This document discusses acute aortic syndrome (AAS), which includes acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. AAS is caused by disruption of the aortic wall layers from tears or ulcers, allowing blood to track within the layers. The most common type is aortic dissection, where blood passes through a tear separating the vessel layers. Presenting symptoms typically include sudden severe chest or back pain. Diagnosis involves imaging like CECT, MRI, or TEE to identify abnormalities. Prognosis depends on factors like involvement of the ascending aorta and complications. Classification systems differentiate type A dissections involving the ascending aorta from type B.
Presentation about the hazards and potential complications that could happen in any cardiac or peripheral catheterization procedure and how to avoid them
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
6. Acute aortic syndrome (AAS)
• Acute aortic syndrome (AAS) is a modern term to describe interrelated
emergency aortic conditions with similar clinical characteristics and
challenges.
• These conditions include :
Acute aortic dissection(80-90 %)
Intramural haematoma (IMH): bleeding in the aortic wall occurs without
evidence of an intimal tear or dissection flap( 10% to 20%)IMH, where
penetrating atherosclerotic ulcer. PAU: (5% )
Other closely related :
trauma to the aorta with intimal laceration
Ruptured aneurysm
7. Acute aortic syndrome (AAS)
• AAS : disruption of the media layer of the aorta resulting in separation of the
layers of the aorta (dissection),
• IMH:with bleeding in the the wall of the aorta
• disruption transmurally through the wall in the case of ruptured PAU or trauma.
In the majority of patients (90%), an intimal disruption is present
• a tear or an ulcer allows blood to penetrate from the aortic lumen into the media
or within rupture of the ‘vasa vasorum’ within the media;
• intimal disruption results in tracking of the blood in a dissection plane within
the media potentially rupturing through the adventitia or back through the
intima into the aortic lumen.
• the inflammatory response to blood in the media may lead to aortic dilatation
and rupture.
• The most common aortic syndrome is aortic dissection.
8.
9.
10. Pathophysiology
• a tear in the aortic intima
• commonly preceded by medial wall degeneration or cystic media necrosis.
• Blood passes through the tear separating the intima from media or
adventitia creating a false lumen.
• Propagation of dissection can proceed in an anterograde or retrograde
fashion from the initial tear involving side branches and causing
complications such as tamponade, aortic valve, insufficiency, or proximal or
distal malperfusion syndromes.
11. Pathophysiology
• In the presence of atherosclerosis, the inflammatory response to
thrombus in the further necrosis and apoptosis of SMC
• degeneration of elastic tissue, which potentiates the risk of medial
rupture
• increased risk of AAS in patients with inflammatory disorders such
as periarteritis nodosa, Takayashu’s syndrome, or Behcet’s
syndrome.
• Prevalent in genetic aortic syndromes
15. Clinical symptoms
• Variable.
• Needs high index of suspicion.
• Abrupt onset of severe chest or back pain is the most classic feature.
• sudden onset, with maximum intensity occurring at its inception. The pain
may be accompanied by a “sense of doom.”
• quality :“sharp,” “severe,” or “stabbing,” “tearing” or “ripping”
• “stabbed in the chest with a knife” or “hit in the back with a baseball bat,”
• burning, pressure, or pleuritic pain.
Painless aortic dissection: occurs in 6% of patients and is more common in
those with diabetes, previous aortic aneurysm, and prior cardiac surgery.
16.
17. Laboratory Findings
(1) CXR:
• abnormal aortic contour or widening of the aortic silhouette, which appears
in approximately 80% of cases
• (83% of type A; 72% of type B).
• Pleural effusions :20% of dissections.
• normal chest x-ray findings on presentation were found in 29% of type A and
36% of type B dissections.
(2) ECG:
• Acute MI
• Low voltage complex in hemopericrdium
18.
19. labs
(3) Elevated D-dimer levels:
• seen within the first 24 hours of onset, a D-dimer level lower than 500 ng/mL had a negative
likelihood ratio of 0.07 and a negative predictive value of 95%.
• sensitivity of 97% and a specificity of 47%.
(4) dedicated aortic imaging:
CECT :the modality of choice most often used
• Fast and reliable
• allows rapid acquisition of thinly collimated images of the entire aorta during arterial transit of
contrast bolus
• CECT is highly accurate in diagnosing aortic
• a sensitivity and specificity of 98% to 100%.
• Risk: Contarst induced neohropathy
20. MRI:
• infrequently used as the initial test for evaluation of acute dissection, but
• given its imaging detail and lack of ionizing radiation, it is particularly attractive for
the long-term follow-up of aortic dissection.
• visualization of blood flow, differentiation of slow flow and clot, evaluation of intimal
flap mobility, and detection of AR ,to assess branch vessel morphology when combined
with contrast-enhanced MRA.
• pericardial effusion, aortic rupture, entry points, and exit points with a high level of
accuracy; MRA may detect and quantify AR.
• ECHO:
• TTE has sensitivity of 70% to 80% and specificity of 93% to 96% for the identification
of type A aortic dissection, but it is much less sensitive (31% to 55%) than other
modalities for the diagnosis of type B aortic dissection.
