Aortic dissection is a very difficult condition in which the inner
sheath of the aortic wall is torn without tearing the outer sheath.
This causes blood to enter the aortic wall through the tear, which
further splits the mediastinum and creates a new channel in the
aortic wall. The serious and often fatal condition of aortic dissection produces symptoms of sudden and tearing chest pain. Although aortic dissection mostly occurs in people around the age of
60, the peak incidence in people with Marfan syndrome is between
20 and 40 years of age.
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.
Acute aortic dissection is a potentially life-threatening condition where blood flows into the layers of the aortic wall, splitting it apart. It occurs in approximately 2.9 per 100,000 people per year in the US. There are several classification systems, but the most important distinguishes between type A dissections, which involve the ascending aorta and require surgery, and type B dissections, which do not involve the ascending aorta and can be treated medically. Risk factors include hypertension, connective tissue disorders like Marfan syndrome, bicuspid aortic valves, pregnancy, and trauma. Prompt diagnosis and treatment are crucial as the risk of death is approximately 1% per hour without treatment.
Neha diwan presentation on aortic aneurysmNEHAADIWAN
The document discusses aneurysms and aortic dissections. It defines an aneurysm as an abnormal dilatation of a blood vessel wall due to weakening. Aortic dissections occur when the inner layer of the aorta tears, allowing blood to surge between the layers. Risk factors include hypertension, smoking, genetics. Symptoms include chest pain. Diagnosis involves imaging tests like ultrasound, CT, or MRI. Treatment depends on location but may include open or endovascular surgery to repair or replace the damaged vessel.
An aortic dissection is a tear within the layers of the aortic wall. It can cause severe chest or back pain and risks damage to organs if blood flow is blocked. Prompt diagnosis through imaging tests and treatment are critical to survival. While type A dissections involving the ascending aorta require emergency surgery, type B dissections of the descending aorta can often be treated through intensive blood pressure control and medication to prevent expansion of the tear. Risk factors include hypertension, genetics, trauma, and certain medical conditions.
An aortic dissection is a tear in the layers of the aortic wall. It can cause severe chest or back pain and may lead to life-threatening complications if not promptly diagnosed and treated. The tear forms a false passageway for blood flow, separating the layers of the aortic wall. Aortic dissections are classified based on their location and extent. Imaging tests are used to diagnose dissections and determine appropriate emergency treatment.
The document discusses aortic dissection, including its causes, risk factors, symptoms, diagnosis, and treatment. It defines aortic dissection as a tear in the inner layer of the aortic wall that allows blood to enter and dissect between the layers. It can cause problems like decreased blood flow or aortic rupture. Diagnosis involves tests like CT scans, echocardiograms, and blood markers. Treatment depends on the location of the dissection and may involve antihypertensive drugs or urgent surgery to repair the aorta.
The document discusses aortic aneurysms and stenosis, including definitions, causes, classifications, symptoms, diagnosis, and surgical considerations. It covers topics such as the etiology of aortic diseases, different classification systems for aneurysms and dissections, signs and symptoms, preoperative evaluation and risk assessment, indications for surgery, and management of anesthesia.
Anesthesia and perioperative care for aortic surgerySpringer
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Risk factors
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.
Acute aortic dissection is a potentially life-threatening condition where blood flows into the layers of the aortic wall, splitting it apart. It occurs in approximately 2.9 per 100,000 people per year in the US. There are several classification systems, but the most important distinguishes between type A dissections, which involve the ascending aorta and require surgery, and type B dissections, which do not involve the ascending aorta and can be treated medically. Risk factors include hypertension, connective tissue disorders like Marfan syndrome, bicuspid aortic valves, pregnancy, and trauma. Prompt diagnosis and treatment are crucial as the risk of death is approximately 1% per hour without treatment.
Neha diwan presentation on aortic aneurysmNEHAADIWAN
The document discusses aneurysms and aortic dissections. It defines an aneurysm as an abnormal dilatation of a blood vessel wall due to weakening. Aortic dissections occur when the inner layer of the aorta tears, allowing blood to surge between the layers. Risk factors include hypertension, smoking, genetics. Symptoms include chest pain. Diagnosis involves imaging tests like ultrasound, CT, or MRI. Treatment depends on location but may include open or endovascular surgery to repair or replace the damaged vessel.
An aortic dissection is a tear within the layers of the aortic wall. It can cause severe chest or back pain and risks damage to organs if blood flow is blocked. Prompt diagnosis through imaging tests and treatment are critical to survival. While type A dissections involving the ascending aorta require emergency surgery, type B dissections of the descending aorta can often be treated through intensive blood pressure control and medication to prevent expansion of the tear. Risk factors include hypertension, genetics, trauma, and certain medical conditions.
An aortic dissection is a tear in the layers of the aortic wall. It can cause severe chest or back pain and may lead to life-threatening complications if not promptly diagnosed and treated. The tear forms a false passageway for blood flow, separating the layers of the aortic wall. Aortic dissections are classified based on their location and extent. Imaging tests are used to diagnose dissections and determine appropriate emergency treatment.
