What is Aortic dissection?

Aortic dissection occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart

Risk factors of aortic dissection?

• hypertension: the most important risk factor
• trauma
• bicuspid aortic valve
• collagens: Marfan's syndrome, Ehlers-Danlos syndrome
• Turner's and Noonan's syndrome
• pregnancy
• syphilis

Symptoms of aortic dissection?

chest/back pain

• typically severe and 'sharp', 'tearing' in nature
• pain is typically maximal at onset
• classically chest pain is more common in type A dissection and upper back pain is more common in type B dissection. However, there is considerable overlap and both chest and back pain are present in many patients

What signs may be found in aortic dissection?

• pulse deficit
  • weak or absent carotid, brachial, or femoral pulse
  • variation (>20 mmHg) in systolic blood pressure between the arms
• aortic regurgitation
• hypertension

What ECG changes may be seen in Aortic dissection?

the majority of patients have no or non-specific ECG changes. In a minority of patients, ST-segment elevation may be seen in the inferior leads

Management of aortic dissection depends on the classification

Type A

• {{c1::surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention}}

Type B* {{c2::

• conservative management
• bed rest
• reduce blood pressure IV labetalol to prevent progression}}

Complications of backward tear of aortic dissection?

aortic incompetence/regurgitation

MI: inferior pattern is often seen due to right coronary involvement

Complications of forward tear of aortic dissection?

• unequal arm pulses and BP
• stroke
• renal failure

Stanford classification of Aortic dissection

• type A - {{c1::ascending aorta, 2/3 of cases}}
• type B - {{c2::descending aorta, distal to left subclavian origin, 1/3 of cases}}

DeBakey classification of Aortic dissection

• type I - {{c1::originates in ascending aorta, propagates to at least the aortic arch and possibly beyond it distally}}
• type II - {{c2::originates in and is confined to the ascending aorta}}
• type III - {{c3::originates in descending aorta, rarely extends proximally but will extend distally}}