Acute Aortic Dissection AM Report 6/29/09 Brandon M. Williams, MD.

Slides:

Advertisements

Similar presentations

Aortic Dissection Riya Chacko, MD November 4, 2009.

Advertisements

Non-Invasive Conference: Aortic Dissection

Connie Tsao, MD Noninvasive/Echo Conference July 29, 2009.

Multiple Aneurysms.

Ross Milner, MDUniversity of Chicago Mark Russo, MD, MS Center for Aortic Diseases.

Aortic Dissection By Hari Bhatt. Definition Aortic dissection is an acute event where blood enters the aortic wall through a tear of the intima followed.

Jason S. Finkelstein, M.D. Cardiology Fellow Tulane University 8/11/03

Project: Ghana Emergency Medicine Collaborative

© Continuing Medical Implementation …...bridging the care gap Valvular Heart Disease Aortic Regurgitation.

Antegrade Stent Grafting of Descending Thoracic Aorta During Acute Debakey I Dissection: Early and Midterm Outcomes Prashanth Vallabhajosyula MD, Joseph.

Angioclub Case Series: Aortic Pathology Candace L. White MA, MD Mount Sinai Medical Center of Florida.

Everything you wanted to know about the aorta but were afraid to ask! By Michael Roberts Aortic ANP.

Vascular Peter Lin, MD Southern Association for Vascular Surgery 2007 Postgraduate Course San Juan, Puerto Rico Penetrating Ulcer and Aortic Dissection.

AORTIC DISSECTION Prof. Dr. Suat Nail ÖMEROĞLU. The most catastrophic disease of the aorta The most catastrophic disease of the aorta 5-10 patients/ 1.

Aortic Aneurysms & Dissection Robbins Aneurysm-localized dilation of a blood vessel True aneurysm: bounded by generally complete but often atentuated.

Thoracic Surgery Brian Schwartz, CCP Perfusion Technology II.

Aortic and peripheral vascular disease. Aortic diseases.

Diseases of the aorta Heart Disease Braunwald CV R4 李威廷醫師 Supervisor: 李貽恆醫師.

Aneurysm, Dissection. Aneurysm Aneurysm: localized dilation of the vessels or the heart May occur at any site, most important is aorta and ventricles.

Dissecting Aortic Aneurysm. Case I  23 y American male visiting his girlfriend  Seen in ER because of chest pain few hours duration  Sudden central,

Epidemiology, Risk Factors, Diagnosis and Intervention of Abdominal Aortic Aneurysms By, Sultan O Al-Sheikh.

Aortic Dissection and Aneurysms Presented by Dr. Daniel Kranitz Prepared by Mary Edwards September 27, 2005 Tintanalli Chapter 58, Pages

Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta.

Preoperative evaluation for aortic surgery Inter-hospital Conference 2 (2/2554) Aortic surgery: Update & Decision making วันเสาร์ที่ 17 กันยายน 2554 ห้องประชุมสมาคมศิษย์เก่าแพทย์ศิริราช.

Coronary Artery Disease Angina Pectoris Unstable Angina Variant Angina Joseph D. Lynch, MD.

Aortic Aneurysm Dr.mehdi hadadzadeh Cardiovascular surgeon IN THE NAME OF GOD.

Echocardiographic Evaluation of Acute Aortic Syndromes

Aortic Dissection Kevin Zahraee, MS4 August 2013 Aditi Gulabani, MD.

Cardiac Case 9/15/07. Coarctation of the Aorta Congenital narrowing of the thoracic aorta; typically distal to the left subclavian artery. M:F – 2:1.

Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin.

THE DOCTORS GUIDE TO PATIENT SURVIVAL AFTER ACUTE AORTIC DISSECTION

Jakub Honěk Kardiologická klinika 2.LF UK a FN Motol.

AORTIC DISSECTION. Aortic Dissection Inciting event is a tear in the aortic intima. Propagation of the dissection can occur proximal (retrograde) or distal.

Aortic Dissection Clinical Presentation, Diagnosis and Medical Management Adoracion N. Abad, M.D.

Diseases of the Aorta.

Acute Coronary Syndrome What is Acute Coronary Syndrome ? How can I look at an EKG and tell what part of the heart is affected ? What do ICU RNs need to.

Aortic Insufficiency Acute and Chronic

Surgery for Aortic Dissection Adrian E. Manapat, M.D.

Vascular diseases: Varicose veins, DVT and Aneurysms CVS6

AORTIC ANEURYSM Prepared by: Dr. Hanan Said Ali. Objectives Define aortic aneurysm. Enumerate causes. Classify aortic aneurysm. Enumerate clinical manifestation.

CARDIOVASCULAR MODULE: AORTIC ANEURYSM Adult Medical-Surgical Nursing.

Vascular diseases: Varicose veins, DVT and Aneurysms CVS6 Hisham Alkhalidi.

