Aortic Dissection – Lecture Review

A set of question-and-answer flashcards covering definition, pathophysiology, risk factors, clinical presentation, diagnosis, classification, treatment, complications, and long-term management of aortic dissection.

What is an aortic dissection?

A tear in the tunica intima of the aorta that allows blood to split the intima and media, creating a false lumen along the vessel wall.

Which aortic wall layer is initially torn in an aortic dissection?

The tunica intima.

Between which two layers does blood collect to form the false lumen in an aortic dissection?

Between the tunica intima and tunica media.

How is the pain of a Type A dissection typically described?

Sudden, severe, tearing chest pain.

How is the pain of a Type B dissection typically described?

Sudden, severe, tearing back pain.

What percentage of aortic-dissection patients report no pain?

Fewer than 7 %.

Which sex and age group are most commonly affected by aortic dissection?

Men aged 60 years and older.

Name two inherited connective-tissue disorders that predispose to aortic dissection.

Marfan syndrome and type IV Ehlers–Danlos syndrome.

List three acquired risk factors for aortic dissection.

Chronic hypertension, cocaine use, pregnancy (other acceptable answers: chronic inflammation, atherosclerosis).

What congenital valve abnormality increases the risk of aortic dissection?

Bicuspid aortic valve disease.

Define an acute aortic dissection.

Symptoms present for ≤ 14 days.

Define a chronic aortic dissection.

Symptoms persisting for > 14 days.

What bedside test is first performed to rule out myocardial infarction when aortic dissection is suspected?

Electrocardiogram (ECG).

Which imaging modality is most commonly used in the emergency department for acute aortic-dissection diagnosis?

CT angiography.

Which imaging modality provides greater detail for chronic aortic-dissection management despite being slower?

MRI angiography.

Describe a Stanford Type A aortic dissection.

The intimal tear involves the ascending aorta (may extend anywhere else).

Describe a Stanford Type B aortic dissection.

The intimal tear is confined to the descending aorta, distal to the left subclavian artery.

Name two key peripheral findings that may be present on physical examination of an aortic-dissection patient.

Pulse deficits and inter-arm blood-pressure difference (other acceptable answers: limb ischemia, shock).

What heart sound abnormality may be auscultated in aortic dissection?

A diastolic murmur of aortic regurgitation.

What life-threatening complication results when blood enters the pericardial sac during a Type A dissection?

Cardiac tamponade.

State the immediate pharmacologic goals in initial management of aortic dissection.

Rapid control of blood pressure and heart rate, reduction of pulse pressure, and pain control with morphine.

What is the definitive surgical treatment for Stanford Type A dissection?

Open replacement of the ascending aorta with a synthetic graft (often with aortic root and valve replacement).

What endovascular procedure is used for complicated Stanford Type B dissections?

Thoracic Endovascular Aortic Repair (TEVAR).

What is the reported 10-year survival rate after acute aortic dissection?

Approximately 30 % – 60 %.

How frequently should follow-up CT imaging of the aorta be performed during long-term surveillance?

Every 2 years.

Give two lifestyle recommendations for patients after an aortic dissection.

Strict blood-pressure control/no smoking and healthy, low-salt diet (other acceptable answers: stress management, regular follow-up).

What does a significant difference in blood pressure between the arms suggest in the context of chest pain?

Possible aortic dissection.

Are syncope and hypotension early or late signs of aortic dissection?

Late signs indicating potential hemodynamic compromise.

What valve complication can occur when a Type A dissection involves the aortic root?

Aortic regurgitation.

What catastrophic event occurs if the dissection ruptures through all vessel layers?

Aortic rupture, which is rapidly fatal without immediate treatment.