5.8 G) Ii) Vascular Aortic Dissection

Front 1

List the predisposing factors for aortic

dissection.

Back 1

1. HYPERTENSION [ 70-90% ]
2. Congenital cardiovascular disorders

[ Aortic stenosis ]
3. Aortic stenosis
- Bicuspid aortic valve
- Coarctation of aorta
4. Connective Tissue disorders
- Marfan's Syndrome
- Ehlers-Danlos Syndrome

5. Aortic manipulation / CAGS

Front 2

List the "associations" for aortic dissection.

Back 2

1. Iatrogenic

[ post cardiac surgery / Balloon angioplasty for coarctation ]
2. Cocaine
3. Pregnancy
4. Inflammatory diseases - Giant cell arteritis

Front 3

List the Anatomical Classification types of

aortic dissection.

Back 3

1. Stanford System [ A and B]
Type A = ascending aorta +/- descending

aorta= 65-70%
= Surgical repair

Type B = Descending aorta distal to origin of

L subclavian artery
= 30-35%
= medically managed

DeBakey [ I , II and III ]
I = Ascending + descending aorta
II= Ascending aorta only
III= Descending aorta only
IIIa = thoracic aorta
IIIb= extends to abdominal aorta

Front 4

List the main CXR findings with aortic

dissection.

Back 4

1. Widening of superior mediastinum 50-75%
2. Dilatation of aortic arch
3. Loss of / obliteration of aortic knob
4. Left apical cap
5. L pleural effusion
6. Disparity of calibre between descending and ascending aorta.

Front 5

List ALL the radiographic features suggesting aortic dissection.

Back 5

1. Widening of superior mediastinum

[ 50-75%]
2. Aortic arch dilatation [ 30-45%]
3. Change in configuration of aorta on

successive CXR
4. Obliteration of aortic knob
5. Double density of aorta
6. Localised prominence along aortic contour
7. Displacement of trachea/NGT to Right
8. Distortion/depression of L main stem bronchus
9. Pleural effusion [15%]
10 Massive left haemothorax
11. Cardiomegaly [20%]
12. Calcium sign* [ > 6mm distance between intimal calcium and outer aortic wall shadow]

{ * most specific sign }

Front 6

Indications for Surgical repair of Type B Aortic Dissection?

Back 6

** High mortality

1. Marfan's Syndrome
2. Intractable pain
3. Intractable Hypertension
4. Leaking / rupture aorta
5. Ischaemic compromise of vital organs

( Major vessel involvement)
6. Extension of dissection-despite medical Mx.
7. Aortic dilatation > 5 cm

Front 7

SHAKEM Notes

Which of the following factS regarding thoracic dissection is correct ?

A. Thoracic dissection is 4 x more common than AAA

B. 45% of thoracic dissections are fatal within 24 hours.

C. The In-Hospital mortality is 25%

D. 65% dissections occur in females.

Back 7

C.

A = 2-3 x more common than AAA

B = 28% fatality within 24 hrs.

D = Males

Front 8

SHAKEM notes.

which of the following facts is correct regarding thoracic dissection ?

A. Patients who have inadvertent thrombolysis for thoracic dissection have 3 x mortality.

B. 85% deaths are due to rupture

C. 50% thoracic dissection rupture occurs into the pericardial sac.

D. Chronic hypertension is present in 90% cases of thoracic dissection.

Back 8

B.

A = 2 x mortality

C = 70%

D = 70% cases chronically hypertensive

Front 9

Which of the following statistics regarding the physical findings in thoracic dissection

is correct?

A. Shock present in 25%

B. Systolic BP differential present in 10%

C. Hypertension present in 50%

D. Pulse deficit present in 20%

Back 9

C. ( 49% to be precise)

A = Shock is present in 18%

B = Systolic BP differential present in 31% (1/3)

D = Pulse deficit present in 15%

Front 10

Which of the following statistics regarding the physical findings in thoracic dissection is

incorrect?

A. Hypertension present 49% cases

B. New aortic insufficiency murmur present in 20%

C. Neurological deficit present in 17%

D. Systolic BP differential present in 31%

Back 10

B = New aortic insufficiency murmur present in 32%

Front 11

Which Radiographical Statistic for Thoracic

dissection is incorrect ?

A. Mediastinal widening is present in 80% cases.

B. Aortic arch changes are present in 50% cases.

C. 10-20% CXR are normal.

D. The most specific radiographic finding of

thoracic dissection is the calcium sign.

Back 11

A = Mediastinal widening is present in 50-75%

Front 12

Which of the following is correct regarding the ECG in thoracic dissection ?

A. It is normal in 22% cases.

B. The most common finding is a sinus

tachycardia.

C. STEMI features are present in 1% cases.

D. Non specific ST-T wave changes do not occur.

Back 12

A. ECG is normal in 22%

B = Most common finding is non specific ST-T wave changes

C = STEMI features present in 3-7%

D = they do.

Front 13

List the risk factors for thoracic dissection in the young age group ( < 40 years).

Back 13

1. Marfans Syndrome (50%)

2. Hypertension ( 34% cases)

3. Bicuspid aortic valve

4. Prior aortic valve surgery

5. Pregnancy

6. Cocaine.

Front 14

Which of the following Thoracic dissection types does not usually require Surgical intervention?

A. Stanford type A

B. DeBakey I

C. DeBakey II

D. DeBakey III

Back 14

D.

As well as Stanford Type B.