Acute Aortic Disease.. - Index of

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Putting It All Together: Symptoms, Signs, and Images 83 Figure 10 Suggested approach to diagnosing acute aortic conditions. Abbreviations: CT, computed tomography; ECG, electrocardiogram; MRI, magnetic resonance imaging; TEE, transesophageal echocardiograph. room physician should promptly alert surgical and cardiovascular services to the potential scenario while confirmatory testing is pursued. In general, a relatively stable patient may undergo whichever imaging test is most readily available, keeping in mind that serious complications may develop quickly and continuous monitoring for change in status is necessary. In the hemodynamically unstable patient, TEE is the preferred initial test, provided that qualified personnel are readily available to rapidly perform and interpret the test. If emergency TEE is not an option, CT, aortography, or MRI may be pursued to confirm the diagnosis. If imaging tests are unavailable, the unstable patient should be emergently transferred to a tertiary referral center, preferably one with aortic expertise, for definitive diagnosis and therapy.
84 Raghupathy and Eagle EDITOR’S COMMENT Aortic dissection can be an easy diagnosis, in the presence of typical symptoms, signs, and radiographic findings. As aortic specialists, we see patients already screened and imaged; we see them through the always accurate “retrospectoscope.” Our plea to those on the front lines, especially in the Emergency Department, is that aortic dissection be part of the mindset, in the differential diagnosis of a wide variety of presentations. If aortic dissection is even remotely entertained, please image the patient. Once a CT scan, TEE, or MRI scan has been performed, the correct diagnosis sis all but assured. We respect our colleagues in the Emergency Department for the great job they do “sifting out” the few aortic dissection cases from the hundreds of patients they see with chest or abdominal symptoms. (See also Section 5: Litigation in Aortic Disease.) BIBLIOGRAPHY Bogaert J, Meyns B, Rademakers FE, et al. Follow-up of aortic dissection: contribution of mr angiography for evaluation of the abdominal aorta and its branches. Eur Radiol 1997; 7(5):695–702. Tittle SL, Lynch RJ, Cole PE, et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovasc Surg 2002; 123(6):1051–1059. REFERENCES 1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA 2000; 283(7): 897–903. 2. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation 2002; 105(2):200–206. 3. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and manaagement. Circulation 2003; 108(5):628–635. 4. O’Gara PT, Desanctis RW. Acute aortic dissection and its variants : toward a common diagnostic and therapeutic approach. Circulation 1995; 92(6):1376–1378. 5. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation 2005; 112(24): 3802–3813. 6. Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000; 117(5):1271–1278. 7. Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37(3):217–279. 8. Mehta RH, O’Gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002; 40(4):685–692. 9. Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD). J Am Coll Cardiol 2004; 43(4):665–669. 10. Nienaber CA, Fattori R, Mehta RH, et al. Gender-related differences in acute aortic dissection. Circulation 2004; 109(24):3014–3021.
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
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Preface Over 100 years ago, the gre
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Preface xi Some distinguishing feat
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xiv Acknowledgments Above all, than
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xvi Contents 6. Genetic Basis of Th
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Contributors Nili Avidan Division o
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Contributors xxi Arun Raghupathy Di
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2 Nienaber and Ince Table 1 Risk Co
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4 Nienaber and Ince In addition to
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6 Nienaber and Ince CLASSIFICATION
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8 Nienaber and Ince Lansman’s Cla
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10 Nienaber and Ince Figure 4 Curve
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12 Nienaber and Ince Figure 6 Evolu
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14 Nienaber and Ince dissection, su
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16 Nienaber and Ince (A) (B) Probab
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18 Nienaber and Ince Table 5 Risk P
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20 Nienaber and Ince of the predila
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22 Nienaber and Ince 34. Pieters FA
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24 Nienaber and Ince 75. Mehta RH,
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26 Nienaber and Ince hematoma (IMH)
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28 Nienaber and Ince One good featu
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30 Isselbacher SYMPTOMS Pain Experi
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Matrix Metalloproteinases in Aortic
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INTRODUCTION 9 Inflammation and Rem
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10 Weight Lifting and Aortic Dissec
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Weight Lifting and Aortic Dissectio
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11 Timing of Acute Aortic Events: H
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Timing of Acute Aortic Events 171 F
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SECTION IV: TREATMENT OF ACUTE AORT
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Natural History of Thoracic Aortic
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14 Acute Aortic Dissection: Anti-im
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Acute Aortic Dissection 231 lamella
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Acute Aortic Dissection 233 P t is
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Acute Aortic Dissection 235 From th
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Acute Aortic Dissection 241 Table 2
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Acute Aortic Dissection 243 dissect
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Acute Aortic Dissection 245 22. Bax
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Acute Aortic Dissection 247 62. Lin
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Acute Aortic Dissection 249 DISSCUS
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252 Elefteriades and Griepp ACUTE A
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254 Elefteriades and Griepp Figure
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256 Elefteriades and Griepp sometim
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262 Elefteriades and Griepp to a se
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266 Elefteriades and Griepp CONCLUS
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268 Elefteriades and Griepp DISCUSS
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270 Brinster et al. thoracic aneury
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274 Brinster et al. artery. Z3 land
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322 Hackmann et al. ACKNOWLEDGMENTS
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330 Hackmann et al. DISCUSSION AND
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332 Elefteriades Diseases of the th
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SECTION VII: SYNTHESIS 20 The Key L
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The Key Lessons of This Book—In a
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362 Index Aging, aortic aneurysms a
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364 Index Cytokines, aortic aneurys
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366 Index Pathoanatomy classificati
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368 Index [Thoracic aortic aneurysm
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Figure 1.C Note from schematic depi
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Figure 8.1 Dramatic clinical exampl
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Figure 11.2 Proposed schema for the
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Figure 19.1 Future prospects in car
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