Updated: 10/27/2020

Aortic Dissection

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
3 3
0
0
0%
0%
Evidence
2 2
0
0
https://upload.medbullets.com/topic/108037/images/09122017vldcardianaorticdissectionmmedits.jpg
https://upload.medbullets.com/topic/108037/images/stanford_type_a_aortic_dissection.jpg
Snapshot
  • A 55-year-old man presents to the emergency department with chest pain. He describes the pain as excruciating and knife-like that began earlier in the morning. His pain is restricted to the anterior chest. Medical history is significant for hypertension, for which he is taking lisinopril. Physical examination is significant for unequal blood pressures in the arm and a diastolic murmur in the left sternal border. An electrocardiogram is unremarkable, his cardiac troponins are not elevated, and a chest radiograph demonstrates a widened mediastinum. Preparations are made to obtain a CT angiography.
Introduction
  • Clinical definition
    • a separation of the media laminal planes, resulting in a blood-filled space in the aortic wall  
      • there are two types of aortic dissection
        • Stanford A type
          • a dissection involving the ascending aorta
        • Stanford B type 
          • a dissection involving only the descending aorta
  • Etiology
    • hypertension (most common)
    • connective tissue disease
    • iatrogenic (e.g., coronary catheterization)
  • Pathogenesis
    • an intimal tear of the aorta causes an intramural aortic hemorrhage that separates the intima from the media
      • the resulting hematoma may rupture through the adventitia, leading to a thoracic or abdominal cavity hemorrhage or cardiac tamponade
  • Associated conditions
    • Marfan syndrome  
    • bicuspid aortic valve
  • Prognosis
    • Stanford type A
      • effective blood pressure control and surgical treatment improves mortality
    • Stanford type B
      • effective conservative or surgical treatment improves mortality
Presentation
  • Symptoms 
    • acute chest or back pain (most common)
      • classically anterior chest pain that radiates to the back between the scapulae
  • Physical exam
    • unequal blood pressures in the arms
    • weak or absent pulses
    • diastolic decrescendo murmur when the aortic valve is involved
      • resulting in aortic regurgitation
Imaging
  • Radiography of the chest
    • indication
      • to rule out other causes of chest pain (e.g., pneumothorax)
    • finding
      • widened mediastinum
  • CT angiography of the chest  
    • indication
      • most accurate imaging test for aortic dissection 
Differential
  • Myocardial infarction 
    • differentiating factors
      • an electrocardiogram may be present (e.g., ST-segment elevation)
      • increased cardiac biomarkers
Treatment
  • Medical
    • β-blockers
      • indication
        • Stanford type B aortic dissection
  • Surgical
    • vascular surgery
      • indication
        • Stanford type A aortic dissection
Complications
  • End-organ damage
    • secondary to poor perfusion
  • Aneurysm rupture

 

 

Please rate topic.

Average 4.5 of 11 Ratings

Questions (3)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.CV.13.61) A 25-year-old male presents for a new primary-care visit. He has never been seen by a physician and reports that he has been in good health. You note a very tall, very thin male whose arm span is greater than his height. The patient reports that his father had a similar build but passed away suddenly in his 40s. You suspect a genetic disorder characterized by a defect in fibrillin-1. What is the histopathology of the most common large-artery complication of this disease? Tested Concept

QID: 100577
1

Focal granulomatous inflammation with mural lymphocytes, macrophages, giant cells

6%

(5/77)

2

Eosinophilic vasculitis

4%

(3/77)

3

Predominant neutrophilic infiltration with fibrinoid necrosis

4%

(3/77)

4

Fibrinoid necrosis of blood vessel walls, endothelial swelling, and neutrophilic infiltrate in skin lesions

16%

(12/77)

5

Cystic medial degeneration

66%

(51/77)

M 1 D

Select Answer to see Preferred Response

Evidence (2)
Topic COMMENTS (3)
Private Note