The document discusses aortic dissection, including its causes, risk factors, symptoms, diagnosis, and treatment. It defines aortic dissection as a tear in the inner layer of the aortic wall that allows blood to enter and dissect between the layers. It can cause problems like decreased blood flow or aortic rupture. Diagnosis involves tests like CT scans, echocardiograms, and blood markers. Treatment depends on the location of the dissection and may involve antihypertensive drugs or urgent surgery to repair the aorta.
The document discusses aortic aneurysms and stenosis, including definitions, causes, classifications, symptoms, diagnosis, and surgical considerations. It covers topics such as the etiology of aortic diseases, different classification systems for aneurysms and dissections, signs and symptoms, preoperative evaluation and risk assessment, indications for surgery, and management of anesthesia.
Anesthesia and perioperative care for aortic surgerySpringer
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Risk factors
Anesthesia and perioperative care for aortic surgerySpringer
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Proper
An aneurysm is an abnormal dilatation of a blood vessel wall due to weakening. The most common types are atherosclerotic aneurysms involving the aorta and its branches in older males. Aneurysms can cause complications like thrombosis, embolism, and rupture. Atherosclerotic aneurysms are usually fusiform and infrarenal in the abdominal aorta, caused by atherosclerotic vessel wall destruction. Syphilitic aneurysms often involve the ascending aorta due to syphilitic aortitis. Dissecting aneurysms are acute and involve a tear in the intima allowing blood into the vessel wall, commonly caused by hypertension or genetic disorders.
1. CT is the imaging modality of choice for diagnosing aortic dissection, allowing visualization of the intimal flap and differentiation of the true and false lumens.
2. Key CT findings include an intimal flap that separates the true and false lumens, as well as complications such as periaortic hematoma.
3. ECG gating is important to minimize motion artifacts and accurately characterize the proximal extent of the dissection and involvement of coronary arteries.
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
The document discusses vascular imaging and interventional radiology. It provides an overview of imaging modalities used for vascular imaging like ultrasound, CT, MRI and angiography. It describes the layers of artery and vein walls and how diseases can affect the walls. Examples of interventional procedures are provided like angioplasty, stent placement, aneurysm embolization and stent graft implantation. Equipment used for these procedures includes catheters, guidewires, balloons and embolic agents.
Acute aortic syndrome (AAS) refers to emergency aortic conditions including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. The common feature is disruption of the aortic media layer allowing blood to enter and separate layers. Aortic dissection occurs when a tear in the intima allows blood to flow between layers. Medical management focuses on controlling blood pressure to limit propagation. Type A dissections involving the ascending aorta require emergency surgery while type B dissections of the descending aorta typically receive medical management. Long term follow up is needed to monitor for complications like aneurysm formation.
Diseases and disorders a nursing therapeutics manualSturgo863
The document provides information on abdominal aortic aneurysm (AAA). It describes AAA as a localized dilation of the arterial wall in the descending portion of the aorta. AAA is most common in men over age 50 and usually results from atherosclerosis weakening the aortic wall. Symptoms may include back or abdominal pain. Diagnosis involves imaging tests like ultrasound or CT scan. Treatment for larger AAAs is surgical repair through graft placement. Postoperative care focuses on monitoring for complications like bleeding or infection. Lifestyle changes like smoking cessation are also important to prevent expansion of small AAAs.
Aortic dissection, pathophysiology, risk, incidence, types and treatment, Moh...Moh'd sharshir
This document presents a case of a 55-year-old man with a history of diabetes, hypertension, and prior stroke who was transferred for endovascular aortic repair after a motor vehicle accident caused multiple injuries including head trauma, chest trauma, cardiac contusion, aortic injury, and bone fractures. On examination, he was intubated and sedated. Imaging showed aortic pseudoaneurysm, lung effusions, and subcutaneous emphysema. The document then reviews aortic dissection including types, risk factors, clinical manifestations, diagnosis, and involvement of the ascending versus descending aorta.
Acute Pericarditis Diagnosis and Management Summary.docxwrite22
Acute Pericarditis Diagnosis and Management Summary examines the diagnosis and management of acute pericarditis. It discusses how acute pericarditis is diagnosed using a combination of clinical features, electrocardiography, chest X-ray, and echocardiography. Treatment involves the use of nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. Corticosteroids may also be used in some cases. The prognosis is generally good if the underlying cause is identified and treated appropriately.
This document discusses coarctation of the aorta, including:
1. The definition and history of coarctation as a congenital narrowing of the upper descending thoracic aorta.
2. Theories on the pathogenesis of coarctation related to reduced blood flow through the left side of the heart or abnormal ductal tissue.
3. Types of coarctation including preductal and postductal, and surgical techniques for repair such as patch aortoplasty or bypass grafting.
4. Presentation varies from heart failure in neonates to hypertension in older children and adults, with complications including aneurysm and rupture.
1. Aortic dissection is a tear in the inner layer of the aorta that allows blood to flow between the layers, causing severe chest pain. It is a medical emergency with high mortality if left untreated.
