Aortic Dissection

Thu, 10/21/2021 - 6:00am
Author: 
Alyse Volino, MD
Editor: 
John Cafaro MD

History:

  • Severe pain 

  • Ripping / tearing pain 

  • Thorax pain 

  • Abrupt 

  • Migrating 

  • Hx of aortic disease or connective tissue disorder

Physical Exam:

  • Look uncomfortable? 

  • Neuro deficit 

  • Pulse deficit (touch the feet) 

  • New diastolic murmur 

  • Vital signs abnormalities? 

Diagnostics:

  • CTA CAP: test of choice in ED

  • MRA 

  • TEE 

Goals:

  • Get patient to OR, prevent rupture: 

  • Decrease chronotropy, inotropy, afterload 

  • HR (goal 60) / decrease catecholamine surge: esmolol  

  • BP (goal SBP 100-110): nicardipine, clevidipine, nitroprusside 

  • Arterial Line!!

  • What if they are hypotensive? Think of why:

  • Acute MI 

  • Not common! < patients with STEMI found to have AAS 

  • Usually RCA 

  • Aortic insufficiency 

  • Aortic rupture 

  • Pericardial tamponade 

  • Look with POCUS