Image Based Question-66875

A patient presented with sudden onset of severe chest pain with a tearing quality and numbnes in the extremities.Following classification as shown in the image is used for the approach of treatment in this condition.Identify this classification.

A. Satnford Classification.

B. DeBakey classification.

C. Ritter Classification.

D. Litter Classification.

Correct Answer » A Explanation

Ans: A. Stanford Classsification.

• The patient is suffering from Aortic Dissection.
• Stanford Classification is used to classify Aortic Dissection.

Aortic dissection

• It essentially features a tear in the intimal layer, followed by the formation and propagation of a subintimal hematoma.

Clinical Features:

• Sudden onset of severe chest pain that often has a tearing or ripping quality (classic symptom)
• Anterior chest pain: Usually associated with anterior arch or aortic root dissection
• Neck or jaw pain: With aortic arch involvement and extension into the great vessels
• Tearing or ripping intrascapular pain: May indicate dissection involving the descending aorta
• Syncope
• Cerebrovascular accident (CVA) symptoms (eg, hemianesthesia, and hemiparesis, hemiplegia) 
• Altered mental status
• Numbness and tingling, pain, or weakness in the extremities

 Classification of Aortic Disscetion

Stanford classification

It is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. 

Type A:

• affects ascending aorta and arch
• accounts for ~60% of aortic dissections
• surgical management
• may result in:
  • coronary artery occlusion
  • aortic incompetence
  • rupture into pericardial sac with resulting cardiac tamponade

Type B:

• begins beyond brachiocephalic vessels
• accounts for ~40% of aortic dissections
• dissection commences distal to the left subclavian artery
• medical management with blood pressure control.

DeBakey classification

• Along with the Stanford classification, the DeBakey classification is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management.

The DeBakey classification divides dissections into :

• type I: involves ascending and descending aorta (= Stanford A)
• type II: involves ascending aorta only (= Stanford A)
• type III: involves descending aorta only, commencing after the origin of the left subclavian artery (= Stanford B)