Diseases of the Aorta - CRASH! Medical Review Series
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- Опубліковано 2 лис 2024
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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
Saturday, October 1, 2022. Cardiology: Diseases of the Aorta: 1) Aortic Dissection is a Tear in the Intimal Layer (Endothelium) of the Aorta (Cx: 1) Aneurysm or 2) Rupture and 3) Hemoperitoneum); Diagnosis is via Computed Tomography with Contrast (CT w Contrast) and is a Medical Emergency. Hx: Hypertension is the Most Common Cause of AD (Aetiology: 1) Hypertension, 2) Connective Tissue Disease, 3) Trauma, 4) Peripartum Pregnancy (Preeclampsia); SSx: 1) Tearing, Stabbing, Sharp Pain of Acute Chest Onset (~20 Minutes) often radiating to the Back. Px: 1) Variable Blood Pressure and Hypertension; 2) Muffled Heart Sound (Stethoscopic Ascultation); 2) New Diastolic Murmur, 3) Unequal Radial Pulses, 4) Adventitious Lung Sounds are Possible; Tx/Mx: 1) Acute Management or ABCs: 1) Airway Attention, 2) Attention to Respiration Rate (Tachypnea, Apnea), 3) Attend the Blood Pressure/Heart Rate. In an Unstable Patient CT is not Indicated. 2) IV Beta Blocker of choice is Esmolol; 3) Nitroprusside (Vasodilator), and 4) Pain Management is Opiates/Opioids: 1) IV Morphine Sulfate or 2) Fentanyl (Analgesic Opioid Agonists); 5) Surgical Correction. 2) Abdominal Aortic Aneurysm (AAA) is the enlargement of the Lumenal Diameter (Normal is 1.9 cm; Pathological is More than 4 cm and over 7 cm implies a 20% Risk of Rupture) of the Aorta at the Level of Abdomen; and Presents (Px) as a Pulsatile Abdominal Mass. SSx: 1) Pulsatile Abdominal Mass, 2) Early Satiety, 3) Nausea/Vomiting, 4) General Mild Flank Pain, Back Pain or Groin Pain, 5) However, AAA is usually Asymptomatic; Tx: An unruptured AAA or those less than 4 cm in Diameter is treated with Risk Reduction (Smoking Cessation) and Metoprolol (Beta Blocker), and Monitoring /Observation by rechecking via Ultrasonography q6 Months; Cx: 1) Rupture (Surgical Emergency due to Sudden Loss of Consciousness (LOC) or Syncope and Demands STAT Emergent Reparative Surgery due to manifested Hemodynamic Instability; Mx: Bilateral Large Bore IV Lines, Fluids, BP Reduction with Esmolol (Beta Blocker of Choice), 2) Sudden Death. Diagnosis: Abdominal Ultrasonography. Goodness, there is indeed always a darker side to everything ie Rupture of an Aneurysm versus AAA. MD Paul Bolin, Hell yeah! This is my kind of Medical Scenario, Always. Heil!
Are there any shunts used in place of surgery for an A.A.A.? Years ago, my first wife diagnosed via PE of the abdominal wall a dissecting aneurism during during her first year as a resident. I was very proud of her the patient survived.
My friend Tomoko-San works at Muji an international department store that sells paper. I do origami and the following is why I do origami. Jack a 95 year old Holocaust survivor was dyeing. He needed a aortic valve replacement but, at his age it would be unlikely that he would survive open heart surgery. If it was not for origami art therapy and its wonderful application of the PAVr (Percutaneous Aortic Valve replacement) Jack probably would not have lived very much longer. Most people get frustrated take piece of paper, crumple it and throw it at the trash. The frustrated thinker usually has to stop and get some form of therapy. Yes, origami art therapy. And this is how the great origami artists, scientists and biomedical origami engineers started to develop the PAVr. Its an aortic valve replacement that is folded in such a way that it is possible to insert and snake through an artery to the heart where it is unfolded into a valve replacement from inside. No open heart surgery and only a few hours work for recovery. Jack, a 95 year old Holocaust survivor would probably have died at 95 during open heart surgery, but did not because of and application of an ancient art, origami. Look at how many lives origami is saving and it all started with a design and a plain (Muji) piece of paper.
Thanks Dr Bolin,
Thomas Lapsley TL
Tunica Intima, Tunica Media, Tunica Adventitia
How to differentiate aortic dissection from MI
couple of things eg, EKG findings and pain radaition also differnt in radial pulses
I thought the cut-off for AAA surgery was greater 5.5
www.ncbi.nlm.nih.gov/pmc/articles/PMC4725249/