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Aortic Dissection

Annuloaortic ectasia


Presentation

  • We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.[ncbi.nlm.nih.gov]
  • Three of the 10 presented as the sudden onset of fatal electromechanical dissociation, 6 presented with hypotension, and 1 was normotensive on presentation.[web.archive.org]
Severe Pain
  • PAIN: Severe pain is the #1 symptom. Seek immediate emergency medical care for a sudden onset of severe pain in the chest, stomach, back or neck. The pain is likely to be sharp, tearing, ripping, moving.[web.archive.org]
  • pain: 90% Characteristics Pain: 95% Type A: 94% Type B: 98% Sharp pain: 64% Tearing/ripping: 50% Type A: 49% Type B: 52% Distribution: Typically involves both above and below the diaphragm Anterior Chest Pain : 61% Type A: 71% Type B: 44% Back pain:[fpnotebook.com]
  • The majority of patients with aortic dissection, present with a sudden severe pain of the chest or back, classically described as 'ripping'.[patient.info]
Plethora
  • Finally, and amidst this plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to “compete” with optimal medical therapy in the management of patients with acute uncomplicated type[ncbi.nlm.nih.gov]
Dyspnea
  • We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur.[ncbi.nlm.nih.gov]
  • […] often sudden pain in the chest ( angina ), shoulders, back, abdomen, arms, neck, hips, or legs Stroke-like symptoms Difficulty swallowing Sweating Anxiety Decreased sensation Nausea Pale skin (pallor) Rapid heart rate (tachycardia) Shortness of breath (dyspnea[utswmedicine.org]
Abdominal Pain
  • Abstract A 52-year-old man presented with sudden abdominal pain and intermittent vomiting.[ncbi.nlm.nih.gov]
  • Pain : 35% Type A: 22% Type B: 42% Migrating pain: 17% Type A: 15% Type B: 19% Associated Findings Syncope : 9% Type A: 13% Type B: 4%[fpnotebook.com]
  • They include: Sudden severe chest or upper back pain, often described as a tearing, ripping or shearing sensation, that radiates down the back Loss of consciousness (fainting) Abdominal pain Sudden onset of leg pain with compromised blood flow Which diagnostic[inovaheart.org]
  • What could possibly tie the abdominal pain, chest pain and vision loss together? Remember: the minute you have a neurologic complaint that accompanies chest pain, aortic dissection must move to the top of your differential.[hippoed.com]
Nausea
  • We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions.[ncbi.nlm.nih.gov]
  • Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include: Anxiety and a feeling of doom Fainting or dizziness Heavy sweating (clammy skin) Nausea and vomiting Pale skin ( pallor ) Rapid, weak pulse Shortness of breath[nlm.nih.gov]
  • […] accident or a gunshot wound Symptoms of aortic dissection can include: Severe, often sudden pain in the chest ( angina ), shoulders, back, abdomen, arms, neck, hips, or legs Stroke-like symptoms Difficulty swallowing Sweating Anxiety Decreased sensation Nausea[utswmedicine.org]
  • Additional symptoms may include the following: Anxiety Difficulty swallowing Dizziness or fainting Nausea and vomiting Pain in the abdomen Pale skin Rapid, weak pulse Shortness of breath or trouble breathing when lying flat Stroke-like symptoms Sweating[houstonmethodist.org]
  • There may be associated nausea, sweating, shortness of breath, and weakness. The patient may pass out (syncope).[medicinenet.com]
Hypertension
  • KEYWORDS: Cardiovascular System; Drug Misuse (including Addiction); Hypertension[ncbi.nlm.nih.gov]
Chest Pain
  • pain and an ECG pattern of NSTEMI.[ncbi.nlm.nih.gov]
  • In most cases, the symptoms begin suddenly, and include severe chest pain. The pain may feel like a heart attack. Pain can be described as sharp, stabbing, tearing, or ripping.[nlm.nih.gov]
  • Have a heightened level of suspicion for patients who present with chest pain and hypertension or chest pain and drug use or chest pain that is tearing and radiating to the back or a pulse deficit between arms.[hippoed.com]
Acrocyanosis
  • Cold agglutinin disease is characterized by acrocyanosis, hemolytic anemia, and occasionally, frank hemoglobinuria.[ncbi.nlm.nih.gov]
Back Pain
  • On the fourth hospital day, he complained of severe back pain, and enhanced CT scan revealed an aortic rupture. The patients with 3ch-AD often have MFS.[ncbi.nlm.nih.gov]
Paresis
  • Monitoring for limb ischemia via peripheral pulses and cyanosis, limb weakness or paresis, or continued pain is worrisome for a complicated type B dissection requiring surgical intervention. C.[clinicaladvisor.com]
  • Both patients showed no pure TGA, but showed TGA-plus-syndrome with additional focal neurological signs such as mild left-side motor deficit, slight anisocoria, and mild facial paresis; therefore, they were classified as having ischemic stroke.[dx.doi.org]
Aphasia
  • Because patients with ischemic stroke as a complication of Stanford type A acute aortic dissection do not often complain of chest or back pain, probably due to consciousness disturbance, amnesia, or aphasia, a fatal course following inappropriate intravenous[ncbi.nlm.nih.gov]
  • Additionally, in case of aphasia, unconscious or TGA patients cannot report chest pain, thus complicating the correct diagnosis.[dx.doi.org]
Tonic-Clonic Seizure
  • Eight of 30 patients (26.7%) presented a combination of different neurological symptoms: hemiparesis and tonic-clonic seizure or syncope (3 times), transient ischemic attack and syncope (twice), ischemic neuropathy and seizure (once), and TGA-plus-syndrome[dx.doi.org]
Foot Drop
  • Larson WL, Wald JJ: Foot drop as a harbinger of aortic occlusion. Muscle Nerve 1995;18:899–903. Le DA, Traynor EN, Ghazvini A: Aortic occlusion causing ischemic neuropathy and paraparesis. Neurology 2004;63:1984.[dx.doi.org]
Spinal Cord Syndrome
  • Clinical manifestations comprise complete spinal cord infarction as well as anterior spinal cord syndrome, Brown-Sequard syndrome, progressive myelopathy or transient spinal cord ischemia [ 6, 12, 17, 21, 27 ].[dx.doi.org]

