Aortic dissection

Question 1

What is the main presenting symptom of aortic dissection?

Answer 1

Chest pain

Question 2

Stanford Type A and Type B classification of

Answer 2

Type A- ascending aorta 2/3 of cases

Type B- descending, distal to left subclavian origin in 1/3 of cases

Question 3

DeBakey classification

Answer 3

• type I - originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally
  
  • type II - originates in and is confined to the ascending aorta
  • type III - originates in descending aorta, rarely extends proximally but will extend distally

Question 4

Medical Associations with Aortic dissection

Answer 4

• hypertension: the most important risk factor
  
  • trauma
  • bicuspid aortic valve
  • collagens: Marfan’s syndrome, Ehlers-Danlos syndrome
  • Turner’s and Noonan’s syndrome
  • pregnancy
  • syphilis

Question 5

Pathophysiology of Aortic dissection

Answer 5

Tear in the tunica intima wall of the aorta

Question 6

Clinical features

Answer 6

• chest pain: typically severe, radiates through to the back and ‘tearing’ in nature
  
  • aortic regurgitation
  • hypertension
  • other features may result from the involvement of specific arteries. For example coronary arteries → angina, spinal arteries → paraplegia, distal aorta → limb ischaemia

Question 7

Complications of backward tear in aortic dissection

Answer 7

• aortic incompetence/regurgitation

* MI: inferior pattern often seen due to right coronary involvement

Question 8

Complication of forward tear

Answer 8

• unequal arm pulses and BP
  
  • stroke
  • renal failure

Question 9

Management of Aortic dissection

Answer 9

Type A
• surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Question 10

Type B management

Answer 10

• conservative management
  
  • bed rest
  • reduce blood pressure IV labetalol to prevent progression