The patient proceeds to a CTA chest.
Q1. What is the diagnosis?
Q2. Outline the classification systems for this condition
The DeBakey Classification
- type 1 originates in ascending aorta, propagates at least to the aortic arch and often beyond it distally
- type 2 originates in and is confined to the ascending aorta
- type 3 originates in descending aorta, rarely extends proximally but will extend distally
- type A is any dissection that involves the ascending aorta (proximal)
type B is any dissection does not involve the ascending aorta (distal)
He was hospitalised for 8 months after his operation but eventually recovered and was able to return to work. He subsequently thanked the surgical team for prolonging his life and worked until the day he died at the age of 99.
The surgeon replied: “Try doing your work with the engine running.”
— legend has it the surgeon was Michael DeBakey (1908–2008)
Q3. Outline the management of this condition
While awaiting definitive intervention, blood pressure control is the most critical intervention. Blood pressure should be controlled as rapidly as possible aiming for a systolic blood pressure of 120mmHg or even less using a combination of IV beta blocker (reduces heart rate and shearing forces on the aorta), then GTN +/- sodium nitroprusside (decreases afterload). Where it is available IV labetatolol is a good choice.