Aortic Dissection Flashcards
What is an aortic dissection?
Where blood splits the aortic tunica intima and tears it away from the tunica media
Does blood exit the aorta into different spaces of the body in an aortic dissection?
NO
What happens after the blood has torn through the intima layer?
It will either continue down the length of the aorta to tear the two layers apart,
OR
the intima will tear again further down and the blood will be able to reenter the aortic lumen
What are the symptoms of an aortic dissection?
Sudden tearing chest pain ± radiating to back/intrascapular Features of Marfans/E-D Radio-radial delay and BP HTN Hemiplegia (if carotids occluded) Shock Anuria Inferior MI Cardiac arrest Syncope Hypotension
What are causes of a dissection?
Chronic hypertension (as causes degenerative changes)
Connective tissue disease (Marfan’s/Ehler-Danlos)
AAA
Trauma
What are the risk factors for dissection?
HTN FH Coarctation of aorta Marfan's/E-D Male (2-3x) Age
What are the different categories of aortic dissection? and how common is each?
Type A (70%) Type B (30%)
What is a Type A aortic dissection?
This is a dissection that involves any part of the ascending aorta and aortic arch up to the left subclavian artery (the third branch)
What is a Type B aortic dissection?
Any dissection that occurs after the LCA and is in the thoracic and descending aorta
What’s the difference in management between Type A and Type B?
Type A require surgery
Type B can be managed medically
Where are the most common aortic dissections?
Type A - just 2cm above the aortic valve
Type B - just after the SCA but within 10cm of the valve
How do we manage/treat aortic dissection?
Bloods - FBC, Xmatch, Trp, UEs, LFTs, lactate Fluids to maintain SBP for 90mmHg ECG CXR CT/TOE Labetolol or esmolol IV Opioid Vasodilator
