tailieunhanh - Ebook Ebook Herzog’s CCU book: Part 2

(BQ) Part 2 book “Herzog’s CCU book” has contents: Acute aortic syndrome, pathway for the management of pericardial disease, infective endocarditis, percutaneous therapy for valvular heart disease, contemporary surgical approach to valvular disease, mechanical ventilation in the cardiac care unit, and other contents. | 914 915 Acute Aortic Syndrome INTRODUCTION Acute aortic syndrome (AAS) represents a spectrum of life-threatening conditions with similar clinical presentation and the need for urgent management. It includes classic acute aortic dissection (CAAD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Although not included in the original definition of AAS, traumatic aortic rupture (TAR) and aortic aneurysm rupture have also been considered to be part of the AAS spectrum. AAS is characterized by disruption of the media layer of the aorta and typically presents with acute chest pain. The term “acute aortic syndrome” was first coined in 2001 by the Spanish cardiologists Vilacosta and San Román, who described AAS as a spectrum of interlinked lesions1 with the intent to increase awareness and to speed up diagnosis and appropriate treatment (Figure ). 916 FIGURE Acute aortic syndrome. The acute aortic syndrome triad first described by Vilacosta and San Román. Arrows signify possible progression of aortic lesions (penetrating aortic ulcer to IMH, penetrating aortic ulcer to classic dissection, IMH to classic dissection). IMH, intramural hematoma. Although the incidence of AAS is lower than that of acute coronary syndrome (ACS), AAS carries a higher mortality, and is therefore a critical component of the differential diagnosis of chest pain in the Cardiac Care Unit (CCU). Overall incidence of AASs is 2 to 4 cases per 100,000 individuals. Because AAS is rare, the International Registry of Acute Aortic Dissection (IRAD) was created in 1996 as a way to combine data acquired from multiple top institutions in Europe, North America, and The 2010 intersocietal guidelines for the diagnosis and management of patients with thoracic aortic disease proposed a standard approach to the diagnosis and treatment of Although clinical history and physical examination are important, imaging is essential in the diagnosis of AAS. .