S7C62 - Aortic dissection and Related Aortic Syndromes

Question 1

Acute Aortic Syndrome

Answer 1

• Ao dissection
• penetrating atherosclerotic ulcer
• intramural hematoma
• aortic aneuysmal leakage
• ruptured AAA

Question 2

Aortic Dissection Classification

Answer 2

-Stanford:

• type A: involvement of the ascending aorta
• type B: descending aorta only

-DeBakey:

• type 1: simultaneously involves asc Ao, arch, and desc Ao
• type 2: only asc Ao
• type 3: only desc Ao

Question 3

Aortic Intramural Hematoma

Answer 3

• infarction of the aortic media
• precursor to dissection

Question 4

Aortic Dissection Diagnosis

Answer 4

• 90% of people will describe it as the worst pain ever
• only 15% have a pulse deficit in their radials
• 49% hypertensive, 18% hypotensive
• ECG normal in 31%, non-specific changes in 41%
• CXR: 12-37% have no abnormality on CXR
• widened mediastinum
• pleural effusion
• abnormal aortic contour
• displacement of aortic intimal calcification
• deviationof the trachea to the right
• depressed L mainstem bronchus
• apical cap
• loss of aorto-pulmonary window

Question 5

Aortic dissection treatment

Answer 5

-BB: metoprolol or esmolol

• metoprolol 5mg IV x3 then infusion at 2-5mg/h
• labetalol 10-20mg IV with repeat doses of 20-40mg q10min, max dose of 300mg
• esmolol bolus of 0.1-0.5mg/kg IV and infusion of 0.025-0.2 mg/kg/min
• CCB may be used if BB contraindicated
• target BP 120-130mmHg
• can add vasodilator: nitroprusside
• if hypotensive may require fluids or blood