peter cheng aortic dissection. irad 12 referral centres 646 patients 1996 -1998
TRANSCRIPT
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- Peter Cheng AORTIC DISSECTION
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- IRAD 12 referral centres 646 patients 1996 -1998
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- AORTIC DISSECTION Wide clinical spectrum Chest pain most common 72.7% Tearing/ripping were not characteristic descriptors Abrupt onset 84.8% and severe 90.6% Migrating 16.6% Abdo pain 29% Back pain 53% Syncope 9.4% No other neuro deficits Hypertension 70% Type B, 35.7% Type A Hypotension = tamponade UPO Aortic regurg murmur in half ECG normal in 31%
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- CXR CXR findings Mediastinal widening Left paraspinal stripe Displacement of intimal calcifications (calcium sign) Apical pleural cap Left pleural effusion Displacement of endotracheal tube or nasogastric tube 63% sensitive for widened mediastinum Completely normal in 12.4%
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- US Limited role as a bedside test except to rule out pericardial tamponade Aortic regurg (doppler) Intimal flap may be seen using parasternal and suprasternal view Transoesophageal (TOE) very sensitive but less accessible than CT
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- TREATMENT Overall mortality 27.4% Type A Surgery reduces mortality from 58% to 26% Type B Surgery worsens prognosis from 10 31%!! Majority successfully managed medically BP control Reduced wall stress Beta-blocker eg esmolol aiming for 60bpm / systolic 120mmHg +/- IV antiHT Fentanyl 25-50mcg Urgent transfer to CTS
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- AD VS AMI Due to dissection of R or L coronary arteries Needs robust discussion with Cardiologist Poor eGFR must not hinder emergent CT aortogram Hypotension Tamponade Myocardial ischaemia Aortic insufficiency Withhold thrombolytics/heparin
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- ALWAYS Palpate bilateral radial pulses Measure bilateral BPs
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- http://emcrit.org/podcasts/aortic-dissection/