Ebook Herzog''s CCU: Part 2
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Ebook Herzog''s CCU: Part 2
RISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2resents 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, traumat Ebook Herzog''s CCU: Part 2ic aortic rupture (TAR) and aortic aneurysm rupture have also been considered to be part of the AAS spectrum.AAS is characterized by disruption of theEbook Herzog''s CCU: Part 2
media layer of the aorta and typically presents with acute chest pain. The term “acute aortic syndrome” was first coined in 2001 by the Spanish cardiRISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2sis and appropriate treatment (Figure 32.1).CLASSIC 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 classic disseơi Ebook Herzog''s CCU: Part 2on. IMH to classic dissection). IMH. intramural hematoma.Although the incidence of AAS is lower than that of acute coronary syndrome (ACS), AAS carrieEbook Herzog''s CCU: Part 2
s a higher mortality, and is therefore a critical component of the differential diagnosis of chest pain in the Cardiac Care Unit (CCU). Overall incideRISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 21996 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.3Although clinica Ebook Herzog''s CCU: Part 2l history and physical examination are important, imaging is essential in the diagnosis of AAS. Transesophageal echocardiography (TEE), computed tomogEbook Herzog''s CCU: Part 2
raphy (CT), and magnetic resonance imaging (MRI) are the preferred imaging modalities and angiography is rarely needed.CLASSIFICATION OF ACUTE AORTIC RISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2extended toinclude IMH and PAU.AASs are classified on the basis of the location and extent of involvement of the aorta. Two systems have been proposed, the DeBakey and the Stanford systems (Figure 32.2). The DeBakey system, which was proposed in 1965 by the Lebanese-American surgeon Michael Ellis De Ebook Herzog''s CCU: Part 2Bakey, divided aortic dissection into three types based on the anatomic location. Type I originates in the ascending aorta and propagates beyond the aEbook Herzog''s CCU: Part 2
ortic arch, type II is limited to the ascending aorta only, and type III is limited to the descending aorta.4□€ SAKtY CLASSIMCAnONSTANFORD CLA&SlFICAnRISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2rta, type II includes the ascending aorta only, and type III includes the descending thoracic aorta only. (DeBakey ME. Henly ws. Cooley DA. et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:130-149.) Right: Stanford classification. Type A aortic disse Ebook Herzog''s CCU: Part 2ction involves the ascending thoracic aorta, and type B involves the descending thoracic aorta only. All three AAS conditions: CAAD. IMH. and PAU useEbook Herzog''s CCU: Part 2
the Stanford classification. CAAD, classic acute aortic dissection; IMH, Intramural hematoma; PAU, penetrating aortic ulcer. (Daily PO. Trueblood HW, RISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2at 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.5 The Stanford classification appears to have wider acceptance and is now used for all Ebook Herzog''s CCU: Part 2three AAS types: CAAD, IMH. and PAU.INTRAMURAL HEMATOMAIMH is defined by crescentic or circumferential thickening of the media layer ofthe aortic wallEbook Herzog''s CCU: Part 2
. I MH is likely due to a ruptured vasa vasorum resulting in intramural bleeding but without a detectable intimal tear. It was first described in 1920RISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) repr Ebook Herzog''s CCU: Part 2metastases from stomach and colon cancers). On TEE, CT, or MRI, IMH is typically visualized as a crescentic or concentric thickening of the aortic wall > s mm (Figure 32.3). The natural history of IMH often includes progression to CAAD, which accounts for its high morbidity and mortality. Ebook Herzog''s CCU: Part 2RISK FACTORS: FROM THE ACUTE SETTING TO CHRONIC MANAGEMENTAUn ỉ ValMDU>Ịt-J.1WVÍ Ỉ4PfAcute Aortic SyndromeINTRODUCTIONAcute aortic syndrome (AAS) reprGọi ngay
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