Aneurysm. It is a blood sac that communicates with the lumen of an artery They are classified according to –Etiology congenital Acquired –pathological,

Case 60 F with PMH HTN, DM, CVA presented to UNC ED CC: seizure. Per the daughter the pt was walking and all of a sudden fell and her whole body started.

ANEURYSMS AND DISSECTIONS

Aortic Emergencies LISA BROUGHTON, PHD, RN, CCRN.

R4 Kim Min Kyung/ Prof. Kim Won Aortic Dissection.

Aortic Aneurysms Optimum Re Underwriting Seminar Dallas 2015 Jean-Marc Fix, FSA, MAAA VP R&D.

Aortic Disease. Aortic Aneurysm Defined asDefined as an abnormal dilatation of the aortic lumen; a true aneurysm involves all the layers of the wall,

AORTIC DISSECTION Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin.

Unexpected and Sudden Death Dr. Raid Jastania. Unexpected Sudden Death WHO definition of Sudden Death: – Death within 24 hours of the onset of Symptoms.

Thorax and Abdomen Injuries. Injuries to the Lungs MOI Pneumothorax Pleural cavity surrounding the lung becomes filled with air that enters through a.

Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin

Jakub Honěk Kardiologická klinika 2.LF UK a FN Motol

Suspected Aortic Dissection and Other Aortic Disorders: Multi–Detector Row CT in 373 Cases in the Emergency Setting Robert G. Hayter, BS, James T. Rhea,

Thoracic Aortic Aneurysms & Aortic Dissection

Aortic Dissection.

DISEASES OF THE AORTA Three types of conditions may affect the aorta: 1.Aneurysm 2.Dissection 3.Aortitis.

ACQUIRED AORTIC ABNORMALITIES

Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin

Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin

Dr. M. SOFI MD; FRCP (London); FRCPEdin; FRCSEdin

Clinical Analysis of Acute Type A Intramural Hematoma: Comparison Between Two Different Pathophysiological Types Kunihide Nakamura, MD, PhD, Toshio Onitsuka,

Diseases of the thoracic aorta in women

Nicole M. Bhave et al. JIMG 2018;11:

Presentation transcript:

Acute Aortic Dissection AM Report 6/29/09 Brandon M. Williams, MD

Classification Two systems: DeBakey Daily (Stanford) = most used

DeBakey Type 1: origin in ascending aorta and propagates to at least arch Type 2: origin in ascending and confined within ascending Type 3: origin in descending and extends (distally or proximally)

Daily (Stanford) Type A: involves ascending aorta Type B: all others - Nomenclature doesn’t change secondary to site of origin

Daily (Stanford)

Pathophysiology Tear in aortic intima Need degeneration of media or cystic medial necrosis for nontraumatic dissections Blood crosses into media via tear and separates intima from media/adventitia creating a false lumen ? If rupture of intima or hemorrhage within media causing rupture of intima is initiating event

Incidence Acute aortic dissection /100,000 person years

Incidence Classic is 60 – 80 yo males (mean 63yo) Women 67 Ascending 2x more likely than descending, with right lateral wall most common site

Risk Factors 13% with known aortic aneurysm (19% if < 40yo) Inflammatory disease vasculitis -giant cell arteritis -takayasu arteritis -rheumatoid arthritis -syphilitic aortitis

Risk Factors HTN (71%) Atherosclerosis (31%) DM (5.1%) Collagen disorders (Marfan, Ehlers-Danlos) 19% of thoracic with family history Bicuspid aortic valve (9% < 40yo) Aortic coarctation (post intervention) CABG AVR Cardiac catheterization Trauma High-intensity weight lifting and cocaine via transient HTN - cocaine 37% of AA inner city population

Signs and Symptoms Abrupt, tearing pain, back (if distal to L subclavian) or anterior (ascending) Associated: syncope, CVA, MI, HF Syncope assoc with worse outcome (almost all type A) Pulse deficit Aortic insufficiency: murmur more at RSB than valve assoc AI (LSB) >20mmHg difference in SBP between UE Vocal cord paralysis (compression of L laryngeal nerve) Hypotension (hemorrhage, tamponade, HF) Spinal cord ischemia “STEMI:” 3/820 EKGs showing STEMI found to have ascending aortic dissection

Images

Diagnosis Abrupt onset of pain, tearing/ripping Mediastinal/aortic widening on Chest X ray Variation in pulse

Imaging Chest Xray TTE TEE CTA chest MRI Coronary angiography

Images

Treatment Involvement of ascending aorta = surgical emergency Descending aorta: medical management unless progression or hemorrhage into pleural or retroperitoneal space -morphine -SBP or lowest tolerated *beta blocker titrate to HR < 60 (labetalol, propranolol, esmolol) *if beta blocker intolerant: verapamil, diltiazem *no nitroprusside until HR < 60 *no hydralazine *no inotropic agents, if hypotensive look for bleeding A-line in radial artery with highest auscultatory pressure

References UpToDate Management of Patients with Aortic Dissection. Weigang et al. Dtsch Arztebl Int Sep. 105 (38) Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention. Gu et at. Neth Heart Journal Oct: 16 (10) Google images