21. • TEE :
• highly accurate in the evaluation and diagnosis
• sensitivity 98%; specificity, 95% but its accuracy is operator dependent
• may not completely visualize the distal ascending aorta and proximal aortic
arch, but it interrogates the remaining thoracic aortic segments well.
• TEE may visualize the intimal tear in 75% to 100% of cases, differentiate
the true and false lumens, and identify fenestrations in the intimal flap
22. Complications of dissection
• a. Type A dissections
i. Aortic regurgitation
ii. Coronary artery involvement
iii. Pericardial effusion/hemopericardium
• b. Aortic rupture or leakage
• c. Branch vessel involvement
• d. Malperfusion
• e. Aneurysmal enlargement
25. Classification
• In 80% to 90% of acute aortic syndromes, classic aortic dissection is present
• Regarding time from the onset of initial symptoms to the time of
presentation
• 1- Acute dissection: within 2 weeks of onset of pain
• 2- Subacute: between 2 and 6 weeks from the onset of pain
• 3- Chronic: more than 6 weeks from the onset of pain
26. Anatomical classification
• according to -either the origin of the intimal tear or whether the dissection
involves the ascending aorta (regardless of the site of origin)
• Accurate classification is important as it drives decisions regarding surgical vs.
non-surgical management
• The two most commonly used classification schemes are the
1. DeBakey system and the
2. Stanford systems
For the purpose of Classification :
the ascending aorta refers to the aorta proximal to the brachiocephalic artery,
and the descending aorta refers to the aorta distal to the left subclavian artery.
28. The DeBakey classification system
• categorizes dissections based on the origin of the intimal tear and the extent
of the dissection
• Type I: Dissection originates in the AA and propagates distally to include at
least the aortic arch and typically the DA (surgery usually recommended)
• Type II: Dissection originates in and is confined to the AA (surgery usually
recommended)
• Type III: Dissection originates in the descending aorta and propagates most
often distally (non-surgical treatment usually recommended).
Type IIIa: Limited to the descending thoracic aorta.
Type IIIb: Extending below the diaphragm.
29. The Stanford classification
• The Stanford classification system divides dissections into two categories,
those that involve the ascending aorta and those that do not.
• Type A: All dissections involving the ascending aorta regardless of the site of
origin (surgery usually recommended).
• Type B: All dissections that do not involve the ascending aorta (non-surgical
treatment usually recommended).
• Note that involvement of the aortic arch without involvement of the
ascending aorta in the Stanford classification is labelled as Type B.
30. Prognostic considerations :
• The risk of death is increased in patients who present with or develop
complications of pericardial tamponade, involvement of coronary arteries
causing AMI, or malperfusion of the brain.
• Other predictors of increased in-hospital death : age ≥70 years old,
hypotension or cardiac tamponade, RF, and pulse deficits.
• Iatrogenic aortic dissection carries a mortality higher than non-iatrogenic
(35 vs. 24%)
• In the absence of immediate surgery, medical management of proximal
dissection is associated with a mortality of 20% by 24 h after presentation
30% by 48 h, 40% by Day 7, and 50% by 1 month
• Even with surgical repair, mortality rates are 10% by 24 h, 13% by 7 days,
and 20% by 30 days tamponade, RF, and pulse deficits.
31. Prognostic considerations :
• Patients with uncomplicated Type B dissection have a 30-day mortality of
10%
• However, patients who develop ischaemic complications such as RF, visceral
ischaemia, or contained rupture often require urgent aortic repair which
carries a mortality of 20% by Day 2 and 25% by Day 3.
• Similar to Type A dissection, advanced age, rupture, shock, and
malperfusion are important independent predictors of early mortality.
• The chronic use of crack cocaine appears to predispose patients to AAD.
32.
33. Inntramural hematoma
• Intramural hematoma is defined as a bleeding of the vasa vasorum in the
medial layer of the aorta with no blood flow within the media .
• aortic wall apoplexy.
• Systemic hypertension is the leading cause.
• Other causes – Aortic trauma, penetrating aortic ulcer.
• Intramural hematoma most frequently involves the ascending or proximal
descending aorta—up to 70% of cases.
• Intramural hematoma is classified in the same way as aortic dissection: type
A when the ascending aorta is involved and type B when involvement is
limited to the descending aorta.
34. • True lumen is surrounded by calcification
most of the times and its usually smaller
than false lumen
• False lumen spirals around true lumen
• In M mode, the flap moves to the false
lumen in systole.
• Spontaneous echo contrast and thrombus
can be seen in the false lumen.
• With color Doppler is delayed systolic
flow seen by secondary or re-entry tear to
the false lumen.
• The false lumen (especially in chronic
dissections) tends to be larger in
comparison to the true lumen
36. TEE
Type A dissection visualized in
the longitudinal and short-axis
view; white arrows indicate
dissection lamella (A) and an
intimal tear in close proximity of
the aortic leaflets (B).
Colour flow mapping in a patient
with chronic Type B dissection
shows vigorous flow into the false
lumen, demonstrating the
communication between the true
and false lumen (C).
Partial thrombosis in the
aneurysmatic false lumen in
chronic Type B dissection (D).
