• Aortic dissection
• Peak (i) 50-70 years, commoner in males
• Most occur within 10cm of the aortic valve, next most common are just distal to the left subclavian.
• Common causes: deceleration trauma, connective tissue diseases, HT, smoking, vasculitis, arteritis, aneurysm, aortic surgery
• Stanford classification
• Type A - ascending aorta & possibly into the arch & descending aorta
• Type B - descending aorta only (distal to L subclavian)
• Type A require surgery, type B is usually managed conservatively
• Type A classically presents with chest pain
  Type B presents with back & abdominal pain
• Can present with tachycardia, pericardial effusion, aortic regurg, acute MI, neurological symptoms
• Anaesthetic management
• Right radial art line
• CVC
• TOE monitoring
• Usually median sternotomy but may be left thoracotomy (double lumen tube)
• CPB may be used, cannulation for anterograde perfusion may be difficult
• Cerebral protection by deep hypothermia +/- barbituates
• Beware of DIC (blood transfusion, drugs, hypothermia)
• Pain relief
• Surgery CI in paraplegia
  Renal/neuro involvement carries a poor prognosis
• Rx: reduce LV contraction while maintaining perfusion.
  
• β-blockers - labetalol
• SNP
• GTN
• Hydralazine
• ECG is ischaemic in 20%, other investigations include CT/MRI/Echo/TOE/aortography. CXR shows aortic knuckle changes and loss of CP angle due to haemothorax.
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/9/1/14.full.pdf