2. Diagnosis is based on symptoms of sudden, severe chest pain and imaging tests like CT scan or MRI that can detect the tear and blood flow between the layers of the aorta.
3. Risk factors include high blood pressure, genetic connective tissue disorders, injuries to the chest, and pregnancy. Prompt diagnosis and treatment are needed to prevent death.
Diseases of the veins can involve varicose veins, chronic venous insufficiency, deep vein thrombosis, and superior vena cava syndrome. Varicose veins and chronic venous insufficiency are caused by damaged valves that allow blood to pool in the veins under gravity, distending and damaging the veins over time. Deep vein thrombosis occurs when blood clots form in the deep veins, usually in the legs, which can lead to pulmonary embolism if pieces of the clot break off. Superior vena cava syndrome involves the occlusion of the superior vena cava by lung cancer or other causes in most cases.
An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of the heart that allows blood to leak from the left to the right side. There are four main types of ASDs. A ventricular septal defect (VSD) is an abnormal opening in the wall between the two lower chambers, allowing blood to flow between the right and left ventricles. Patent ductus arteriosus (PDA) occurs when the fetal blood vessel between the aorta and pulmonary artery fails to close after birth, allowing blood to flow back to the lungs. These three types of congenital heart defects are considered non-cyanotic as they do not result in low blood oxygen.
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.
Anesthesia And Congenital Heart DiseaseAhmed Shalabi
This document summarizes adult congenital heart disease and considerations for anesthesia management. It discusses that:
1) Congenital heart diseases are increasingly common as more children with complex defects now survive into adulthood.
2) Adults with CHD can be categorized as those with complete repair, partial/palliative repair, or no operation.
3) Five factors influence perioperative risk - pulmonary hypertension, cyanosis, reoperation, arrhythmias, and ventricular dysfunction.
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic separation of the coronary arterial walls, creating a false lumen. It predominantly affects young to middle-aged women and can lead to myocardial ischemia. Diagnosis is challenging as angiographic findings can mimic atherosclerosis. Intravascular ultrasound and optical coherence tomography provide better visualization of the dissection and intimal tears. Management involves antiplatelet therapy but thrombolysis and anticoagulation should be avoided due to risk of extension. Prognosis is generally good but recurrence risk remains.
Cardiac emergencies in the first year of lifesxbenavides
This document discusses cardiac emergencies that may present in infants in the first year of life. It describes the most common cyanotic congenital heart lesions which cause central cyanosis, including Tetralogy of Fallot, Transposition of the Great Arteries, Tricuspid Atresia, Total Anomalous Pulmonary Venous Return, and Truncus Arteriosus. For each condition, it outlines the pathophysiology, typical presentation, physical exam findings, ECG and chest x-ray characteristics. It also discusses cyanosis, cyanotic heart disease, and the transition of cardiovascular physiology at birth.
Challenges and Practices in Modern Hand Surgery Nursingsemualkaira
Purpose This study aims to explore the changes in the patient spectrum and the challenges and practices in nursing brought about by
the evolution of modern hand surgery patients and medical development. Methods A retrospective study was conducted on clinical
data from 21,512 hand surgery patients in our hospital over the
past 15 years. T
The Impact Visceral Abdominal Fat and Muscle Mass Using CT on Patients with S...semualkaira
The association between abdominal visceral
fatty area (VFA) and muscle mass and mortality is not fully understood despite the fact that being overweight is an established
risk factor for the onset and severity of acute pancreatitis (AP). We
assessed the effect of VFA on severe AP (SAP) mortality
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Anesthesia and perioperative care for aortic surgerySpringer
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Proper
An aneurysm is an abnormal dilatation of a blood vessel wall due to weakening. The most common types are atherosclerotic aneurysms involving the aorta and its branches in older males. Aneurysms can cause complications like thrombosis, embolism, and rupture. Atherosclerotic aneurysms are usually fusiform and infrarenal in the abdominal aorta, caused by atherosclerotic vessel wall destruction. Syphilitic aneurysms often involve the ascending aorta due to syphilitic aortitis. Dissecting aneurysms are acute and involve a tear in the intima allowing blood into the vessel wall, commonly caused by hypertension or genetic disorders.
1. CT is the imaging modality of choice for diagnosing aortic dissection, allowing visualization of the intimal flap and differentiation of the true and false lumens.
2. Key CT findings include an intimal flap that separates the true and false lumens, as well as complications such as periaortic hematoma.
3. ECG gating is important to minimize motion artifacts and accurately characterize the proximal extent of the dissection and involvement of coronary arteries.
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
The document discusses vascular imaging and interventional radiology. It provides an overview of imaging modalities used for vascular imaging like ultrasound, CT, MRI and angiography. It describes the layers of artery and vein walls and how diseases can affect the walls. Examples of interventional procedures are provided like angioplasty, stent placement, aneurysm embolization and stent graft implantation. Equipment used for these procedures includes catheters, guidewires, balloons and embolic agents.
