Management of Aortic Dissection Flashcards
Acute disection of the ascending aorta are considered?
surgical emergencies
Dissection confined to the descending aorta are
treated medically unless the patient the Pt demonstrates pragressive dissection or continued hemorrhage
Acute management of an aortic disection is
SBP reduction to 100-120 or as low as tolerated
Initial medical management would be a
Beta Block to keep HR below 60
propranolol or labetolol
esmolol in acute setting
verapimil / cardazem if unable to tolerate a Beta Blocker ie. asthma or HF
BP control is managed through
Nipride or Nitro
Which medication should be avoided for vasodilation
hydralizine as it increases aortic wall shear stress
What Daily and DeBakey type is treated medically
Type B or Type III
What is the relative containdication to surgical of the ascending aortic disection
Hemorrhagic CVA
Poor prognosis for surgical intervention include
Over 70 yrs of age
abrupt onset of pain
hypotension, shock, tamponade
Renal failure
pulse deficit
Abnormal EKG w ST elevation
Prior MI
aortic valve replacement
CAD is present in most dissections so angiography is suggested to preform what while fixing the disection
CABG
Endovascular stent grafts are used on what tye of disections
Type B Daily classification
the stent graft is use to do what with repairing the disection
cover the intimal flap and seal the entry site causing thrombosis of the false lumen
a hybrid approach to type A Daily disections is the
frozen elephant trunk repair
uses an open approach to the ascending disection and a stent graft to the descenting aorta
Long term maagement entails
medical therapy to prevent shear stress
serial imaging for progression
reoperation when indicated
suggested long term medical management for BP is a tagert BP of less than
120/80
