Aortic Dissection - Cardiovascular

Snapshot
- A 32-year-old man with eunuchoid proportions and arachnodactyly presents to the emergency department with severe substernal chest pain that radiates to the back. He says that the pain occurred acutely and denies any recent trauma. Medical history is significant for Marfan syndrome. On physical exam, there are unequal blood pressures in the upper extremity. A chest radiograph demonstrates a widened mediastinum. A CT angiography demonstrates a Stanford A type aortic dissection.

Summary
- Aortic dissection is a condition that results from a tear in the innermost layer of the aorta leading to a hematoma and separation of layers of the aortic wall. Patients with hypertension and advanced age are more at risk for dissection. These patients typically present with abrupt onset of severe, tearing chest pain.
- Diagnosis is made with CT angiography or transoesophageal echocardiogram. Chest X-ray is often acquired first, which may show a widening of the mediastinum.
- Treatment depends on the type of dissection. Regardless though, medical therapy is concurrently initiated with IV beta-blockers, IV fluids for hypotension, and surgical therapy indicated for type A dissections.

Anatomy
- The aorta has three distinct wall layers
  
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