Acute aortic syndrome (AAS) refers to emergency aortic conditions including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. The common feature is disruption of the aortic media layer allowing blood to enter and separate layers. Aortic dissection occurs when a tear in the intima allows blood to flow between layers. Medical management focuses on controlling blood pressure to limit propagation. Type A dissections involving the ascending aorta require emergency surgery while type B dissections of the descending aorta typically receive medical management. Long term follow up is needed to monitor for complications like aneurysm formation.
Diseases and disorders a nursing therapeutics manualSturgo863
The document provides information on abdominal aortic aneurysm (AAA). It describes AAA as a localized dilation of the arterial wall in the descending portion of the aorta. AAA is most common in men over age 50 and usually results from atherosclerosis weakening the aortic wall. Symptoms may include back or abdominal pain. Diagnosis involves imaging tests like ultrasound or CT scan. Treatment for larger AAAs is surgical repair through graft placement. Postoperative care focuses on monitoring for complications like bleeding or infection. Lifestyle changes like smoking cessation are also important to prevent expansion of small AAAs.
Aortic dissection, pathophysiology, risk, incidence, types and treatment, Moh...Moh'd sharshir
This document presents a case of a 55-year-old man with a history of diabetes, hypertension, and prior stroke who was transferred for endovascular aortic repair after a motor vehicle accident caused multiple injuries including head trauma, chest trauma, cardiac contusion, aortic injury, and bone fractures. On examination, he was intubated and sedated. Imaging showed aortic pseudoaneurysm, lung effusions, and subcutaneous emphysema. The document then reviews aortic dissection including types, risk factors, clinical manifestations, diagnosis, and involvement of the ascending versus descending aorta.
Acute Pericarditis Diagnosis and Management Summary.docxwrite22
Acute Pericarditis Diagnosis and Management Summary examines the diagnosis and management of acute pericarditis. It discusses how acute pericarditis is diagnosed using a combination of clinical features, electrocardiography, chest X-ray, and echocardiography. Treatment involves the use of nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. Corticosteroids may also be used in some cases. The prognosis is generally good if the underlying cause is identified and treated appropriately.
This document discusses coarctation of the aorta, including:
1. The definition and history of coarctation as a congenital narrowing of the upper descending thoracic aorta.
2. Theories on the pathogenesis of coarctation related to reduced blood flow through the left side of the heart or abnormal ductal tissue.
3. Types of coarctation including preductal and postductal, and surgical techniques for repair such as patch aortoplasty or bypass grafting.
4. Presentation varies from heart failure in neonates to hypertension in older children and adults, with complications including aneurysm and rupture.
1. Aortic dissection is a tear in the inner layer of the aorta that allows blood to flow between the layers, causing severe chest pain. It is a medical emergency with high mortality if left untreated.
2. Diagnosis is based on symptoms of sudden, severe chest pain and imaging tests like CT scan or MRI that can detect the tear and blood flow between the layers of the aorta.
3. Risk factors include high blood pressure, genetic connective tissue disorders, injuries to the chest, and pregnancy. Prompt diagnosis and treatment are needed to prevent death.
Diseases of the veins can involve varicose veins, chronic venous insufficiency, deep vein thrombosis, and superior vena cava syndrome. Varicose veins and chronic venous insufficiency are caused by damaged valves that allow blood to pool in the veins under gravity, distending and damaging the veins over time. Deep vein thrombosis occurs when blood clots form in the deep veins, usually in the legs, which can lead to pulmonary embolism if pieces of the clot break off. Superior vena cava syndrome involves the occlusion of the superior vena cava by lung cancer or other causes in most cases.
An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of the heart that allows blood to leak from the left to the right side. There are four main types of ASDs. A ventricular septal defect (VSD) is an abnormal opening in the wall between the two lower chambers, allowing blood to flow between the right and left ventricles. Patent ductus arteriosus (PDA) occurs when the fetal blood vessel between the aorta and pulmonary artery fails to close after birth, allowing blood to flow back to the lungs. These three types of congenital heart defects are considered non-cyanotic as they do not result in low blood oxygen.
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.
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This document summarizes adult congenital heart disease and considerations for anesthesia management. It discusses that:
1) Congenital heart diseases are increasingly common as more children with complex defects now survive into adulthood.
2) Adults with CHD can be categorized as those with complete repair, partial/palliative repair, or no operation.
3) Five factors influence perioperative risk - pulmonary hypertension, cyanosis, reoperation, arrhythmias, and ventricular dysfunction.
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic separation of the coronary arterial walls, creating a false lumen. It predominantly affects young to middle-aged women and can lead to myocardial ischemia. Diagnosis is challenging as angiographic findings can mimic atherosclerosis. Intravascular ultrasound and optical coherence tomography provide better visualization of the dissection and intimal tears. Management involves antiplatelet therapy but thrombolysis and anticoagulation should be avoided due to risk of extension. Prognosis is generally good but recurrence risk remains.
