This document discusses risk factors, symptoms, and signs of acute aortic dissection. It notes that risk factors include connective tissue disorders, hereditary conditions, hypertension, smoking, and trauma. Symptoms often include tearing chest or back pain, which can vary in intensity. Signs may include blood pressure differences in arms, decreased pulse, murmurs, and fever. Diagnosis is often made using angiography CT, MRI, or ultrasound to identify the flap between the true and false lumens. Proper identification of the type and extent of dissection guides treatment and prognosis.

1. Síndrome Aórtico Agudo
C. Benítez P
CCVT HLV UG

2. Risk Conditions for Aortic Dissection
• Connective tissue disorders
• Hereditary fibrillinopathies
• Marfan’s syndrome
• Ehlers-Danlos syndrome
• Hereditary vascular diseases
• Bicuspid aortic valve
• Coarctation
• Chronic hypertension and atherosclerosis
• Smoking, dyslipidemia, cocaine/crack
• Vascular inflammation
• Giant cell arteritis
• Takayasu arteritis
• Behcet’s disease
• Syphilis
• Ormond’s disease
• Deceleration trauma and iatrogenic origin
• Deceleration trauma (car accident, fall from height)
• Iatrogenic factors
• Catheter/instrument intervention
• Valvular/aortic surgery
• Side or cross clamping/aortotomy
• Graft anastomosis
• Patch aortoplasty
• Cannulation site

4. • El punto del desgarro
intimal da la
deficinicón del tipo .
…………………….
………….. Y su pronóstico y
tratamiento

5. • Symptom Comment
• Experience of pain Almost ubiquitous—96% of patients report pain
• Location of pain Anterior characterizes ascending dissection;
• posterior characterizes descending dissection
• Severity of pain “10 out of 10”
• Onset of pain Abrupt (distinguishes from MI)
• Quality of pain “Tearing” quality
• Variability of pain Classical patterns common, but not invariable;
• 4% of patients experience no pain
• Waxing and waning Variability in severity of pain reflects physiological
• of pain (decrease in aortic wall tension with rx of BP) and
• anatomic events (spontaneous re-entry).
• Pleuritic component Reflects pericardial and pleural inflammation
• Cardiac ischemia True anginal/infarction symptoms may occur from
• involvement of RCA
• Abdominal pain Vigilant search for intestinal ischemia essential
• (lethal phenomenon)
• Renal ischemia Usually asymptomatic, except in case of infarction
• Leg pain From involvement of iliac artery by dissection
• process
• Paralysis of legs From spinal cord ischemia or peripheral nerve ischemia
• (paraplegia)
• Syncope From either:
• Involvement of head vessels
• Tamponade
• Acute aortic insufficiency
• Vaso-vagal response to pain
• Dyspnea Acute aortic insufficiency poorly tolerated

6. Signs of Aortic Dissection
Sign Comment
• Hypertension (or hypotension) Hypertension more common in descending
dissection
• Hypotension may signify tamponade
• Aortic insufficiency AI murmur may hide
• Pulse deficits Most common in an arm: “pseudo-hypotension”
• Fever Intense inflammatory response to dissection
• Local signs in mediastinum Hoarseness (stretch of recurrent laryngeal nerve)
• Tracheal obstruction (by aorta)
• Hemoptysis (pulmonary rupture)
• Hematemesis (esophageal rupture)
• Continuous murmur (rupture into RA, RV, LA)

7. AngioTAC

9. AngioTAC 3d

10. MRI

11. MRI
• Desventajas :
Mayor tiempo
Metales
Pcte inestable

12. Eco TE
Objetiva
• Flap de Disección
• Flujo o trombosis en
falso lumen

14. Recordar

16. Todo es igual ????

19. Asociados a Válvula Bicúspide
• Recuerde
2% de la población
Válvula bicúspide

20. • Recuerde :
• Gradiente medio > 30
= INTERVENCION

21. Que es mejor ???

22. Zonas de Landing

23. Clasificación de Crawford
Tipo I Desde el tercio superior de la aorta torácica hasta la
parte superior de la abdominal. Incluye arterias
viscerales.
Tipo II Desde el tercio proximal de la aorta descendente a la
aorta infrarrenal.
Tipo III Empieza en los dos tercios distales de la aorta torácica y
se extiende por gran parte de la aorta abdominal
Tipo IV Confinado a la aorta abdominal, incluyendo vasos
viscerales

24. Identificação do real diametro do vaso
Lei de Laplace
Davies JE and Sundt TM (2007) Surgery Insight: the dilated ascending aorta—indications
for surgical

25. Crecimiento Aneurisma
Coady M. A. et al.; J Thorac Cardiovasc Surg 1997;113:476-491

26. Manejo en Urgencia
• Dx Diferencial:
TEP masivo
SCA
Neumotórax a tensión

27. Manejo en Urgencia
• Analgesia
• Stress de la Pared
Vasodilatadores
directos
Betabloqueo
Descartar compromiso
visceral precoz.

28. No lo Olvide
• “There is no disease more conducive to
clinical humility than aneurysms of the
aorta”
Sir William Osler
1900