Diferencia entre revisiones de «Nontraumatic thoracic aortic dissection»
Sin resumen de edición |
Sin resumen de edición |
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| Línea 1: | Línea 1: | ||
== Background == | == Background == | ||
* | *Most commonly seen in men 60-80 yrs old | ||
*Intimal tear w/ blood leaking into media | |||
==Risk Factors== | ==Risk Factors== | ||
| Línea 33: | Línea 33: | ||
===Studies=== | ===Studies=== | ||
*ECG | *ECG | ||
**Ischemia - 15% | **Ischemia (esp inferior) - 15% | ||
**Nonspec ST-T changes - 40% | **Nonspec ST-T changes - 40% | ||
*CXR | *CXR | ||
| Línea 42: | Línea 42: | ||
*CT Aortogram | *CT Aortogram | ||
**Study of choice | **Study of choice | ||
== Treatment == | == Treatment == | ||
*Keep | *Keep SBP 100-120, HR 60-80 | ||
#Beta-Blockers | #Beta-Blockers | ||
##Esmolol | ##Esmolol | ||
| Línea 58: | Línea 55: | ||
#Vasodilators | #Vasodilators | ||
##Only use if beta-blocker is ineffective | ##Only use if beta-blocker is ineffective | ||
##Do not use without a beta-blocker | ##Do not use without a beta-blocker (must suppress reflex tachycardia) | ||
##Nitroprusside 0.3-0.5mcg/kg/min | ##Nitroprusside 0.3-0.5mcg/kg/min | ||
Revisión del 19:50 12 feb 2012
Background
- Most commonly seen in men 60-80 yrs old
- Intimal tear w/ blood leaking into media
Risk Factors
- HTN
- Inflammatory vasculitis
- Smoking
- Cocaine
- 3rd trimester pregnancy
- Decelerating trauma
- Connective tissue disorders (Marfan, Ehlers Danlos syndrome)
- Bicuspid aortic valve
- History of surgery (coarctation of aorta repair, aortic valve replacement, cardiac cath)
Classification (Stanford)
- Type A - Involves any portion of ascending aorta
- Requires surgery
- Type B - Isolated to descending aorta
- Primarily medical management with surgery consultation
Diagnosis
History
- Chest Pain - Abrupt, severe (90% of pts) radiating to back
- Neurologic Deficit
- Syncope (10%)
Physical Exam
- Pulse discrepencies (15%)
- Aortic regurgitation (30%)
- Tamponade
- Neuro - hemiplegia, parapesia, neuropathy (15%)
Studies
- ECG
- Ischemia (esp inferior) - 15%
- Nonspec ST-T changes - 40%
- CXR
- Abnormal in 90%
- Mediastinal widening (seen in 63%)
- Left sided pleural effusion (seen in 19%)
- Widening of aortic contour, displaced calcification (6mm), aortic kinking, double density sign
- Abnormal in 90%
- CT Aortogram
- Study of choice
Treatment
- Keep SBP 100-120, HR 60-80
- Beta-Blockers
- Esmolol
- Advantage of short half life, easily titratable
- Bolus 0.1-0.5mg/kg over 1min; infuse 0.025-0.2mg/kg/min
- Metoprolol
- 5mg IV x 3; infuse at 2-5mg/hr
- Labetalol
- 10-20mg w/ repeat doses of 20-40mg q10min up to 300mg
- Esmolol
- Vasodilators
- Only use if beta-blocker is ineffective
- Do not use without a beta-blocker (must suppress reflex tachycardia)
- Nitroprusside 0.3-0.5mcg/kg/min
Complications
- AV Regurgitation/Insufficiency
- CHF w/ diastolic murmur
- Rupture
- Pericardium > tamponade
- Mediastinum > hemothorax
- Vascular obstruction
- Coronary > ACS
- Carotid > CVA
- Lumbar > Paraplegia
- Mesenteric, renal, limb
See Also
Source
Tintinalli