Cardiac emergencies in the first year of lifesxbenavides
This document discusses cardiac emergencies that may present in infants in the first year of life. It describes the most common cyanotic congenital heart lesions which cause central cyanosis, including Tetralogy of Fallot, Transposition of the Great Arteries, Tricuspid Atresia, Total Anomalous Pulmonary Venous Return, and Truncus Arteriosus. For each condition, it outlines the pathophysiology, typical presentation, physical exam findings, ECG and chest x-ray characteristics. It also discusses cyanosis, cyanotic heart disease, and the transition of cardiovascular physiology at birth.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
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Volume 10 Issue 9 -2024 Research Article
IMH and PAU are rarer intense aortic syndromes and as a rule
have absent luminal flow. IMH may emerge from unconstrained
break of aortic vasa vasorum or from a thrombosed aortic untrue
lumen, whereas PAU happens secondary to atherosclerotic plaque
rupture, comparable to a coronary plaque rupture, coming about
in an intimal imperfection and pseudoaneurysm with or without
blood flow in it.
The foundation of the International Registry of Acute Aortic
Dissection (IRAD) database has permitted an universal collec-
tion of centers to collaborate in evaluating the introduction, ad-
ministration, and results of acute AD. The foremost dangerous,
life-threatening acute aortic syndrome is acute type A aortic dis-
section (ATAAD). ATAAD has an frequency of approximately 10
per 10,000 within the United States and a 1-3% mortality rate/h
without surgical repair due to cardiac tamponade, end-organ malp-
erfusion, and aortic crack. Untreated ATAAD is associated with an
over 33% mortality rate within the to begin with 24 h, 50% at 48
h, and 75-90% at 2 weeks. With forceful therapeutic and surgical
treatment, 30-day survival can be as high as 80-90%.
4. Classification
IMH and PAU based on the area of pathology [2]. Whereas numer-
ous classification frameworks exist, the two most common are the
Stanford and DeBakey classifications.
Timing of acute AD is greatly critical since it can alter adminis-
tration methodology. Chronicity is based on the beginning intimal
tear and side effect onset, concurring to agreement North Ameri-
can and European rules for thoracic aortic infection:
• Acute: ≤14 days
• Subacute: 15-90 days
• Chronic: >90 days
5. Pathophisiology
A typical aortic diameter is decided by patient age, size, and sex
[2]. The rising, arch, and descending aorta are regularly 2-3 cm in
distance across. Advertisement happens as a result of expanded
divider stretch based on Laplace’s law, where the pressure (wall
stress) is equal to weight increased by sweep, separated by two
times the wall thickness. Any component that increments divider
push past its capacity will at that point incline that person’s aorta
to dissection.
AD most commonly happens in patients aged 60-70 (mean age 63)
and includes a 3:1 male to female predisposition. The foremost
common hazard figure for AD is incessant hypertension, which
is display in >75% of cases. Connective tissue infections are too
vital chance variables for AD. The three most common are Mar-
fan syndrome, Loeys-Dietz, and Ehlers-Danlos. Connective tissue
disorders weaken the elastin and/or collagen layers of the aortic
wall media, which incline the aorta to aneurysm and dissection.
Extra chance components for AD may be partitioned into coordi-
nate strengths that affect the aortic wall and others that change the
composition of the aortic wall.
Most commonly the intimal tear in ATAAD starts at the correct
front viewpoint of the proximal climbing aorta along the more
noteworthy ebb and flow and may engender through the iliac arter-
ies. Intimal tears starting within the aortic arch or descending tho-
racic supply route may advance retrograde back to the rising aorta,
which speaks to an similarly case not more dangerous illness. Type
B acute ADs most commonly include an intimal tear fair distal to
the cleared-out subclavian or less as often as possible from a tear
within the abdominal aorta with retrograde movement. ADs tend
to happen toward the external layers of the media, making the ex-
ternal wall of the untrue lumen thinner than the intimal fold and
subordinate upon the adventitia for its quality. All vessels emerg-
ing from the aorta counting the coronaries, aortic arch vessels, in-
tercostal supply routes, visceral vessels, and iliac courses may be
sheared off the lumen, impeded by the dissecting media, remain
in communication with the wrong lumen, or stay uninvolved. The
wrong lumen may rupture, re-communicate with the true lumen by
re-entry tears, thrombose, or stay intaglio, driving to future aneu-
rysm arrangement.
6. Emergency
Acute aortic dissection (AAD) is a medical and often a surgical
emergency [3]. AAD has an surmised rate of 3.5/100,000 people
yearly within the United States. It is five times more common in
guys than females and incorporates a top rate within the fifth and
sixth decades of life. Over 60% of the time, aortic dissections in-
clude the ascending aorta, and the remainder of cases include es-
sentially the descending thoracic and stomach aorta. Even though
treatment has advanced over the past a few decades, various con-
troversies remain. Our most later and total information around
AAD comes from the multicenter International Registry of Acute
Aortic Dissection, which has more than 1,700 patients from 22
institutions.
