Aortic dissection

Aortic dissection

What is the usual character of pain in Aortic dissection?

A. Tearing type

B. Squeezing type

C. Compression type

D. Dull aching type

Aortic dissection that involve ————– of the aorta usually requires surgery

A. First part

B. Second part

C. Third part

D. Fourth part

What is the prognosis of aortic dissection without treatment in people with Stanford type A dissections ?

A. 10% die in 10 days

B. 15% die in 7 days

C. 30% die in 5 days

D. 50% die in 3 days

Anterior chest pain is associated with dissections involving the

A. Ascending aorta

B. Arch of aorta

C. Thotacic desending aorta

D. Abdominal aorta

What is the most common cause of death from Aortic dissection

A. Neurogenic shock

B. Pericardial tamponade

C. Aortic insufficiency

D. Myocardial Infarction

Heart attack occurs in ——— of aortic dissections.

A. 1–2%

B. 5-10%

C. 10–12%

D. 15-20 %

Which of the following is TRUE about Aortic dissection complicated with myocardial infarction?

A. Thrombolysis with Streptokinase

B. Thrombolysis with Alteplase

C. Thrombolysis with Tenecteplase

D. Thrombolysis is contraindicated

All of the following are TRUE about Aortic Dissection EXCEPT –

A. Hypertension present in 70% of patients with distal Standford type B aortic dissection

B. Marfan syndrome present in 50% of patients who are under age 40 years

C. More common in women than Men

D. Thrombolysis is contraindicated

Extra-Points

What are the common sites for Aortic Dissection?

  1. Nearly 2-2.5 cm above the aortic root (the most common site)
  2. Just distal to the origin of the left subclavian artery
  3. In the aortic arch

Pseudohypotension in Aortic Dissection –

Pseudohypotension -may occur due to involvement of –

brachiocephalic artery or the left subclavian artery

Why severe hypotension at presentation is a grave prognostic indicator in Aortic Dissection.

Severe hypotension at presentation is a grave prognostic indicator.

It is usually associated with one of the following –

pericardial tamponade

severe aortic insufficiency

rupture of the aorta.

Stanford Classification for Aortic Dissection –

Based on whether ascending or descending part of the aorta involved

Stanford system is more frequently employed. It classifies dissections into two types based on whether ascending or descending part of the aorta involved. 

  • Type A involves the ascending aorta, regardless of the site of the primary intimal tear. Type A dissection is defined as a dissection proximal to the brachiocephalic artery.
  • Type B aortic dissection originating distal to the left subclavian artery and involving only descending aorta.

DeBakey classification is based upon the site of origin of the dissection.

Type 1 originates in the ascending aorta and to at least the aortic arch.
Type 2 originates in and is limited to the ascending aorta.
Type 3 begins in the descending aorta and extends distally above the diaphragm (type 3a) or below the diaphragm (type 3b).
Ascending aortic dissections are almost twice as common as descending dissections

Absolute Contraindications for Thrombolytic Treatment

  • Recent intracranial hemorrhage (ICH)
  • Structural cerebral vascular lesion
  • Intracranial neoplasm
  • Ischemic stroke within three months
  • Possible aortic dissection
  • Active bleeding or bleeding diathesis (excluding menses)
  • Significant head injury or facial trauma within three months
  • Recent Intracranial or spinal surgery 
  • Severe uncontrolled hypertension
  • For streptokinase, previous treatment within six months

Relative Contraindications for Thrombolytic Treatment 

  • History of severe and poorly controlled hypertension
  • Severe hypertension at presentation (systolic blood pressure >180 mmHg or diastolic blood pressure >110mmHg)
  • Prolonged (>10 minutes) cardiopulmonary resuscitation (CPR) or major surgery within three weeks.
  • History of ischemic stroke.
  • Dementia
  • Internal bleeding within 2 to 4 weeks
  • Noncompressible vascular punctures
  • Pregnancy
  • Active peptic ulcer
  • Concurrent therapy of anticoagulants is associated with an elevated international normalized ratio (INR) higher than 1.7 or a prothrombin time (PT) longer than 15 seconds.