Diferencia entre revisiones de «Nontraumatic thoracic aortic dissection»
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Sin resumen de edición |
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== Background == | == Background == | ||
*Most commonly seen in men 60-80 yrs old | |||
*Most commonly seen in men 60-80 yrs old | |||
*Intimal tear w/ blood leaking into media | *Intimal tear w/ blood leaking into media | ||
==Risk Factors== | == Risk Factors == | ||
*HTN | |||
*Inflammatory vasculitis | *HTN | ||
*Smoking | *Inflammatory vasculitis | ||
*Cocaine | *Smoking | ||
*3rd trimester pregnancy | *Cocaine | ||
*Decelerating trauma | *3rd trimester pregnancy | ||
*Connective tissue disorders (Marfan, Ehlers Danlos syndrome) | *Decelerating trauma | ||
*Bicuspid aortic valve | *Connective tissue disorders (Marfan, Ehlers Danlos syndrome) | ||
*Bicuspid aortic valve | |||
*History of surgery (coarctation of aorta repair, aortic valve replacement, cardiac cath) | *History of surgery (coarctation of aorta repair, aortic valve replacement, cardiac cath) | ||
===Classification (Stanford)=== | |||
*Type A - Involves any portion of ascending aorta | === Classification (Stanford) === | ||
**Requires surgery | |||
*Type B - Isolated to descending aorta | *Type A - Involves any portion of ascending aorta | ||
**Requires surgery | |||
*Type B - Isolated to descending aorta | |||
**Primarily medical management with surgery consultation | **Primarily medical management with surgery consultation | ||
== | ==Clinical Features== | ||
*Chest Pain - Abrupt, severe (90% of pts) radiating to back | *Chest Pain - Abrupt, severe (90% of pts) radiating to back | ||
*Neurologic Deficit | *Neurologic Deficit | ||
*Syncope (10%) | *Syncope (10%) | ||
*Pulse discrepencies (15%) | |||
*Aortic regurgitation (30%) | |||
*Tamponade | |||
*Neuro deficits | |||
**Hemiplegia, neuropathy (15%) | |||
== | ==Diagnosis== | ||
*ECG | |||
**Ischemia (esp inferior) - 15% | |||
**Nonspec ST-T changes - 40% | |||
*ECG | |||
**Ischemia (esp inferior) - 15% | |||
**Nonspec ST-T changes - 40% | |||
*CXR | *CXR | ||
**Abnormal in 90% | **Abnormal in 90% | ||
***Mediastinal widening (seen in 63%) | ***Mediastinal widening (seen in 63%) | ||
***Left sided pleural effusion (seen in 19%) | ***Left sided pleural effusion (seen in 19%) | ||
***Widening of aortic contour, displaced calcification (6mm), aortic kinking, double density sign | ***Widening of aortic contour, displaced calcification (6mm), aortic kinking, double density sign | ||
*CT Aortogram | *CT Aortogram | ||
**Study of choice | **Study of choice | ||
== Treatment == | == Treatment == | ||
*Keep SBP 100-120, HR 60-80 | *Keep SBP 100-120, HR 60-80 | ||
#Beta-Blockers | #Beta-Blockers | ||
##Esmolol | ##Esmolol | ||
###Advantage of short half life, easily titratable | ###Advantage of short half life, easily titratable | ||
###Bolus 0.1-0.5mg/kg over 1min; infuse 0.025-0.2mg/kg/min | ###Bolus 0.1-0.5mg/kg over 1min; infuse 0.025-0.2mg/kg/min | ||
##Metoprolol | ##Metoprolol | ||
###5mg IV x 3; infuse at 2-5mg/hr | ###5mg IV x 3; infuse at 2-5mg/hr | ||
##Labetalol | ##Labetalol | ||
###10-20mg w/ repeat doses of 20-40mg q10min up to 300mg | ###10-20mg w/ repeat doses of 20-40mg q10min up to 300mg | ||
#Vasodilators | #Vasodilators | ||
##Only use if beta-blocker is ineffective | ##Only use if beta-blocker is ineffective | ||
##Do not use without a beta-blocker (must suppress reflex tachycardia) | ##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 | ||
==Complications== | == Complications == | ||
*AV Regurgitation/Insufficiency | *AV Regurgitation/Insufficiency | ||
**CHF w/ diastolic murmur | **CHF w/ diastolic murmur | ||
*Rupture | *Rupture | ||
**Pericardium | **Pericardium > tamponade | ||
**Mediastinum | **Mediastinum > hemothorax | ||
*Vascular obstruction | *Vascular obstruction | ||
**Coronary | **Coronary > ACS | ||
**Carotid | **Carotid > CVA | ||
**Lumbar | **Lumbar > Paraplegia | ||
**Mesenteric, renal, limb | **Mesenteric, renal, limb | ||
==See Also== | == See Also == | ||
*[[Hypertensive Emergency]] | |||
*[[Aortic Transection]] | *[[Hypertensive Emergency]] | ||
*[[Aortic Transection]] | |||
*[[Abdominal Aortic Aneurysm (AAA)]] | *[[Abdominal Aortic Aneurysm (AAA)]] | ||
== Source == | == Source == | ||
Tintinalli | |||
Tintinalli | |||
[[Category:Cards]] | [[Category:Cards]] | ||
Revisión del 22:02 27 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
Clinical Features
- Chest Pain - Abrupt, severe (90% of pts) radiating to back
- Neurologic Deficit
- Syncope (10%)
- Pulse discrepencies (15%)
- Aortic regurgitation (30%)
- Tamponade
- Neuro deficits
- Hemiplegia, neuropathy (15%)
Diagnosis
- 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