SELF ASSESSMENT-Aortic Dissection
MedEducation Flix – Aortic Dissection Self-Assessment
1. What is acute aortic dissection?
A tear in the aortic intima allowing blood to enter the media, creating a false lumen.
2. What are the two main classification systems for aortic dissection?
Stanford (Type A and B) and DeBakey (Types I, II, III).
3. What is the Stanford Type A dissection?
Involves the ascending aorta, regardless of site of origin.
4. What is the Stanford Type B dissection?
Confined to the descending aorta, distal to the left subclavian artery.
5. What Clinical symptoms suggest aortic dissection?
Sudden severe chest, back, or tearing pain; pulse deficit; neurological deficits.
6. What clinical signs raise suspicion for acute aortic dissection?
Pulse asymmetry, BP differential, new murmur of aortic regurgitation, focal neuro signs.
7. What is the Aortic Dissection Detection Risk Score (ADD-RS)?
Clinical tool using history, exam, and risk markers to stratify dissection risk.
8. What components make up the ADD-RS?
High-risk history (Marfan, family hx), exam (pulse/BP deficit), and chest X-ray findings.
9. What is the role of D-dimer in suspected dissection?
High sensitivity; negative D-dimer (<500 ng/mL) in low-risk patients may help rule out dissection.
10. What are the limitations of D-dimer in dissection?
Poor specificity; may be elevated in other conditions like PE, MI, or inflammation.
11. What imaging modalities confirm aortic dissection?
CT angiography (preferred), TEE, or MRI depending on availability and stability.
12. Why is ECG-gated CT angiography preferred?
Reduces motion artifact in the ascending aorta, improving diagnostic accuracy.
13. What ECG changes can mimic aortic dissection?
ST elevations (if coronary involvement), LVH, or non-specific changes.
14. Why is beta-blocker therapy first-line in dissection?
Reduces shear stress by lowering heart rate and contractility.
15. Why should you give beta-blockade, with or before vasodilators?
Avoid reflex tachycardia which increases shear stress; beta-blockers blunt this effect.
16. What is the target blood pressure and heart rate in dissection?
SBP 100–120 mmHg and HR <60 bpm.
17. When is emergency surgery indicated in dissection?
All Stanford and DeBakey Proximal Type A dissections or complicated Type B (malperfusion, rupture, persistent pain).
18. How are uncomplicated Type B dissections managed?
Initially medically with BP and HR control; surgical/endovascular if complications arise.
19. What medications are used for acute BP control?
IV beta-blockers (labetalol, esmolol), with vasodilators (nitroprusside, nicardipine) added afterwards.
20. What is the mortality rate of untreated Type A dissection?
1–2% increase per hour after symptom onset; up to 50% by 48 hours.