Intraabdominal Hypertension (IAH)

Question 1

Aortic Dissection

Answer 1

Often misnamed “dissecting aneurysm” but this is not a type of aneurysm
Result of a false lumen between layers of wall of aorta through which blood flows

Question 2

Etiology and Patho

Answer 2

Due to degeneration of the elastic fibers in the arterial wall
Chronic HTN hastens the process
Tear in inner layer allows blood to “track” between inner and middle layer
As heart contracts, each systolic pulsation increases pressure on damaged area
Further dissection
May occlude major branches of aorta
Cutting off blood supply to brain, abdominal organs, kidneys, spinal cord and extremities

Question 3

Acute Type A aortic dissection: ascending aorta and arch

Answer 3

Abrupt onset of excruciating anterior chest pain
Neuro deficiencies r/t aortic arch involvement
Disruption of blood flow in coronary arteries and aortic valve insufficiency

Question 4

Acute Type B aortic dissection: descending aorta

Answer 4

More likely to report pain located in their back, abdomen, legs

Question 5

Aortic Dissection Pain

Answer 5

Sudden, severe pain in anterior part of chest or intrascapular pain radiating down spine to abdomen or legs
Described as “sharp” and “worst ever”
May mimic that of MI
Cardio, neuro, and resp signs may be present

Question 6

Cardiac tamponade

Answer 6

Severe, life-threatening complication

Occurs when blood escapes from dissection into pericardial sac

Question 7

Medications fo IAH

Answer 7

need to manage HR and BP because every beat of heart risk for increasing dissection, rupture worse, vital organ dissection worse:
IV beta blockers
Esmolol (Brevibloc) continuous infusion
Other antihypertensive agents
CCBs
Nitroprusside
Angiotensin-converting enzyme inhibitors
Morphine for pain, also affects SNS, can help with cardiac

Question 8

HR Goal with IAH

Answer 8

Goals: HR 60, systolic 100-110

Question 9

Initial Goal When Treating

Answer 9

HR and BP control

Decrease BP and myocardial contractility to diminish pulsatile forces within aorta

Question 10

Thoracic endovascular aortic repair (TEVAR)

Answer 10

standard to treat acute and chronic type B aortic dissections with complications; similar to EVAR, stent diverts bloodflow back thru aorta

Question 11

Surgical therapy

Answer 11

Emergent surgery for acute Type A aortic dissection
When drug therapy ineffective or complications are present
Surgery is delayed to allow edema to decrease and permit clotting of blood if possible
Involve resection of aortic segment and replacement with synthetic graft material
In-hospital mortality and neuro complications are high