Ebook Ebook Herzog’s CCU book: Part 2
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Ebook Ebook Herzog’s CCU book: Part 2
914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2AS) represents a spectrum of life-threatening conditions with similar clinical presentation and the need for urgent management. It includes classic acute aortic dissection (CAAD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Although not included in the original definition of AAS, Ebook Ebook Herzog’s CCU book: Part 2traumatic aortic rupture (TAR) and aortic aneurysm rupture have also been considered to be part of the AAS spectrum.A AS is characterized by disruptioEbook Ebook Herzog’s CCU book: Part 2
n of the media layer of the aorta and typically presents with acute chest pain. The term “acute aortic syndrome” was first coined in 2001 by the Spani914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2p diagnosis and appropriate treatment (Figure 32.1).916CLASSIC AORTICFIGURE 32.1 Acute aortic syndrome. The acute aortic syndrome triad first described by Vilacosta and San Roman. Arrows signify possible progression of aortic lesions (penetrating aortic ulcer to IMH, penetrating aortic ulcer to clas Ebook Ebook Herzog’s CCU book: Part 2sic dissection, IMH to classic dissection). IMH, intramural hematoma.Although the incidence of AAS is lower than that of acute coronary syndrome (ACS)Ebook Ebook Herzog’s CCU book: Part 2
, AAS carries a higher mortality, and is therefore a critical component of the differential diagnosis of chest pain in the Cardiac Care Unit (CCƯ). Ov914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2 created in 1996 as a way to combine data acquired from multiple top institutions in Europe, North America, and Asia.2 The 2010 intersocietal guidelines for the diagnosis and management of patients with thoracic aortic disease proposed a standard approach to the diagnosis and treatment of A AS.3Alth Ebook Ebook Herzog’s CCU book: Part 2ough clinical history and physical examination are important, imaging is essential in the diagnosis of AAS. Transesophageal echocardiography (TEE), coEbook Ebook Herzog’s CCU book: Part 2
mputed tomography (CT), and magnetic resonance imaging (MRI) are the preferred imaging modalities and angiography is rarely needed.CLASSIFICATION OF A914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2 subsequently extended to include 1M11 and PAU.AASs arc classified on the basis of the location and extent of involvement of the aorta. Two systems have been proposed, (he DeBakey and the Stanford systems (Figure 32.2). The DeBakey system, which was proposed in 1965 by the Lebanese-American surgeon Ebook Ebook Herzog’s CCU book: Part 2Michael Ellis DeBakey, divided aortic dissection into three types based on the anatomic location. Type 1 originates in the ascending aorta and propagaEbook Ebook Herzog’s CCU book: Part 2
tes beyond the aortic arch, type 11 is limited to the ascending aorta only, and type 111 is limited to the descending aorta.4DE BAK EV CLASSIFICATIONS914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2 of aortic dissection. Type 1 includes the ascending and descending aorta, type 11 includes the ascending aorta only, and type 111 includes the descending thoracic aorta only. (DeBakey ME, Henly ws, Cooley DA, el al. Surgical management OÍ dissecting aneurysms of the aorta. J Thorac Cardiovasc Sưrg. Ebook Ebook Herzog’s CCU book: Part 2 1965;49:130-149.) Right: Stanford classification. Type A aortic dissection involves the ascending thoracic aorta, and type B involves the descendingEbook Ebook Herzog’s CCU book: Part 2
thoracic aorta only. All three AAS conditions; CAAD, ĨMĨĨ, and PAU use the Stanford classification. CAAD, classic acute aortic dissection; ĨMĨĨ, intra914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 21970; 10(31:237-247.)The Stanford system, which was created by researchers at Stanford University in 1970, divides aortic dissections into two types. Type A includes any dissection that involves the ascending aorta, whereas type B dissections are limited to the descending thoracic aorta.r’ The Stanf Ebook Ebook Herzog’s CCU book: Part 2ord classification appears to have wider acceptance and is now used for all918three AAS types: CAAD, IMH, and PAU.INTRAMURAL HEMATOMAIMH is defined byEbook Ebook Herzog’s CCU book: Part 2
crescentic or circumferential thickening of the media layer of the aortic wall. IMH is likely due to a ruptured vasa vasorum resulting in intramural 914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA Ebook Ebook Herzog’s CCU book: Part 2 his description of the so-called Kruckenberg tumors (transperitoneal ovarian metastases from stomach and colon cancers). On TEE, CT, or MRI, IMH is typically visualized as a crescentic or concentric thickening of the aortic wall > 5 mm (Figure 32.3). The natural history of I MH often includes progr Ebook Ebook Herzog’s CCU book: Part 2ession to CAAD, which accounts for its high morbidity and mortality.919914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AA914RISK FACTORS: FROMTHE AC UTE SETTING TO CHRONIC MANAGEMENT915A link vainrib Mu tamed SanrAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAGọi ngay
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