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Aortic Dissection, Thoracic

Aortic Dissection, Thoracic is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Aortic dissection begins when there is an intimal tear.
  • Blood then dissects through the media under aortic systolic pressure.
  • It is thought that hypertension is a major factor in the dissection process.
  • Dissections can start proximally at the root and dissect distally to involve any or all branches of the aorta, such as the carotid and subclavian arteries.
  • The dissection process can also proceed proximally to involve the aortic root, the coronary ostia, and the pericardium.
  • Dissection that progresses proximally may lead to occlusion of the coronary ostia, aortic valve incompetence, or cardiac tamponade.
  • Classification related to portion of aorta involved:
    • Stanford classification:
      • Type A: Ascending aorta
      • Type B: Distal to ascending aorta
    • DeBakey classification:
      • DeBakey I: Intimal tear in aortic arch or root
      • DeBakey II: Ascending aorta
      • DeBakey III: Distal to takeoff of left subclavian artery
  • Peak age for occurrence:
    • Proximal dissection: 50–55 yr
    • Distal dissection: 60–70 yr

Pregnancy Considerations
Risk of dissection increases in the presence of pregnancy:
  • In women <40 yr of age, 50% of dissections occur during pregnancy.

Etiology

Any process that affects the mechanical properties of the aortic wall can lead to dissection:
  • Hypertension (72% of patients in the Registry of Acute Aortic Dissection)
  • Congenital heart disease (bicuspid aortic valve, coarctation)
  • Aortic wall connective tissue abnormalities (cystic medial necrosis)
  • Connective tissue disease (Marfan disease, Ehlers–Danlos syndrome)
  • Pregnancy
  • Infectious/inflammatory conditions that can cause vasculitis (lupus, syphilis, endocarditis, giant cell arteritis, rheumatoid arthritis, Takayasu arteritis)
  • Previous cardiac surgery including CABG, aortic valve repair
  • Tobacco use

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Citation

Rosen, Peter, et al., editors. "Aortic Dissection, Thoracic." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307247/all/Aortic_Dissection__Thoracic.
Aortic Dissection, Thoracic. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307247/all/Aortic_Dissection__Thoracic. Accessed April 24, 2019.
Aortic Dissection, Thoracic. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307247/all/Aortic_Dissection__Thoracic
Aortic Dissection, Thoracic [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307247/all/Aortic_Dissection__Thoracic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Aortic Dissection, Thoracic ID - 307247 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307247/all/Aortic_Dissection__Thoracic PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -