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Flashcards in Diagnosis of Aortic Disection Deck (23)
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1


The primary event in aortic deisection is


A tear in the aortic intima

2


propagation of the disection can occur


Both distal and proximal to the initial tear

3


The most importan predisposing factor for acute aortic disection is

HTN

4


Predisposing factors for aortic disection


Preexisting aortic aneurysm

Inflammatory disease

Disorders of collagen

biscuspid aortic valve

aortic coarctation

turner syndrom

CABG

Aortic valve replacement

Crack Cocaine

5


Classification systems of aortic disections


DeBakey and Daily (Stanford)

6


Daily calssifications

Most common system used


ascending aorta - Type A

all other - Type B

7


DeBakey system of classification is base on what


The origin of the tear

8


DeBakey Type 1 disection


ascending aorta to aortic arch

9


DeBakey type 2 disection


originating in and confined to the aortic arch

10


Debakey type 3


originating in the descending aorta and extending distally and or proximally

11


Ascending aortic disection are 2x more common the descending disection?

T/F


True

12


Where is the most common site of aortic dissection


Right lateral wall of the Ascending aorta

13


Varients of aortic dissection

Intimal tear without hematoma

aortic intramural hematoma

penetrating athrosclerotic ulcer

14


Typical presentation of aortic disection


sever sharpe or tearing posterior chest or back pain

with radiation to any where in th thorax or abd

can be associated with:

CVA, MI, Heart failure,

15


Chest pain is more common with what type of Daliy calssification


type A

ascending aorta

16


HTN is more common in what type of disection?


Type B

distal dissection

17


Ascending disection can induce the following

Aortic insufficiency causing a decrescendo murmur

hypotension, HF ( in 1/2 -2/3 of these disections)

AMI, cardiac tamponade, hemothorax, CVA and > 20 mmHg BP difference in the arms

18


Clinical manifestations of Type B dissection


Chest or back pain- 86 %

abrupt onset - 89 %

migrating pain - 25 %

hypertension - 69 %

hypotensive shock - 3 %

pulse deficit - 21 %

19


DIagnosis of aortic dissection clinically


Abrupt onset of thoracic or abd pain
 that is sharp and tearing

medialstinal or aortic wideing of CXR

Variation in BP in the ext by >20 mmHg

20

STANDARD CT scan disadvantages


intimal flap is seen in less than 75% of cases

site of entry is rarely ID

 

21


TEE sensitivity for thoracic disection is


97-99%

22


TEE findings include


Intimal disection flap

ture and false lumens

thrombosis of false lumen

23


Prefered methods for evaluating an aortic disection


MRI, CT, multiplane TEE