Friday, April 27, 2012

Aortic Dissection

Severe, tearing chest pain, radiating to the back/inter-scapular area
Hypertension (or hypotension)
Asymmetrical BP
BP lower in rt arm if tear extends into brachiocephalic artery
BP lower in left arm if tear extends into left Subclavian
signs of ischemic stroke if tear extends into common carotid
New murmur if aortic regurgitation, due to aortic root involvement

Best initial test is CX-ray : widened mediastinum
TEE more sensitive
Most accurate test however is angiography (but is not usually necessary and carries higher risks)

Tmt of Ascending aortic dissection is emergent surgery
Tmt of Descending aortic dissection is BP control first! Beta blocker to reduce shearing force then Nitroprusside.
Don't give Nitroprusside before Beta blocker in aortic dissection.

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