Acute aortic syndromes
Aortic dissection
classification
- Stanford Type A vs B
- A: ascending aorta +/- arch
- B: distal to origin of L subclavian artery
- DeBakey Type 1/2/3
- 1: entire aorta
- 2: ascending aorta and/or the arch of the aorta
- 3: only the descending aorta
progression
- rupture → DEATH
- occlusion → ischaemia (pulse deficits)
- aortic regurgitation
| tear of intima | |
|---|---|
| Etiology/Risk factors | - Inherited disease: connective tissue disorders - EDS, Marfan's - ↓ resistance across aortic wall: pregnancy, ↑ age - Aortic wall stress: hypertension, cocaine misuse, arteritis, infection (syphilis) |
| Clinical presentation | 80-90% present with pain - anterior chest, posterior chest, less commonly abdo Others: focal neurology - TLOC, paraplegia (occlusion of spinal arteries), stroke and stroke-like symptoms; acute heart failure - widened pulse pressure - BP discrepancies - 20% of patients |
| risk stratification | ADD-RS |
| Pathogenesis | arterosclerotic ulcer → intima tear; or disruption of vasa vasorum; de novo intimal tear → blood into false lumen |
| Diagnostic investigations | ECG: Gold standard: CT aorta |
| Management | Decide if you need: Buy time to surgical intervention if appropriate Analgesia! Beta blockers then vasodilators (avoid reflex tachycardia) Type A typically gets surgical repair; Type B typically supportive care |
Ruptured aortic aneurysms
AAA screening
AAA definition: permanent pathological dilation of the abdominal aorta with a diameter over 1.5 times the expected anteroposterior diameter of that segment
- diagnostic threshold = >3.0cm
- Men >65 get a one off abdo USS
- No aneurysm found (less than 3.0 cm) — no further scans are required.
- Small AAA (3.0 cm to 4.4 cm) — the person is placed under surveillance and a repeat scan offered in 12 months.
- Medium AAA (4.5 cm to 5.4 cm) — the person is placed under surveillance and a repeat scan offered in 3 months.
- Large AAA (5.5 cm or larger) — the person is referred to a vascular surgeon.