Aortic Dissection

Question 1

what is an aortic dissection?

Answer 1

results from the creation of a false lumen between the intima ( inner lining ) and the media ( middle layer ) of artieral wall

It’s literally a tear through the inner layer into the middle layer, think of it like a cut

Question 2

what its the most important risk factor for patients who end up having aortic dissection?

Answer 2

hypertension

Question 3

each heartbeat increases pressure on damaged area making it ___for patient with aortic dissection

Answer 3

worse

Question 4

aortic dissection pain is like what?

Answer 4

gradual onset than mi with increased intensity

its like having a myocardial infarction, just like gradually increasing

its not an obstruction, its lack of blood supply because its being diverted

Question 5

what are some clinical manifestations of aortic dissection ?

Answer 5

back pain that can go into the arm and up into their jaw

” sharp “

Question 6

a complication of aortic dissection is what?

Answer 6

cardiac tamponade

Question 7

what is cardiac tamponade?

Answer 7

occurs when blood/fluid/pus escapes from the dissection into the pericardial sac

( heart is beating under water, outside pressure pressing on your heart, your heart can’t contract normally, and immediate and severe cardiac decreased output )

Question 8

what is the clinical manifestation of cardiac tamponade?

Answer 8

muffled heart sounds!!! ( underwater )
shortness of breathe
hypotension
narrowed pulse pressure
distended neck veins
pulses paradoxus

Question 9

how are patients going to sound like in cardiac tamponade?

Answer 9

muffled heart sounds

Question 10

how do you treat cardiac tamponade?

Answer 10

draining, needle
open chest needle

paracardioal window, hole in the pericardial space into the abdomen

Question 11

is cardiac tamponade an emergency ?

Answer 11

yes!

Question 12

aortic dissection causes a decreases in blood supply anything _____

Answer 12

below the dissection

Question 13

what medication can we give to patients with aortic dissection?

Answer 13

beta blockers
morphine

Question 14

most of the time we have to surgery for patients with aortic dissection. which type ?

Answer 14

endovascular dissection repair

Question 15

Preoperative
Semi-Fowler’s position & quiet environment to  HR and SBP
Anxiety and pain management
Opioids and sedatives
Titrate IV antihypertensive agents
Continuous BP and ECG monitoring
Frequent VS ( every 2 to 3 minutes)

Question 16

Preoperative
Observation of changes in quality of peripheral pulses
Monitor for:
Increasing pain
Restlessness
Anxiety

Question 17

Postoperative
See aneurysm postop care (discussed earlier)
Discharge teaching
Long-term HR and BP control
Antihypertensive drugs and side effects
β-blockers or ACE inhibitors
Regular follow-up with CT or MRI
If pain returns or symptoms progress, instruct patient to seek immediate help

Question 18

whenever a patient is having an surgery for anersyum or like dissection

graft patency and renal perfusion are priority