Aortic Dissection

Exam Cram

• In Aortic Dissections the inner lining of the thoracic aortic tears, blocking the aortic lumen causing ischaemia and infarction

• Presentation: sudden onset, severe tearing chest pain to back

• Diagnosis: CT Angiogram

• Management: 

  • Type A: emergency theatre

  • Type B: BP control (labetolol) and endovascular repair (EVAR)

Outline

Background

• Risk factors

  • Poorly controlled Hypertension & vasculopathy- previous myocardial infarctions/ strokes, diabetes, smokers

  • Marfan's Syndrome , Ehlers Danlos syndrome (EDS) , Syphilis , Turner's Syndrome 

Assessment

History

• Elderly man

• Sudden onset, severe chest pain

• Tearing, radiating to the back

Examination

• Globally unwell

• Hypotensive +- tachycardia

• Radial- radial, radial-femoral delay or BP difference L vs R arms

Investigations

• Troponin and d-dimer can be raised

• Chest XR: mediastinum narrowing

• CT or MR Angiogram: 99% sensitivity and specificity

Diagnosis

Diagnostic criteria: CT or MR Angiogram findings

Differentials: STEMI, Pulmonary Embolus 

Classification: by location of tear

• Type A: including aortic arch

• Type B: after aortic arch

Management

Type A

• 10% mortality per hour

• Requires emergency cardiothoracic surgery post CT

Type B

• Medically managed by Cardiology 

• Aim SBP 100-120 (betablockers)

Med Reg Points

Systolic BP aims: 100-120, see hypertension section for acute secondary causes of hypertension and their comparable BP aims. 

Betablockers are negatively inotropic, hence first line

Type A dissection can present with ST elevation in the inferior leads, mimicking an inferior STEMI. 

Resources and References

Written 2024