Aortic Dissection

Question 1

What is aortic dissection?

Answer 1

Haemorrhage into the wall of the aorta, causing the media to separate from the outer layers. Blood passes through creating a ‘false’ lumen

Question 2

Type 1 AD

Answer 2

All dissections that affect the ascending aorta, regardless of the site origin

Question 3

Type 2 AD

Answer 3

All dissections that do not affect the ascending aorta

Question 4

Symptoms

Answer 4

Severe tearing chest pain, radiating to the back
Hypotension
Syncope

Question 5

ECG findings

Answer 5

ST segment elevations V1, V2, aVR

Reciprocal ST depression I, II, III, V4-V6

Question 6

Chest X-ray findings?

Answer 6

Widening of the mediastinum- aorta

Question 7

Signs?

Answer 7

Differing blood pressures in each arm

Early diastolic decrescendo murmur

Question 8

Causes of early diastolic murmur in AD

Answer 8

Aortic Regurgitation

Stretching of the aortic annulus in Type A is responsible for aortic regurgitation, may lead to LVF and shock

Question 9

Why is there unequal pulses in each arm?

Answer 9

Likely to be involvement of the brachiocephalic trunk (supplies blood to one arm on one side)

Question 10

Risk factors

Answer 10

Advanced age
Male
Arterial hypertension
Aortic Aneurysm
Connective Tissue disorders: Marfan, Ehlers Danlos, Loeys Dietz
Bicuspid aortic valves

Question 11

Investigations

Answer 11

1st line CT Aortography
Transoesophageal echocardiography
MRI

Question 12

Complications

Answer 12

Occlusion of the arterial branches
Aortic regurgitation
Obstruction
Rupture of the aorta
Intrabronchial haemorrhage

Question 13

Treatment

Answer 13

Manage type A surgically if possible
Uncomplicated distal type B- intensive hypertensive drug treatment
Complicated type B- surgical intervention
BP reduction- labetolol infusion