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Aortic Dissection mind map
Aortic Dissection Revision Notes
Pathophysiology
Aetiology: Marfan's syndrome, hypertension, atherosclerosis
Hypertension + thinned + diseased intima
progressive dilation/ aneurysm
Intimal tearing, blood flows forwards and backwards, causing false lumen
Types: type A- proximal/ ascending; Type B: Descending- beyond subclavian artery.
Investigations
ECG: ST elevation if coronary arteries involved, small complexes if pericardial effusion
CXR: mediastinal widening, cardiomegaly, pleural effusion
Echocardiography: transoesophageal best, view dissection flap, assess aortic valve
CT scan: diagnostic test- urgent
Clinical features
Pain- radiating to back, tearing
Blood pressure discrepancy R > L arm
Type A:
tamponade
,
aortic regurgitation
,
myocardial infarction
,
stroke
Type B:
limb ischaemia
,
renal failure
, ischaemic gut
Management
!Keep blood Pressure low!- IV betablocker, IV GTN
Type A- emergency surgery, mortality increases 2% per hour without surgery
Type B- conservative, lower BP, surgery in life saving situation only
Endovascular- stent- type B
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