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Aortic Dissection

Aortic Dissection. Aortic Dissection. Inciting event is a tear in the aortic intima. Propagation of the dissection can occur proximal (retrograde) or distal ( antegrade ) to the initial tear, involve the aortic valve, or branches of the thoracic and/or abdominal aorta.

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Aortic Dissection

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  1. Aortic Dissection

  2. Aortic Dissection Inciting event is a tear in the aortic intima. Propagation of the dissection can occur proximal (retrograde) or distal (antegrade) to the initial tear, involve the aortic valve, or branches of the thoracic and/or abdominal aorta. Propagation of the dissection is responsible for clinical manifestations that can include aortic regurgitation, cardiac tamponade, and end-organ ischemia (coronary, cerebral, spinal, or visceral).

  3. Aortic Dissection • International Registry of Acute Aortic Dissection (IRAD) • 2.6 to 3.5 per 100,000 person-years • Most likely 60 – 80 year old men • Risk factors (especially for younger patients): • Preexisting aortic aneurysm • Collagen disorders, Turner syndrome, inflammatory diseases • Bicuspid aortic valve • Aortic coarctation • Previous aortic valve replacement (5% of all, 12% under 50) • Cocaine usage within last 24 hours

  4. Aortic Dissection • Symptoms: • “Tearing” abdominal or back pain, much more common in Type B • Type A more likely to present with anterior chest pain • 73% of patients with Type A presented with abrupt onset of chest pain and more often sharp than tearing • Can be alone or accompanied by syncope, CVA, MI, HF

  5. Aortic Dissection • Blood pressure at presentation: • Most patients with an aortic dissection have a h/o HTN the blood pressure is quite variable at presentation with acute aortic dissection • With a proximal aortic dissection, 36% present with hypertension, while 25% present with hypotension. • In those who present with distal aortic dissections, 70% present with hypertension while 4% present with hypotension.

  6. Clinical Manifestations • Study found that 96% of aortic dissections could be identified based on : • Abrupt onset of thoracic or abdominal pain with a sharp, tearing or ripping character • Mediastinal or aortic widening on chest radiograph • A variation in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20 mmHg difference between the right and left arm) • >83% had variation in pulse or BP differential • 77% had 2 of the 3 variables • 39% had CXR abnormalities

  7. Clinical Pearl **If a patient presents with chest pain and neurologic symptoms, suspect Aortic Dissection!

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