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aortic syndrome
Includes:
- acute aortic dissection
- acute intramural aortic hematoma
- penetrating aortic atherosclerotic ulcer
Clinical manifestations:
- abrupt onset of severe chest pain or back pain
- pulsus paradoxus
- asymmetric upper extremity blood pressure
- asymmetric radial pulse
Radiology:
- CT angiography [1]
Management:
- beta blocker: i.e. esmolol drip
- control blood pressure
- reduce heart rate
- IV nitroprusside as needed to control blood pressure [1,2]
- emergency surgery
- indications
- involvement of the ascending aorta
- type B syndrome (distal to left subclavian artery)
- occlusion of major aortic branch with visceral or limb ischemia
- progressive dilatation or extension despite medical therapy
- contained rupture of aortic dissection
- penetrating astherosclerotic ulser
- > 20 mm in diameter & > 10 mm in depth
- associated intramural hematoma
- no role for prophylatic endovascular grafting
General
aortic disease
syndrome
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 18.
American College of Physicians, Philadelphia 2012, 2018.
- Nienaber CA, Powell JT
Management of acute aortic syndromes.
Eur Heart J. 2012 Jan;33(1):26-35b
PMID: 21810861