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Aortic Dissection (Clinical Presentation (Pain is maximal from the time of…
Aortic Dissection
Clinical Presentation
Pain is maximal from the time of onset, unlike in MI where the pain gains in intensity
Patients may be shocked and may have neurological symptoms secondary to loss of blood supply to spinal cord
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May develop aortic regurgitation, coronary ischaemia and cardiac tamponade
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Distal extension may produce acute kidney failure, acute lower limb ischaemia or visceral ischaemia
Sudden onset of severe and central chest pain that radiates to the back and down the arms - mimics a MI
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Treatment
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At least 50% are hypertensive and may require urgent antihypertensive medication to reduce blood pressure to less than 120mmHg - give IV beta-blockers or vasodilators
Pathophysiology
The tear allows a column of blood under pressure to enter the aortic wall, forming a haemotoma which separates the intimal from the adventitia and creates a false lumen
The false lumen extends for a variable distance in either direction; anterograde (towards bifurcations) and retrograde (towards aortic root)
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Diagnosis
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Urgent CT scan, trans-oesophageal echocardiography or MRI will CONFIRM DIAGNOSIS
Differential Diagnosis
Acute coronary syndrome, MI, aortic regurgitation without dissection, MSK pain, pericarditis, cholecystitis, atherosclerotic embolism