5.8 G) Ii) Vascular Aortic Dissection

Front 1

List the predisposing factors for aortic

dissection.

Back 1

1. Hypertension ( 70-80%)
2. Congenital cardiovascular disorders
3. Aortic stenosis
a. Bicuspid aortic valve
b. Coarctation of aorta
4. Connective Tissue disorders
a. Marfan's Syndrome
5. Ehlers-Danlos Syndrome

6. Cocaine

7. pregnancy

8. Iatrogenic ( post cardiac surgery)

9. Inflammatory diseases ( GCA)

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
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 ( comparative change)
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]

Front 6

Indications for Surgical repair of Type B Aortic Dissection?

Back 6

1. Marfan's Syndrome
2. Intractable pain
3. Intractable Hypertension
4. Leaking / ruptures aorta
5. ischaemic compromise of vital organs
6. Extension of dissection-despite medical Mx.
7. Aortic dilatation > 5 cm

Front 7

List the complications of sodium nitroprusside.

Back 7

1. Cyanide poisoning ( Thiocyanate toxicity)

2. Methaemoglobinaemia

3. Excessive hypotension

4. Extravasation -skin necrosis

**avoid in pregnancy

Front 8

List the contraindications / complications of GTN.

Back 8

Contraindications

1. Viagra

2. Fixed cardiac outputs states ( Aortic stenosis)

Complications

1. headache

2. tachyphylaxis

Front 9

In regards to GTN infusions, what does 30mg of GTN in D5W equate to ( x / mL) ?

Back 9

600 mcg / mL

Front 10

What is the mortality of thoracic dissection once the diagnosis is made in the Emergency

Department ?

Back 10

25% in theatre

further 5% in Hospital

(total 30%)

Front 11

What percentage of patients die of thoracic

dissection before getting to Hospital?

Back 11

50%