STEP2: CARDS: Aortic Dissections

Question 1

Which on requires emergent surgical intervention:

Answer 1

TYPE A

Question 2

What are some complications due to extension of an acute aortic dissection?

Answer 2

Question 3

A pt presenting with concerns for an acute aortic dissection starts developing signs of rapidly developing pulmonary edema including lung crackles, orthopnea, and sob. This leads to …

Answer 3

acute aortic regurg

Question 4

What is the initial pharmacotherapy of choice after pain managment in the treatment of aortic dissection?

Answer 4

BETA BLOCKERS! they decrease contractility, BP, and HR in order to reduce aortic wall sheer stress

Question 5

Risk factors for an acute aortic dissection

Answer 5

chronic hypertension
underlying aortopathy (like marfans)
cocaine use

Question 6

What is the clinical presentation for an acute aortic dissection?

Answer 6

severe tearing chest or back pain
+/- variation in SBP between arms greater than 20 mmhg
htn usuallt present

Question 7

How do you diagnose an acute aortic dissection?

Answer 7

ECG: normal or nonspecific ST segment and t-wave changes
CXR: mediastinal widening
CT angio or TEE for definitive diagnosis

Question 8

Treatment for an acute aortic dissection

Answer 8

PAIN control (morphine)
IV BBlockers (esmolol)
+/- nitroprusside (if SBP >120 mmhg despite bb’s)
Emergent surgical repair if ascending dissection

Question 9

When considering what diagnostic test to perform in a patient with suspected aortic dissection, what should you take into account?

Answer 9

hemodynamic instability; someone who is not stable should not get CT or MRA, do TEE.
Contrast: if someone has impaired kidney function or another contraindication to contrast media, then consider MRA over CT if hemodynamically stable

Question 10

32 yo m pt comes in with tearing chest pain that radiates to his back. He is a marfanoid looking motherfucker. Which of the following are you most likely to auscultate and why:
S3
Early diastolic mumur
Fixed split S2
Opening Snap
Pulsus parvus et tardus

Answer 10

Early diastoluc murmur; this patient has marfans, he is likely undergoing an acute aortic dissection and has aneurysmal aortic root dialation. This leads to aortic regurg which presents as an early diastolic murmur

Question 11

Sudden severe chest pain that radiates to the back and pt is exhibiting signs of becks triad…

Answer 11

this is acute aortic dissection. Pts can get cardiac tamponade as a result of acute aortic dissection. DO NOT GIVE ANTICOAG