Study note

Aortic dissection: pain, examination and branch occlusion

THE CONTEXT

Aortic dissection produces characteristic abrupt pain, vascular examination findings and complications from occluded aortic branches.

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Ascending aortic involvement typically causes anterior chest pain; descending aortic involvement typically causes intrascapular back pain.

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Pain is typically tearing and very abrupt in onset, and collapse is common.

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Unless major haemorrhage occurs, the patient is invariably hypertensive.

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Brachial, carotid or femoral pulses may be asymmetric, and signs of aortic regurgitation may be present.

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Coronary artery occlusion may cause myocardial infarction; carotid occlusion may cause stroke.

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Spinal arterial occlusion may cause paraplegia.

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Coeliac and superior mesenteric arterial occlusion may cause mesenteric infarction with an acute abdomen.

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Renal arterial occlusion may cause renal failure, while limb arterial involvement may cause acute ischaemia, usually of a leg.

NEETx

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