Aortic Dissection

Question 1

What is aortic dissection?

Answer 1

A tear in the wall of the aorta, the walls are then forced apart by blood.
Comes in Acute & chronic forms

Question 2

What causes aortic dissection?

Answer 2

• Trauma
• Cardiac Surgery
• Marfan’s Syndrome
• Congenital Bicuspid AV
• Atherosclerosis
• Hypertension

Question 3

What are the risk factors for aortic dissection?

Answer 3

Trauma - Smoking - Hypercholesterolaemia - Hypertension - Pregnancy - Cocaine use - Arteritis

Question 4

What are the symptoms of Aortic Dissection?

Answer 4

• Severe tearing chest pain radiating to the back (location varies based on location/spread of tear)
• Collapse due to tamponade/Acute AR/External rupture
• Pleuritic Chest Pain due to cardiac tamponade and/or haemothorax from an external rupture

Question 5

What are the clinical signs of aortic dissection?

Answer 5

• reduced or absent peripheral pulses
• BP mismatch between limbs
• AR murmur (sort early diastolic)
• Hyper/Hypotension
• Pulmonary Oedema
• Inferior ST elevation

Question 6

How do we investigate a case of Aortic Dissection?

Answer 6

CXR: Can show mediastinal widening - pleural effusion - Loss of aortic knob - tracheal deviation. A -ve CXR doesnt rule out AD

CTA/MRA: MRA is the best and can confirm the diagnosis

TOE: The most common way to confirm the diagnosis

Question 7

How do we classify Aortic dissection?

Answer 7

Stanford:
A = Asc. Aorta involved - treat Surgically
B = Asc. aorta excluded - Treat medically

Debakey:
1 = Propagates from Asc. Aorta
2 = Stays in Asc. Aorta
3 = Starts in Desc. Aorta and can move

Question 8

How do we medically treat Aortic Dissection?

Answer 8

With Strict BP control:

CCBs - Beta Blockers - Sodium Nitroprusside (vasodilator)

Question 9

How do we surgically treat Aortic Dissection?

Answer 9

Surgically replacing the valve and/or a section of the aorta.