aortic syndrome

Introduction

Includes:

• acute aortic dissection
• acute intramural aortic hematoma
• penetrating aortic atherosclerotic ulcer

Clinical manifestations

• abrupt onset of severe chest pain or back pain
• pulsus paradoxus
• asymmetric upper extremity blood pressure
• asymmetric radial pulse

Radiology

• CT angiography

Management

• beta blocker: i.e. esmolol drip
  • control blood pressure
    • reduce heart rate
• IV nitroprusside as needed to control blood pressure
• emergency surgery
  • indications
    • involvement of the ascending aorta
    • type B syndrome (distal to left subclavian artery)
      • occlusion of major aortic branch with visceral or limb ischemia
      • progressive dilatation or extension despite medical therapy
      • contained rupture of aortic dissection
      • penetrating astherosclerotic ulser
        • > 20 mm in diameter & > 10 mm in depth
        • associated intramural hematoma
• no role for prophylatic endovascular grafting

More general terms

• aortic disease
• syndrome