Even though the common approach has been surgical administra-
tion for AAD of the proximal or climbing aorta and restorative
administration for the slipping aorta, more up-to-date modalities
of treatment have driven to changes in generally treatment. A few
of the basic issues to consider when treating AAD are understand-
ing the classification framework and its pertinence, considering
which AADs ought to be overseen therapeutically or surgically,
what methodology of imaging ought to be utilized, what the part
of blood pressure treatment is in AAD, and the part endovascular
treatment may play within the current time.
7. Pain
The torment of infarction is ordinarily extreme and persistent and
rapidly creates all the hallmarks of peritonitis [3]. The understand-
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Volume 10 Issue 9 -2024 Research Article
ing regularly finds it troublesome to find the location of the tor-
ment, which gets continuously more regrettable in case cleared
out untreated and which is irritated by any development and is
as it were diminished by solid analgesics. Vomiting may go with
the torment and most patients are extremely disgusted. Enormous
vomiting and complete dysphagia happen within the few patients
who create the uncommon condition of localized necrosis of the
stomach caused by a gastric volvulus.
A few patients may depict a classical colic in which the torment
gets to be ceaseless and much more extreme as the blood supply
of a discouraged circle is compromised by the method of stran-
gulation. Patients may know they have a hernia that has ended up
irreducible and excruciating, or they may give a history of past
abdominal surgery, showing the possibility of adhesions as a cause
of strangulation.
A history of angina, heart attacks, strokes or intermittent claudi-
cation demonstrates coexisting atherosclerotic disease and incre-
ments the probability of a mesenteric thrombosis.
Splenic infarction is common in patients with sickle-cell disease,
who may moreover create bowel ischaemia, as may patients with
autoimmune vasculitis.
Severe chest pain going before the abdominal pain demonstrates
the possibility that an aortic dissection has compromised the mes-
enteric vessels and driven to localized necrosis.
When getting an understanding history, the doctor ought to main-
tain a strategic distance from questions that are leading and ought
to center on points of interest of the pain [4]. This incorporates
data on the onset, character, duration, and area of pain as well as
the nearness of radiation of pain.
Concerning onset, pain that creates all of a sudden may be sugges-
tive of a perforated viscus or ruptured abdominal aortic aneurysm.
Pain that gradually worsens over time may be the result of condi-
tions characterized by the dynamic advancement of infection and
irritation such as intense appendicitis and cholecystitis.
With respect to character, pain described as „burning“ may impli-
cate the pain of a perforated peptic ulcer whereas a „ripping“ or
„tearing“ sensation regularly speaks to the torment of an aortic dis-
memberment. Pain that’s discontinuous or colicky ought to be dis-
tinguished from pain that’s persistent in nature. Colicky torment
is regularly related with obstructive forms of the intestinal, hepa-
tobiliary, or genitourinary tract, whereas pain that’s continuous is
usually the result of underlying ischemia or peritoneal inflamma-
tion. The last mentioned may happen fundamentally or taking after
an introductory scene of colicky pain when an obstructive handle
is complicated by the improvement of ischemia. Illustrations of
this incorporate cases of biliary colic that advances to acute chole-
cystitis or an imprisoned circle of digestive system that gets to be
strangulated and ischemic.
The area of pain is critical to consider as different pathologic con-
ditions tend to happen in particular locales or quadrants of the ab-
domen. In this manner, in the event that the doctor is learned of
the infection forms that cause torment in these ranges, they may
be able to essentially limit their differential. This holds genuine for
those with the understanding that certain conditions may result in
torment that transmits or is alluded to an range past the location of
illness due to shared innervation. Classic cases of this incorporate
biliary torment that’s alluded to the correct subscapular locale, the
pain of acute pancreatitis that emanates to the back, and genitou-
rinary pain that radiates from the flank down to the groin. At last,
it is vital to note any chronological variety within the pain as this
may give accommodating clues to the determination. One of the
leading cases of this is often within the case of intense appendi-
citis, in which pain is at first seen within the periumbilical locale
some time recently localizing to the right lower quadrant (RLQ).
This wonder reflects the move from visceral to parietal torment
as appendiceal inflammation advances to include and irritate the
peritoneal lining.
The larger part of patients showing with intense stomach torment
have partner indications (e.g., nausea, vomiting, diarrhea, consti-
pation, hematochezia) that are regularly accommodating in mak-
ing a diagnosis. Chronology of nausea is vital to consider as heav-
ing that happens after the onset of abdominal pain is more likely to
be surgical in nature as a result of medullary spewing centers that
are fortified by torment-driving forces traveling through secondary
visceral afferent fibers. Furthermore, constipation or obstipation
may point towards an intestinal obstruction, whereas diarrhea (par-
ticularly if bloody) is related with gastroenteritis, inflammatory
bowel disease, and intestinal ischemia.
8. Disruption
As imaging modalities have duplicated and their determination
made strides, a huge number of aortic pathologies have been re-
vealed and given descriptions [5]. A few of these substances in-
corporate aortic intramural hematoma and entering aortic ulcer,
as well as the catch-all determination of intense aortic disorder.
