Aortic Dissection (Thoracic)
Summary
Symptoms
Symptoms
- Sudden, midline, sharp searing pain, may radiate to back
- May radiate to abdo, flank, legs
- Pre/ Syncope
- Marfan's syndrome
- Radioradial delay
- L/R BP difference (SBP>20mmHg)
- Diastolic murmur (aortic regurg)
- (Acute limb ischaemia)
- (Hemiplegia/ Paraplegia)
- (Anuria)
- Bedside: ECG
- Bloods: FBC+CRP, Troponin, UEC, x-match blood
- Imaging: CXR/ CT/ MRI/ TOE
- Ascending tear: surg repair
- Descending tear: med (SBP~100)/ surg repair
Epidemiology
70% ascending aorta (Type A)/ Type B = non ascending aorta
Acute operative mortality <25%
Clinical Features
Sx
Signs
Investigations
Source
OHCM 9th Ed 2014
Murtagh 4th Ed 2007
70% ascending aorta (Type A)/ Type B = non ascending aorta
Acute operative mortality <25%
Clinical Features
Sx
- Sudden, midline, tearing chest pain
- May radiate to back, abdomen, flank, legs
Signs
- Radio-radial delay
- L/R BP difference
- Hemiplegia (carotid artery)/ Paraplegia (anterior spinal a)/ anuria (renal a)
Investigations
- Bedside: ECG (rule out AMI)
- Bloods: FBC+CRP (rule out anaemia/ AMI/ infections-pleuritis), Troponin (rule out AMI), UEC (baseline/dehydration-shock/?renal failure), x-match blood (for transfusion)
- Imaging: CXR (mediastinal expansion rare)/ CT/ MRI/ TOE (transoesophageal echocardiography)
- Admit --> keep SBP ~ 100 (IV Labetalol/ CB/Blood transfusion - 10U) --> Surgical referral/ repair
Source
OHCM 9th Ed 2014
Murtagh 4th Ed 2007