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HWN Suggests

Thoracic Aortic Dissection

STEMI on ECG does not exclude concomitant aortic dissection and may be a consequence of it. Do not give thrombolytics before you have considered and reasonably excluded aortic dissection (i.e., no H&P features or CXR findings to suggest the diagnosis)...

Vasodilators should not be initiated prior to rate-controlling agents, as they may result in reflex tachycardia that serves to propagate the dissection.

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Featured

 Episode 92 – Aortic Dissection Live from The EM Cases Course

When it comes to management, treat pain first, then HR and then BP.

Articles of Interest

Aortic Dissection in the ED: A Review of ACEP’s New Guidelines

In early 2015, ACEP released its clinical policy on the evaluation and management of adults with ‘suspected’ non-traumatic AAD. The key word here is of course ‘suspected’—and that word is exactly our diagnostic dilemma: in those patients with acute chest (or abdominal or back) pain, when should we suspect AAD as the cause?

D-dimer for aortic dissection: the evidence

Is there a role for D-dimer testing in the workup of aortic dissection in the emergency department?

The ADvISED Trial: A Novel Clinical Algorithm for the Diagnosis of Acute Aortic Syndromes

Acute Aortic Syndromes (AAS) are life threatening cardiovascular emergencies that are the bane of every emergency physician’s existence. They are diagnostic challenges due to the clinical presentation being highly non-specific.

A case of aortic dissection with highly suggestive features of COVID-19

This case report highlights an important impact of the COVID-19 pandemic on the identification and management of aortic dissection in the emergency department.

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes.

Father Time: Aortic Dissection Style

We used to intervene in the acute phase during the initial hospitalization, but found that TEVAR interventions in the subacute phase were safer for the patients.

Interventional Management in Acute Type B and Type A Aortic Dissection

Acute aortic dissection may be life-threatening and initial therapy includes stabilization, anti-impulse blood pressure control with beta-blocker, urgent surgery for Type A (ascending – proximal to the brachiocephalic artery) dissection and optimal medical therapy (and intervention for complications) for Type B (not involving the ascending aorta, typically distal to the left subclavian artery) dissection. Optimal medical therapy includes reducing the systolic blood pressure to <120 mm Hg and heart rate to <70 beats/minute.

Resources

Core EM

Classic presentation: sudden onset of tearing chest pain radiating to the back, however, dissection may occur anywhere along the aorta and thus the presentation may be broad and mimic other common disorders.

emDOCs

Aortic dissection may occur in any location along the aorta and therefore the range of presentations is broad. Many AD patients do not fit the textbook presentation.

International Emergency Medicine Education Project

Aortic dissection carries high morbidity and mortality. Although patients generally present with acute symptoms and classic signs, a subset of patients may present with syncope, GI bleeding, and neurological deficits. The clinician needs to remain vigilant for such atypical presentations.

Life in the Fastlane

The most common catastrophe of the aorta (3:100,000); 3 times more common than AAA rupture •aortic dissection is a type of acute aortic syndrome characterised by blood entering the medial layer of the wall with the creation of a false lumen. •“acute aortic syndrome” (AAS) refers to a spectrum of life-threatening thoracic aortic pathologies including intramural hematoma, penetrating atherosclerotic ulcer, and aortic dissection.

Podcast Addict

Nicardipine and Esmolol are compatible and can be given through the same IV.

THINK AORTA

The THINK AORTA campaign aims to raise awareness and improve diagnosis of Aortic Dissection worldwide.