tailieunhanh - CURRENT ESSENTIALS OF CRITICAL CARE (PART 5)

Đột ngột khởi phát nghiêm trọng, chảy nước mắt đau ngực tỏa ra sau; đạt cường độ tối đa ngay lập tức triệu chứng liên quan đến khu vực của thỏa hiệp động mạch: bịnh liệt (trước cột sống), đột quỵ (động mạch cảnh) | 116 Current Essentials of Critical Care Aortic Dissection Acute Essentials of Diagnosis Abrupt onset of severe tearing chest pain radiating to back reaches maximal intensity immediately Symptoms related to area of arterial compromise paraplegia anterior spinal stroke carotid abdominal pain mesenteric tamponade proximal aorta Dizziness dyspnea oliguria Tachycardia unequal blood pressures in upper extremities murmur of aortic insufficiency Myocardial infarction from coronary ostia involvement rare Chest radiograph with widened mediastinum CT and MRI highly sensitive and specific transesophageal echocardiogram if imaging not feasible Aortography carries significant risk and time delay Risk factors hypertension Marfan Ehlers-Danlos syndromes coarctation bicuspid aortic valve aortitis syphilis age 60-80 pregnancy cardiac catheterization intra-aortic balloon pump trauma Differential Diagnosis Acute myocardial infarction Acute pericarditis Angina pectoris Boerhaave syndrome Pneumothorax Pulmonary embolism Treatment Close hemodynamic monitoring with goal to decrease systolic blood pressure and sheer forces across aortic wall Labetalol drug of choice to reduce sheer forces Calcium-channel blockers alternative for beta-blockers Vasodilators nitroprusside nitroglycerin hydralazine for blood pressure control once adequate beta-blockade achieved Pain control Avoid anticoagulation and thrombolytics Surgical repair for Stanford Type A dissection involves ascending aortic arch Stanford Type B distal to take-off of last great vessel managed medically unless rupture limb or organ ischemia persistent pain saccular aneurysm formation Pearl The mortality rate from untreated acute aortic dissection is estimated to be approximately 1 per hour. Reference Erbel R et al Diagnosis and management of aortic dissection. Eur Heart J 2001 22 1642. PmID 11511117 Chapter 9 Cardiology 117 Aortic Valvular Heart Disease Essentials of Diagnosis Dyspnea orthopnea paroxysmal nocturnal dyspnea cough .