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Title: Aortic Dissection - Clinical Summary
Description: This provides a summary of Aortic Dissection as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
Description: This provides a summary of Aortic Dissection as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
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AORTIC DISSECTION
Aortic dissection = disruption of medial layer of aorta (tunica media) due to blood, causing separation of the layers,
resulting in a true lumen and false lumen
...
Acute aortic syndrome = disruption of the arterial wall layers, split into 3 subgroups: aortic dissection, penetrating aortic
ulcer, intramural hematoma
...
§ Artery walls consist of three main layers: tunica intima (innermost) ® tunica media ® tunica adventitia (outermost)
§ Aortic dissection is a tear in the intimal layer of the aortic wall
o Blood flows between this layer and splits apart the tunica intima and media
o This creates a true lumen and a false lumen
§ The tear can progress distally, proximally or in both directions from origin
o Anterograde dissection ® towards iliac arteries
o Retrograde dissection ® towards aortic valve
§ Can result in prolapse of aortic valve, bleeding into pericardium and cardiac tamponade
§ Acute = diagnosed <14 days after occurrence
§ Chronic = diagnosed >14 days after occurance
§ Other conditions that fall under the acute aortic syndrome can cause a dissection eventually, including:
o Penetrating aortic ulcer: penetrates the intima and progresses into the media of artery
o Intramural hematoma: contained aortic wall hematoma with bleeding into the media
...
DeBakey Classification
This groups dissections anatomically
...
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§
Type II ® confined to the ascending aorta
o Classically seen in elderly patients with atherosclerotic disease and hypertension
...
Risk factors ® hypertension, atherosclerosis, male, connective tissue disorder, bicuspid aortic valve, Turner’s syndrome,
Noonan’s syndrome, metabolic disorders, syphilitic aortitis, pregnancy, trauma, iatrogenic, cocaine use
...
It will also be highly likely an ECG will have been done to exclude other chest pain
causes
...
CT Angiogram
§ Recommended 1st line imaging
§ Allows for classification, diagnosis and anatomy of the pathology
§ Can assist surgical planning
...
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Management
Urgent assessment is required for any patient as this is a medical emergency
...
Fluid resuscitation ® done cautiously, in setting of rupture the target pressure should be sufficient only for cerebral
perfusion, in uncomplicated dissection the target systolic pressure should be <110 mmHg systolic
...
Stanford Type B Dissection Management
§ Uncomplicated ones are best managed medically and have good survival rates
§ 1st line treatment ® management of hypertension with beta blockers (labetalol) or calcium channel blockers (2nd line)
o Rapidly lower systolic BP, pulse pressure and pulse rate to minimise stress of the dissection and limit further
propagation
§ Endovascular repair not recommended due to risk of retrograde dissection
§ Surgical intervention only warranted in the presence of certain complications: rupture, renal, visceral or limb ischaemia,
refractory pain, uncontrollable hypertension
§ These can go on to be chronic with continued leakage into dissection, even with a stent
o Most common complication of chronic ® aneurysm
Title: Aortic Dissection - Clinical Summary
Description: This provides a summary of Aortic Dissection as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.
Description: This provides a summary of Aortic Dissection as a condition including the background, symptoms and signs/clinical presentation, investigations to diagnose the condition and management plan.