standard?
MRI angiography: preferred if hemodynamically stable
What is the surgical management?
acute proximal (debakey I and II) or acute distal (type III) w. complications
What is the medical management?
descending if no complications (debakey III), nonselective BB w. sodium nitroprusside
What is debakey I?
originates in ascending aorta → propagates to aortic arch and often beyond it
What is debakey II?
originates in and is confined to ascending aorta
What is debakey III?
originates in descending aorta, rarely extends proximally but will extend distally
What is stanford A?
involves ascending aorta and/or aortic arch and possibly descending aorta
What is stanford B?
involves descending aorta w.out involvement of ascending or aortic arch
