CHAPTER 59 Aortic Dissection and Related Aortic Syndromes

Question 1

TRUE or FALSE: Acute aortic syndromes occur in the setting of acute hypertension

Answer 1

FALSE

Question 2

Two most common intimal tear sites

Answer 2

sinotubular junction at the start of the acending aorta (50% to 65%)

just beyond the left subclavian artery (20% to 30%) at the junction between the acending and descending aorta. 3

Question 3

Age distribution of aortic dissection

Answer 3

BIMODAL

1st peak - Younger pxs: (connective tissue disorders)

2nd peak: >50 years with chronic hypertension and/or ischemic heart disease

Question 4

risk factor for recurrent dissection

Answer 4

Prior aortic dissection

Question 5

Stanford classification: any involvement of the ascending aorta

Answer 5

type A dissection

Question 6

Stanford classification: restricted to only the descending aorta

Answer 6

type B dissection

Question 7

DeBakey classification: simultaneously involve the ascending aorta, the arch, and the descending aorta

Answer 7

type 1 dissection

Question 8

DeBakey classification: involve ONLY the ascending aorta

Answer 8

type 2 dissection

Question 9

DeBakey classification: involve ONLY the descending aorta

Answer 9

type 3 dissection

Question 10

Results from infarction of the aortic media, usually from injury to the vasa vasorum;
may resolve spontaneously or may lead to dissection

Answer 10

Aortic intramural hematoma

Question 11

TRUE or FALSE: Dissection in or near a carotid artery may present as a classic stroke, and 20% of patients with type A dissection display neurologic findings, which predicts a poorer prognosis

Answer 11

TRUE

Question 12

TRUE or FALSE: A proximal dissection to the aortic root may lead to cardiac tamponade and is generally fatal.

Answer 12

TRUE

Question 13

Imaging modality of choice for diagnosis of dissection

Answer 13

CT

Question 14

Initial treatment should be a _________________ in order to lower blood pressure without increasing the shear force on the intimal flap of the aorta

Answer 14

negative inotropic agent

Question 15

Ideal B-blockade use

Answer 15

Short-acting (esmolol or labetalol)

Question 16

Ideal target BP

Answer 16

SBP 120-130

100-120 (in the absence of aortic regurgitation)

Question 17

TRUE OR FALSE: Aortic dissection in pregnancy is rare and usually occurs in the thirdNtrimester and postpartum period.

Answer 17

TRUE