AORTIC DISSECTION Wide clinical spectrum Chest pain most common
72.7% Tearing/ripping were not characteristic descriptors Abrupt
onset 84.8% and severe 90.6% Migrating 16.6% Abdo pain 29% Back
pain 53% Syncope 9.4% No other neuro deficits Hypertension 70% Type
B, 35.7% Type A Hypotension = tamponade UPO Aortic regurg murmur in
half ECG normal in 31%
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CXR CXR findings Mediastinal widening Left paraspinal stripe
Displacement of intimal calcifications (calcium sign) Apical
pleural cap Left pleural effusion Displacement of endotracheal tube
or nasogastric tube 63% sensitive for widened mediastinum
Completely normal in 12.4%
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US Limited role as a bedside test except to rule out
pericardial tamponade Aortic regurg (doppler) Intimal flap may be
seen using parasternal and suprasternal view Transoesophageal (TOE)
very sensitive but less accessible than CT
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TREATMENT Overall mortality 27.4% Type A Surgery reduces
mortality from 58% to 26% Type B Surgery worsens prognosis from 10
31%!! Majority successfully managed medically BP control Reduced
wall stress Beta-blocker eg esmolol aiming for 60bpm / systolic
120mmHg +/- IV antiHT Fentanyl 25-50mcg Urgent transfer to CTS
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AD VS AMI Due to dissection of R or L coronary arteries Needs
robust discussion with Cardiologist Poor eGFR must not hinder
emergent CT aortogram Hypotension Tamponade Myocardial ischaemia
Aortic insufficiency Withhold thrombolytics/heparin