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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