Stanford classification

■ Type A: involving ascending aorta or arch.

■ Type B: limited to descending aorta (distal to left sub-clavian).

Clinical manifestations vary depending on the site and extent of the dissection. ECG changes of myocardial infarction can be present if the coronary arteries are involved, and neurological signs may indicate haematoma or intimal flap narrowing the head and neck vessels.

Patients with Sandford type-B dissection are treated medically with management of hypertension and those with type A are treated surgically. Diagnostic imaging modalities include transthoracic and trans-oesophageal echocardiography, angiography, CT and MRI. 39

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