vascular

Question 1

Aortic dissection , risk factors ?

Answer 1

1- HTN 
2- CT disease : Marfan
3-  Iatrogenic :aortic instrumentation( cath) 
4-arteritis ( GCA ) 
5- Male 
6- Smoking 
7- age >50 
8- Congenital heart disease: aortic coarctation
9- valve disease : bicuspid valve , AS
10-Catecholamine surge : cocaine use 
11- pregnancy 
12- atherosclerosis

Question 2

CXR features of aortic dissection

Answer 2

A - mediastinum : 1 - Obscured :

                          - opacification of aorto-pulmonary window AP window 
                            - widened 
                       - Obliteration of aortic notch 
                        - Paratracheal  stripe R >4mm , Lt > 5mm 

                        2-  displaced : -depression of  left main bronchus 
                                                  - mediastinal structures to the right 
                                                  -  deviation of NGT , ETT to right                B - Lungs fields : 1- apical cap 
                          2- LT pleural effusion

Question 3

Immediate MX priorities

Answer 3

1- Airway and breathing
2- HR control : propranolol 0.5-1 mg IV
3- BP control : GTN 50 mg/50 ml as 0-3ml/hr or SNP 0.25-10 mcg/kg/hr , aim for HR <60bpm , SBP <140 mmHg
5- analgesia : fentanyl 25-50mcg IV aliquots
4- Surgery : type A ,
type B if perf