Flashcards in Aortic dissection Deck (6):
What is an aortic dissection?
An aortic dissection is a tear in the tunica intima, causing blood to pool between the tunica intima and media, creating a false lumen, that may or may not communicate back to the true lumen. There are two types, one that affects the ascending aorta (Type A), and one that affects below the ascending aorta (Type B).
The dissection can bypass branches of the aorta causing no blood supply to these arteries (Coronary Arteries cause angina, spinal arteries cause paraplegia, distal aorta causes acute limb ischaemia, carotid arteries causes neurological deficit)
What are the causes of aortic dissection
Common – Hypertension, Trauma, Connective tissue disorder, Aortic Valve Disease, Aortitis
What will you find on a history taking of aortic dissection?
Chest Pain - S (Central Chest), Q (Tearing), I (10), T (Immediate onset, R (Radiating to the back)
Systemic signs: Nausea, vomiting, fatigue
Recent history of heavy lifting
Cardiovascular risk factors
Aortic Valve disease
MI - Raised Troponin, pain is more crushing, pain comes on over minutes, not immediately
Pericarditis - Pain constant and worse on position
Pneumonia - Productive Cough
PE - Dyspnoea, hypoxia, and pleuritic chest pain.
MSK pain - Very localised, history of trauma
Acute Pancreatitis – Risk Factors E.g. Gallstones, Alcohol
What will you find on an examination of a patient with aortic dissection?
End of the bed:
Pale from shock
Reduced capillary refill time
A BP differential between the 2 arms is suggestive and a hallmark feature.
Diastolic Murmur – Due to aortic regurgitation
What investigations will you order in an aortic dissection?
ECG – Aortic dissection commonly causes an inferior MI
Crossmatch – Risk of rupture
Troponin - To rule out MI
FBC - Assess Hb levels for transfusion and rule out infection and
Clotting - They are bleeding
LFT - They are going to theatre, there may be impaired liver function due to hypo-perfusion
U&E - They are going to theatre, there may be impaired renal function due to hypo-perfusion
Amylase – Rule out pancreatitis
ABG – To assess hypo-perfusion and shock, also a good marker of severity
CXR - Mediastinal widening
CT - First line diagnostic imaging
Transoesophageal echo – Another diagnostic imaging modality