Aortic Dissection

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Classification

- Type A: intimal tear in ascening aorta (propagates proximally and distally)
- Type B: intimal tear in desceing aorta (usually propagetes distally)

QuickNotes

Risk factors

- HTN
- Atherosclerosis
- Marfan’s

Clinical features


Pain:
- sudden-onset
- interscapular
- severe
- tearing

Complications

- Hypovolaemic shock
- Pericardial tamponade (pulsus paradoxus, paradoxical ­ JVP - Kussmaul’s sign)
- Side-branch occlusion (MI, stroke (CVA), acute limb ischaemia (arm / leg), paraparesis (spinal artery), acute renal failure, gut ischamia)

Investigations

- ECG (exclude MI)
- Urgent contrast CT (see an intimal flap) or preoperative TOE

Management

- ABC
- lower ABP to systolic < 100mmHg (morphine, IV blockers)

Type A
- hourly mortality = 2 %
- urgent surgery (aortic root replacement, ± aortic valve surgery)

Type B
- conservative Mx
- ?? surgery (if life-threatening complication e.g. rupture)


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