3- Diagnosis and treatment of aortic dissection

what is an aortic dissection

• rupture in the intimal layer of the aorta → blood into medial layer

what is the etiology of aortic dissection

• hypertension in patients of 40-60yo

• CT disorders- Mafans, Ehlers, Danlos

• atherosclerosis, chest trauma, pregnancy

what is the morphology

what are the symptoms of aortic dissection

• can be asymptomatic

• tearing chest pain that radiates to the back

• migrating pain

• different BP

what are the risk factors for AD

• HTN

• CT disease

what are the complciations of AD

• rupture → pericardial, pleural, peritoneal cavity

  • haemothorax, haemopericardium, tamponade, RSHF

what is the mechanism of AD

• intimal tear of aorta leads to dissection of layers of aorta creating a false lumen

what are the classifications of AD

• stanford A→ proximal aorta

  • De Bakey t1- ascending, arch and descending aorta

  • De Bakey t2- only ascending aorta

• stanford B/ De Bakey t3- only dscending aorta

what are the findings in physical exam for AD

• HTN

• aortic murmur

• pulse difference

• neuro deficits

  • if up to carotid

what are the signs of AD in imaging

• wide mediastinum on CXR

• CT angio chest

• echo

• TTE and TOE

• aortography

what do you have to consider when doing imagine tests in AD

• risk of invasive diagnostic tests

• renal function

• gravidity

• allergy to contrast media

what are the signs of AD on ECG

• ischemia, coronary involvement

what are the lab tests done in AD

• necroenzymes

• WBC

• d dimer

• coagulation

what is the triple rule out in AD

• rules out most dangerous causes of acute chest pain in 1 CT scan

• MI, AD, PE

What is the management of AD

• HR and BP monitoring

• pain relief

• lowering BP by BB or in COPD CCB

• ICU transport

• ideal SBP 110-120mmHg

what is a TEVAR

• thoracic endovascular aortic repair

• minimally invasive to treat descending thoracic aortic aneurysm