Article No. 44

How would you rate this article?

Awful

Poor

Average

Good

Perfect

Create a Notebook

You currently don't have any notebooks.

If you want to save this article into a notebook, you can create one now.

Flag/Report
Article No. 44

Instructions:

What is the issue?

Let us know in a brief paragraph or sentence why you are flagging this article. Here are some other issues we, at Medzcool, would like to know about:

  • Spam or misleading content
  • Violation of privacy
  • Unnescessary sexual content
  • Unnescessary violent content
  • Hateful or abusive content
  • Promotion of harmful acts

Report:

Flagged articles and users are reviewed withing 24 - 48 hours upon submission of a report. The report will be reviewed to determine whether the article and it's author (user) has violated Medzcool's Terms of Use and/or Community Guidelines. Accounts are penalized for violations to either the Terms of Use and/or Community Guidlines. Repeated violations can lead to account termination.

Thank you for your report, it will be reviewed within the next 24-48 hrs.
Aortic Dissection
ARCHIVE
RATE
REPORT/FLAG

Aortic Dissection

(2)

Introduction

An aortic dissection refers to a tear inside the walls of the aorta. Blood can enter and further force layers of the aorta apart.

Pathophysiology

From inner to outer, the aorta consists of three layers: the intima, media and adventitia. During a dissection, a small tear in the intima allows the high pressure arterial blood to rip through the intimal layer and penetrate into the media. Interestingly, the blood splits the media layer in such a way that it separates the inner two thirds and outer third of the layer. It does not typically penetrate into the adventitia layer. At this point, the blood can dissect along the course of the aorta either in an anterograde fashion (toward the iliac bifurcartion) or retrograde (toward the aortic root).

Most dissections originate in the ascending aorta (65-70%). This is called a Type A dissection. Type B dissections refer to those that originate in the descending aorta (25-30%).  


Some dissections may even penetrate the media layer, dissect for a certain length and then reenter the intravascular lumen. This is referred to as a double-barrel aorta.

Etiology

Causes are varied and can include hypertension, vasculitis, connective tissue disorders and a congenital condition called bicuspid aortic valve.

Epidemiology

Rare. The estimated rate is 3 persons per 100,000 per year. 65% are male. The mean age is 63 years old.

Signs and Symptoms

The classic presentation is a male patient with a history of hypertension who presents with acute onset chest pain with a tearing sensation radiating to the back. The area of the dissection correlates with the location of pain. Ascending dissections tend to present with anterior chest pain while descending dissections, back pain.

Other signs and symptoms to raise the suspicion of aortic dissection include new diastolic murmur of aortic insufficiency (if the dissection involves the aortic root), decreased pulsation in peripheral arteries, hypotension (poor prognosis), hypertension, tachycardia, and neurologic sequelae.

Diagnosis

You will need radiographic evidence to confirm the diagnosis.

CXR - some studies estimate that 80% of patients with aortic dissection will have an abnormal CXR. There may be evidence of a widened mediastinum or the ‘calcium sign’ : intimal calcium deposits that are distant from the outer contour of the aorta indicating a false lumen.

Most commonly, CT with contrast will be used. It is 83% to 100% sensitive and 87% to 100% specific.

Other modalities, but less likely to be used in an emergency department, include transesophageal echocardiogram and aortogram.

Management

Management depends on the type of dissection.

  1. Type A dissection: Prompt surgical intervention. Consult thoracic surgery. Ensure patient connected to monitor, two large bore IVs, fluids for hypotension, cross matched blood. Disposition: admit.

  2. Type B dissection: Blood pressure control. Rapidly titratable medications such as esmolol or labetalol are preferred. Disposition: admit.

  3. Prognosis: the risk of death is 25% within 24 hours for an untreated dissection.
Are you enjoying this article? Sign-up to see more and join the community of medical professionals
Add Section
  • New Section
    Creates a new section with
    subtitle and text

  • Text Block
    Insert text without a subtitle

  • Image
    Insert an inline image

Add Margin
  • Text Block
    Insert text without a subtitle

  • Image
    Insert an inline image

Article Type (optional)

File limit size: 2MB. Accepted files: .png, .jpg, .jpeg

Including tags helps other users find your article easier.

DISCARD CHANGES & EXIT

File limit size: 8MB. Accepted files: .png, .jpg, .jpeg

Choose Layout
Default Layout
Layout 1 - Caption below
Layout 2 - Side caption
DISCARD CHANGES & EXIT
Add Margin

File limit size: 2MB. Accepted files: .png, .jpg, .jpeg

DISCARD CHANGES & EXIT