Workup

  • A workup for secondary hypertension was negative and no other risk factors for aortic dissection were determined.[ncbi.nlm.nih.gov]
  • Workup for aortic dissection in STEMI patients should be reserved for those patients with a significant pretest probability of dissection.[emergencymedicinecases.com]
  • Patients who present to the outpatient setting need to be quickly identified for expeditious transfer for further workup and treatment. Miz and Sam Ashoo discuss both typical and atypical presentations for aortic dissection.[hippoed.com]
  • Diagnostic Workup In the setting of suspected aortic disease, the diagnostic workup may include ECG, chest radiography, myocardial markers, transthoracic echocardiogram, transesophageal echocardiogram, CT, and MRI.[dx.doi.org]
Lymphocytic Infiltrate
  • Immunoglobulin G subclass 4-related disease (IgG4-RD) is a recently recognized systemic inflammatory disease characterized by an elevated serum IgG4 level and an IgG4-positive lymphocyte infiltrate mainly in exocrine tissues.[ncbi.nlm.nih.gov]

Treatment

  • However, the results of this treatment may improve when associated with other imaging tests.[ncbi.nlm.nih.gov]

Prognosis

  • CT scanning may be used to confirm the diagnosis but is less helpful in complications and prognosis.[patient.info]
  • The patient obtained favorable clinical prognosis and was smoothly discharged. During subsequent follow-up, he remained physically stable.[ncbi.nlm.nih.gov]

Etiology

  • The etiology could not be reversed and the patient died. Critical care ultrasound is an important skill that intensivists should master for fast screening of life-threatening complications in patients with AAAD.[ncbi.nlm.nih.gov]
  • In young patients, an underlying etiology (i.e. Marfan’s) should be explored. E. Common Pitfalls and Side-Effects of Management.[clinicaladvisor.com]
  • Type of Dissection, Predisposing Conditions, and Etiology All patients had Stanford type A dissection; DeBakey type I was identified in 60.8% of patients.[dx.doi.org]
  • The etiology may differ depending on the location of the aneurysm.[omicsonline.org]

Epidemiology

  • […] new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies (including biomarkers and imaging), endograft design, and surgical treatment, which have led to a better understanding of the epidemiology[ncbi.nlm.nih.gov]
  • Epidemiology and clinicopathology of aortic dissection. Chest. 2000 ; 117 :1271–1278. Crossref Medline Google Scholar 3. Feldman M, Shah M, Elefteriades JA. Medical management of acute type A aortic dissection.[dx.doi.org]
  • Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81.[nlm.nih.gov]
  • Epidemiology: 10,000 deaths in the US annually Incidence 16/100,000 for men, 9/100,000 for women ( Milewicz 2011 ) Ratio of Aortic Dissection (AD) to Acute Coronary Syndrome is 1:600 22% of cases undiagnosed prior to death (Cline 2012) Predisposing Factors[coreem.net]
  • The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic aortic disease in a large contemporary population.[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • This comprehensive review discusses the pathophysiology, classification, clinical manifestations, early diagnosis, and management of this important cardiovascular emergency.[ncbi.nlm.nih.gov]
  • The Stanford classification: Type A: Dissection involving any part of the ascending aorta Type B: Dissection remaining confined to the descending thoracic aorta Pathophysiology When the intima becomes compromised, a tear can occur leading to dissection[healio.com]
  • Aortic dissection: epidemiology, pathophysiology, clinical presentation, and medical and surgical management. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 81.[nlm.nih.gov]

Prevention

  • Endovascular fenestration on the abdominal aorta is effective for preventing visceral malperfusion in aortic dissection.[ncbi.nlm.nih.gov]
  • PREVENTION: Medical management is essential to preventing aortic dissection. If you have thoracic aortic disease, medical management that includes optimal blood pressure control, aortic imaging and genetic counseling is strongly recommended.[web.archive.org]

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