Case Files: Case 6

Front 1

Aortic Dissection

clinical features (5), radiological feature

Back 1

1. Sudden onset
of ripping or tearing chest pain ± radiation to the back, neck, extremities

2. Pain is maximal at onset

3. Pain is not relieved by nitrates (ie. nitroglycerin)

4. Presence of an early diastolic
murmur due to aortic insufficiency

5. If it occludes branch arteries, it can lead to different pulses + BPs in the extremities

6. Widened mediastinum

Front 2

Classification of Aortic Dissection

i (2), ii (3)

Back 2

1. Type A: proximal or ascending
- always involves the ascending aorta but can involve any other part
- surgical emergency

2. Type B: tranverse or descending
- originates in the aortic arch distal to the left subclavian artery
- does not involve the ascending aorta but can involve any other part
- managed medically and surgery performed only for complications

Front 3

Aortic Dissection: Risk Factors

(4)

Back 3

1. Hypertension

2. Marfan syndrome

3. Congenital aortic anomalies

4. Women in the 3rd trimester of pregnancy

Front 4

Aortic Dissection: Medical Therapy

(3)

Back 4

1. IV beta-blockers: metoprolol or labetalol

2. ↓ cardiac contractility, ↓ BP, ↓ shear stress

3. ↓ propagation dissection

Front 5

Aortic Dissection: Complications

(3)

Back 5

1. Rupture

2. Occlusion of any branch
artery of the aorta

3. Retrograde dissection with hemopericardium + cardiac tamponade

Front 6

Abdominal Aortic Aneurysm (AAA)

def, sx, detection

Back 6

1. Dilation of the aorta with a diameter > 3 cm

2. Asymptomatic

3. Midline pulsatile mass or noted incidentally on ultrasound or other imaging modality

Front 7

AAA

rupture risk, when surgery, when/how monitored

Back 7

1. Risk of rupture of AAA ↑ w/ size

2. Aneurysms > 5.5 cm should undergo elective surgical repair

3. Aneurysms < 5 cm can be monitored with serial US, CT, MRI