Particularly characterized, an AAD may be a disturbance of the
layers of the arterial wall of the aorta. It is ordinarily characterized
by a breach of the intimal layer with expansion and disturbance
of the media of the vessel wall. A dismemberment is complex in
that it may frame a winding tear because it expands distally and
proximally. Rarely is the tear or disturbance direct, and it may in-
volve several reentry focuses between genuine and untrue lumens.
In case the adventitial layer is disturbed, at that point the AAD is
basically a rupture and may openly extravasate blood into the chest
or midriff.
By accepted definition, AADs are those that are recognized less
than 14 days from time of the onset of indications. Those that are
analyzed more than 14 days are regularly called subacute in case
recognized earlier to two months from side effects or inveterate in
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Volume 10 Issue 9 -2024 Research Article
the event that more noteworthy than two months from side effect
onset.
The three essential sorts of terminology that exist incorporate the
DeBakey classification, the Stanford classification, and the ana-
tomical classification. The DeBakey framework separates AADs
into three discrete categories based on area of the dismemberment
and area of the intimal tear. DeBakey type I AADs include the
proximal or climbing aorta and the descending aorta. The type II
AAD includes as it were the rising aorta without inclusion of the
curve or bracheocephalic vessels. Sort III beneath the DeBakey
construction portrays AADs that are constrained to the slipping
aorta alone and are further subdivided into IIIa that’s restricted
to the slipping thoracic aorta distal to the subclavian or IIIb, con-
strained to the infra-diaphragmatic aorta.
The other major framework of classification was developed
at Stanford University Medical Center and may be a simplified
grouping of type A involving a dissection within the ascending
aorta and any other portion of the aorta and type B being limited
to a dissection within the aorta distal to the take-off of the cleared
out subclavian. The Stanford type A includes the DeBakey types
I and II, and the type B incorporates DeBakey types IIIa and IIIb.
A framework that may well be more precise and doubtlessly
graphic depends on anatomic specificity. A case would be isolat-
ing AADs into those that include the ascending aorta (that parcel
from the aortic valve to the level of the innominate course), the
transverse or arch aorta (that parcel enveloping the innominate,
cleared out carotid, and cleared out subclavian beginnings) and the
plummeting aorta. The descending aortic dissections seem at that
point be assist isolated into descending thoracic aortic dissections
and thoracoabdominal dissections for those that navigate the dia-
phragm and include the visceral vessels. This framework would
permit clear depiction of both the area of the intimal tear and the
expansion of the dissection.
9. Aneurysms
Thoracic aortic aneurysms are oftentimes noiseless until catastro-
phe strikes, and nearly 95% of patients with thoracic aortic an-
eurysms are undiscovered and completely unconscious of their
condition [6]. The administration of thoracic aortic aneurysms
remains challenging in both the elective and new settings. The
mortality of ruptured thoracic aortic aneurysms approaches 100%,
and it can be a troublesome choice whether or not to function on a
thoracic aortic dismemberment once it has been found. Clinician
conclusions contrast on when to start forceful surgical methods,
and these choices hold huge results for patients. It is profoundly
likely that detailed frequencies of thoracic aortic aneurysms are
thought little of, as fatal thoracic aortic aneurysm ruptures can be
misdiagnosed as myocardial infarctions. No two thoracic aortic
aneurysms are the same, and it is basic to get it the etiology and
administration of this phenomenon. Generally, the only treatment
alternative for aortic arch illness has been open arch substitution
beneath circulatory capture conditions with or without particular
cerebral perfusion. However, this open method has noteworthy
morbidity and mortality, especially in elderly patients with numer-
ous comorbidities. To possibly moderate the dangers related with
open aortic arch substitution, endovascular arch repair has picked
up force as an elective treatment choice. As of now, endeavors to
stent the aortic curve are being trialed in various healthcare offices
around the world. Patients chosen for this strategy are considered
a tall chance for customary open curve substitution.
Thoracic aortic aneurysms affect more than 15,000 individuals
within the United States each year, and around 60% of all tho-
racic aortic aneurysms are within the climbing aorta. One of the
foremost causes of death because of thoracic aortic aneurysms
may be a dismemberment, or a tear within the divider of the aor-
ta, as well as add up to crack. Type A aortic dissection (TAAD),
for illustration, is indicated within the Stanford classification as a
dismemberment of the rising aorta, notwithstanding of the distal
extent of the tear, while type B dissection includes the lower aor-
ta. In general, pooled healing center mortality from a later precise
survey and meta-analysis illustrated that hospital mortality for all
surgical repairs of TAAD was 11.9%. Etiologies of TAAD incor-
porate hypertension, atherosclerosis, connective tissue disorders,
injury, disease, and past cardiac or vascular surgery. The acquired
disarranges related with TAAD incorporate aortopathies related
with Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz
syndrome, and the bicuspid aortic valve.
