Cardiovascular Medicine Book

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Aortic Dissection

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  1. Epidemiology
    1. Most common in males 40-70 years old
    2. Incidence: 2000 per year in US
  2. Pathophysiology
    1. Intimal tear precedes dissection
  3. Symptoms
    1. Chest Pain (Universal)
      1. Severe tearing sensation
      2. Aortic dissection pain radiates to back or abdomen
        1. Myocardial Infarction rarely radiates like this
      3. Aortic dissection pain is most severe at onset
        1. Myocardial Infarction pain is crescendo in nature
    2. Neurovascular symptoms
      1. Cerebrovascular Accident
      2. Syncope
  4. Signs
    1. Hypertension (60%)
    2. Dissection of hematoma
      1. Cerebrovascular Accident
      2. Hemiplegia
      3. Pulse deficits
      4. Aortic Insufficiency
    3. Cardiac Tamponade
  5. Diagnosis
    1. Electrocardiogram
      1. Left Ventricular Hypertrophy
      2. Myocardial Ischemia
      3. Myocardial Infarction
    2. Chest XRay
      1. Mediastinal widening (progressive)
  6. Imaging
    1. Aortic Angiography (gold standard)
      1. Accuracy
        1. Sensitivity: 90-98%
        2. Specificity: 95-98%
    2. CT Chest
      1. Sensitivity: 94%
      2. Specificity: 90%
    3. Transesophageal Echocardiogram (Increasingly popular)
      1. Sensitivity: 97%
      2. Specificity: 75-90%
    4. MRI Chest
      1. Sensitivity: 98%
      2. Specificity: 98%
  7. Complications
    1. Neurologic deficits
      1. Cerebrovascular Accident
    2. Unequal perfusion
      1. Unequal pulses
      2. Unequal extremity Blood Pressures
    3. Myocardial Ischemia
    4. Myocardial Infarction
    5. Aortic Regurgitation
    6. Cardiac Tamponade
  8. Management
    1. Lower Blood Pressure
      1. Nitroprusside 0.5-10 ug/kg/min IV
      2. Labetalol 20-40 mg incremental boluses IV
      3. Trimethaphan 1-4 mg/min IV
    2. Proximal Aortic Dissection
      1. Surgical Management
    3. Distal Aortic Dissection
      1. Medical Management

Dissection of aorta (C0340643)

ConceptsDisease or Syndrome (T047) , Anatomical Abnormality (T190)
EnglishAORTIC DISSECTION, Dissection of aorta
Spanishdiseccion aortica
Parent ConceptsArteriopathic disease (C0852949), Aneurysm, Dissecting (C0002949), Aortic Aneurysm (C0003486)
SourcesDXP, NCI, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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