FL, false lumen; TL, true lumen.
37. Inntramural hematoma
• Aortic IMH is considered a precursor of dissection
• IMH may, progress, dissect, regress, or resorb;
• two-thirds of cases are located in the descending aorta and are typically
associated with hypertension.
• Similar to dissection, chest pain is more common with ascending (proximal)
• IMH, whereas back pain is more common with descending (distal) IMH.
• Nonetheless, the diagnosis of IMH cannot be made on clinically grounds
alone-CT
38. Intramural hematoma
• Acute IMH : for 5–20% of all AAS,
• regression : 10%,
• progression to classic aortic dissection : 28–47%,
• and a risk of rupture : 20–45%.
• Although there is ongoing debate on the natural history of IMH Caucasian
patients benefit from surgical repair in proximal IMH.
• an association between increasing hospital mortality and the proximity of
IMH to the aortic valve, irrespective of medical or surgical treatment.
(In the IRAD registry of 1010 patients)
40. Penetrating aortic ulcer
• account for 7.5% of all cases of acute aortic syndrome.
• Deep ulceration of atherosclerotic aortic plaques can lead to IMH
• present as acute pain syndrome with aortic dissection or perforation.
• disease process that often complicates IMH and appears as an ulcer-like
projection into the haematoma.
• PAUs almost exclusively seen in patients with Type B IMH.
• PAUs originate from atherosclerotic aortic segments and are localized in the
descending thoracic aorta in over 90%.
• the classic appearance is mushroom-like outpouching of the aortic lumen
with overhanging edges.
• Symptomatic ulcers with signs of deep erosion are more prone to develop
dissection or rupture.
• Transthoracic endovascular repair with stent grafting (TEVR) is an
attractive therapeutic modality.
41. Penetrating aortic ulcer
• Typically, penetrating atherosclerotic ulcers are seen in older male patients
with :
history of hypertension (up to 92%),
smoking (up to 77%) and
coronary artery disease (up to 46%) as well as
chronic obstructive pulmonary disease (24-68%)
43. Treatment concepts
• Acute aortic syndromes (dissection or IMH) involving the ascending aorta
are surgical emergencies;
• acute aortic pathology confined to the descending aorta is subject to medical
treatment unless complicated by organ or limb malperfusion, progressive
dissection, extraaortic blood collection (impending rupture), intractable pain,
or uncontrolled hypertension.
• Initial management of AAS :
• Aortic dissection :limiting propagation of dissected wall components by
control of blood pressure and reduction in dP/dt (pressure development).
• Reduction in pulse pressure to just maintain sufficient end-organ perfusion
is a priority with the use of intravenous b-blockade as first-line therapy.
44. Treatment concepts
• Initial therapy:
• intravenous b-blockade. Labetalol, Esmolol with both a- and b-blockade, is useful for
lowering both blood pressure and dP/dt, with a target systolic pressure of 100–120 mmHg
and a heart rate of 60–80 b.p.m.
• Often multiple agents are required, with patients ideally managed in an intensive care
setting.
• Opiate analgesia should be prescribed to attenuate the sympathetic release of
catecholamines to pain with resultant tachycardia and hypertension.
• endovascular intervention :is dictated by the site of the lesion and evidence of
complicationsn(persisting pain, organ malperfusion), as well as evidence of disease
progression on serial imaging.
• Pericardiocentesis: generally avoided in acute type A dissection and urgent surgery is
recommended(can result in recurrent bleeding and acute hemodynamic collapse,
especially if a larger volume of fluid is removed and increased BP leads to further brisk
bleeding into the pericardial space.
45. Treatment concepts
• Acute Type A dissection: has a mortality of 1–2% per hour during the first
24–48 h of presentation.
• if left untreated up to 50% of the patients will be dead in 1 week.
• Death is caused by proximal or distal extension of the dissection leading to
valvular dysfunction, pericardial tamponade, arch vessel occlusion, or
rupture.
• Medical management alone is associated with a mortality of 20% by 24 h
and 30% by 48 h;
• In experienced centers, 30-day surgical mortality for acute type A dissection
is 10% to 35%.
• Factors increasing mortality included shock, heart failure, cardiac
tamponade, MI, renal failure, age, and malperfusion
46. Treatment concepts
• Patients with acute type B aortic dissection have a lower acute mortality
rate than those with acute type A dissection.overall in-hospital mortality
rates of approximately 10%.
• complicated type B dissection carries a much higher mortality rate,
especially when accompanied by shock or malperfusion.
• In the IRAD era, 57% of patients with acute type B dissection were treated
medically, 32% received endovascular therapy, and 7% were treated with
OSR with in-hospital mortality rates of 10%, 14%, and 21%, respectively.
• TEVAR covers the area of the primary intimal tear and redirects flow to the
true lumen, promoting thrombosis of the false lumen and allowing aortic
remodeling.often corrects malperfusion syndromes and branch vessel
ischemia
• The STABLE trial :30-day mortality rate of 4.7%.
• The DISSECTION trial treated complicated type B dissection with TEVAR,
reporting a 30-day mortality of 8% and 12-month mortality of 15%.