10. Diagnosis
Early and exact diagnosis of AAD is critical [5]. A high degree
of clinical doubt combined with cautious indication cross exami-
nation regularly give the diagnosis, which can at that point be af-
firmed with imaging. The foremost common side effect detailed is
pain, regularly portrayed as a shearing, tearing, or ripping in nature
with an area that’s regularly interscapular or paraspinous. Torment
is show within the endless larger part of AADs, with as it were 4%
of patients denying side effects.
Electrocardiogram-gated, multidetector row computed tomogra-
phy (CT) imaging, with and without the utilize of an intravenous
contrast agent, is the mainstay of radiological assessment of the
persistent with asuspected AAD. A CT of the chest, abdomen,
and pelvis can quickly (less than 30 seconds securing time) and
precisely give imaging of the whole aorta from the level of the
aortic valve to the femoral vessels. The essential finding is that of
two lumens or channels with blood, as restricted to one particu-
lar channel, and the visualization of the intimal or average flap.
CT with differentiate will also permit for understanding the area
and extent of the dissection. A non-contrast CT check frequently
provides important data approximately calcification within the di-
viders of the aorta and whether intramural hematoma is displayed
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Volume 10 Issue 9 -2024 Research Article
or thrombosis of the false lumen has happened. Fitting renal de-
fensive techniques ought to be utilized for patients who have sus-
pected or known lessening of their renal function. Hydration and
alkalinization of the patient’s urine are thought to be the foremost
successful techniques to diminish the nephrotoxicity of most intra-
venous iodinated contrast agents.
The precision of multidetector CT with contrast for the discovery
of aortic dissection was 100% in a few considers. In terms of find-
ing the entry tear, CT includes 82% sensitivity and 100% specific-
ity. For characterizing the association of the cephalic or visceral
department vessels, the affectability and specificity are 95% and
100%, individually. A few other ponders report about 100% sensi-
tivity and specificity for CT checking to detect aortic dissections.
Magnetic resonance imaging (MRI) is an elective methodology
that’s utilized when conventional contrast agents cannot be man-
aged due to renal insufficiency or allergies. Gadolinium, the dif-
ferentiate specialist utilized for most MRIs, has been involved in
a many-fold increment in nephrogenic systemic fibrosis and needs
to be avoided in patients with persistent renal lacking. Moreover,
MRI is related to longer picture acquisition times (up to 30 min-
utes) and is regularly not promptly accessible in numerous remote
restorative centers, particularly during off hours. MRI has been
famous for having between 95% and 100% sensitivity and 94%
and 98% specificity for the discovery of aortic dissection.
Invasive imaging, such as contrast aortography, is nearly out of
date for the acute diagnosis of AAD, even though it was the pre-
vious gold standard. Catheterization and angiography is now and
then valuable in agent arranging, such as the imaging of coronary
courses or the appraisal of visceral vessel patency and run-off. In
this respect, intravascular ultrasound has been demonstrated to be
a valuable adjunct for intraoperative imaging and in superior char-
acterizing and recognizing the true and false lumens of vessels.
Transesophageal echocardiography (TEE) is an important asset
when disparity exists concerning the diagnosis or on the off chance
that clarification is required to get it whether an AAD includes the
ascending aorta. Given that type A dissections require quick sur-
gery, the affirmation of a genuine fold or dissection within the as-
cending aorta by TEE is required if there’s any question or equiv-
ocation on the CT images. Even though its utility is constrained
within the descending thoracic aorta, and despite the methodology
being much more operator-dependent than CT or MRI, TEE can
regularly clearly characterize the beginning of the dissection as ei-
ther distal or proximal to the subclavian artery and authoritatively
reveal whether the ascending aorta is included.
Plain chest X-rays, although suggestive, are not diagnostic and
don’t give the fundamental detail for the diagnosis of either type
A or type B acute aortic dissections. Discoveries on chest X-rays
of an extended mediastinum, tracheal deviation, obscured or al-
tered aortic forms, or the noted displacement of a nasogastric tube
within the thoracic portion should all prompt further, more specific
diagnostic imaging modalities.
11. Conclusion
Aortic dissection occurs most often due to damage to the aortic
wall, and this is the cause of this problem in the majority of cas-
es. Damage to the aortic wall can occur for several reasons, the
most common of which is high blood pressure. Various diagnos-
tic modalities can be used to establish a diagnosis. Primarily, an
X-ray of the chest can be taken, on which the expansion of the
mediastinum will be visible, regardless of the type of dissection
being performed. In order to rule out acute coronary syndrome, it
is necessary to perform an ECG, which normally does not show
any changes, except in cases where the dissection spreads to the
coronary blood vessels. The diagnosis of aortic dissection is most
easily confirmed by transthoracic ultrasound of the heart. CT, as
well as aortography and magnetic resonance are also in use. Each
diagnostic procedure has its advantages and disadvantages, so it
would be ideal to combine them, for example, CT will give ad-
equate data on the location of the entrance and exit rupture, the
length of the dissection, and the involvement of the aortic branch-
es, while on the other hand, echocardiography will provide infor-
mation on valve involvement, that is, about the possible existence
of aortic regurgitation and pericardial rupture.
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