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00:00 What about the signs and symptoms? Chest pain, tearing, radiating to the back. Doc, well this thing hurts on a scale of 1 out of 10, 10 being the worst pain the patient has ever experienced, it is a 10, radiating to the back, severity and intensity. Sudden onset because of dissection. What about the patient’s unequal blood pressure where? I just told you the robbing the blood because of the dissection it is removing the blood. 00:32 Not removing the blood, you are losing the blood literally. Unequal blood pressure in both arms due to dissection, obstruction of branches of the aorta. You have issues there because of dissection. Look for that, please. Diagnosis made by CT and on this particular CT you will notice right in the middle where there is a tear of your aorta resulting in blood quickly leaking out and resulting in all kinds of issues including that unequal blood pressure between the arms to the point where maybe there is the pericardial cavity effusion or in other words rapidly there might be a tamponade and that is exactly what the middle portion of the CT is then showing you. Diagnosis. Control of blood pressure. Usually, ICU, IV nitropusside and perhaps you are thinking about esmolol or other IV beta blockers because you are trying to control that bleeding that is now taking place quite a bit. You don’t want that cardiac output to be quite high because that is then going to then contribute to the blood being lost through the dissection. That must be understood. You want to relax the heart so that you have control of the dissection. Medical management. The only one that I will be point out here to you will be Stanford type B. Where am I? The descending aorta, in other words, it is not the ascending. A is ascending type of dissection. The B is the one that you to pay attention to the type of dissection. It is persisitent pain, persistent dissection which then requires immediate surgery. A, ascending. B, distal, by the thoracic and descending aorta.
About the Lecture
The lecture Aortic Dissection: Signs, Symptoms, Diagnosis and Treatment by Carlo Raj, MD is from the course Arrhythmias.
Included Quiz Questions
What is the correct order of the layers of the wall of the aorta from interior to exterior?
- Intima, media, adventitia
- Media, intima, adventitia
- Adventitia, media, intima
- Intima, adventitia, media
- Media, adventitia, intima
What is the rationale behind the Stanford classification of aortic dissection?
- They guide treatment based on the area of the aorta involved in the dissection.
- They are based on anatomic location of the initial tear.
- Type A presents acutely, while type B presents chronically.
- Type A involves a true lumen, and type B involves a false lumen.
- They have different etiologies.
Which modality is most commonly used to diagnose an aortic dissection?
- CTA chest and abdomen with IV contrast
- Aortography
- Transesophageal echocardiogram
- Lateral chest x-ray
- Transthoracic Echocardiogram
In a patient presenting with Stanford type A aortic dissection, what is the mainstay of management?
- Emergency surgical correction
- IV esmolol
- IV digoxin
- IV morphine
- IV nitroprusside
In a patient presenting with a descending aortic dissection, what is the goal of medical management?
- Decrease shearing forces.
- Decrease heart rate.
- Manage hypotension.
- Prevent cardiac ischemia.
- Increase cardiac output.
Author of lecture Aortic Dissection: Signs, Symptoms, Diagnosis and Treatment
Carlo Raj, MD
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