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22 Cards in this Set
- Front
- Back
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What are three drugs that are given for patients with aortic dissection?
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1. Esmolol (beta-blocker)
2. Nitroprusside 3. Labetalol 4. Verapamil (Calcium channel blocker if cannot tolerate beta-blocker) |
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What is the treatment goal (2) for thoracic aortic dissection?
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1. Decrease the sheer stress (dp/dt)
2. Decrease the force of blood being pumped into the aorta (BP) |
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What is the systolic blood pressure goal for treatment of aortic dissection?
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Systolic blood pressure rang of 100-120 mmHG
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What is the (definitive) treatment for an acute proximal aortic dissection?
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Surgical correction
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What is the (definitive) treatment for acute distal aortic dissection?
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Medical correction
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What is the heart rate goal for pharmacology correction of aortic dissection?
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60-80 bpm
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What are 5 risk factors for aortic dissection?
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1. Male
2. Hypertension 3. Cocaine 4. Connective Tissue disorders (Marfan's, Turner's) 5. Family History 6. Polycystic kidney disease 7. Pregnancy 8. Aortic Valvular Heart Disease |
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What is the classification for aortic dissection?
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1. DeBakey (I/II: ascending; III: descending)
2. Stanford (A- ascending and B- descending) Note Stanford A - involve the aortic arch and B - do not involve the aortic arch |
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What findings on physical exam should tip you off for aortic dissection? (3)
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1. Pulse deficit -i.e. weak/ absent pulse in one arm and strong in other
2. Neuro exam (odd presentations of neurologic findings) 3. Murmur: Diastolic Aortic Murmur Proximal Dissection) |
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Rare presentations for Aortic Dissections?
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1. Left recurrent larygeal nerve palsy (vocal cord paralysis)
2. Dysphagia (compression of esophagus) 3. Hemoptysis, Hematemesis, SVC syndrome, pulsating neck mass, Horner's Syndrome) **CHEST PAIN + ANY OTHER SYSTEM*** |
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EKG findings on Aortic Dissections?
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Non-discriminatory (non-specific changes) - However important to r/o Aortic dissection for those with an acute MI (thrombolytic therapy)
- Dissection is usually inferior MI (II, III, aVF) |
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What are the classic findings for aortic dissection?
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1. Mediastinal Widening (61%) (>8 cm)
2. Obliteration of the aortic knob (50%) 3. Left sided pleural effusion (19%) 4. "Calcium sign" (14%) 5. Left apical pleural cap 6. Displacement of the trachea to the right |
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What is the imaging study of choice for Aortic Dissection?
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CT - with contrast is ideal (gold standard)
TEE Angiography - no longer gold standard MRI |
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What is the imaging study of choice for Aortic Dissection?
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CT - with contrast is ideal (gold standard)
TEE Angiography - no longer gold standard MRI |
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What is the imaging study of choice for Aortic Dissection?
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CT - with contrast is ideal (first test to get)
TEE Angiography - no longer gold standard MRI |
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What is the most important drug to give in aortic dissection?
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Beta Blocker - to reduce post-infarction arrhythmias and BP control
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What two beta-blockers for treatment of aortic dissection?
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1. Esmolol
2. Labetolol |
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What is the second medication used in aortic dissection to reduce blood pressure further?
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(Vasodilator) - Both of these are titratable
1. Nitroprusside (reduces afterload) 2. Fenoldopam |
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Dose of Esmolol in Aortic Dissection
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(B-Blocker)
500 mcg/kg IV over 1 minute followed by 50 mcg/kg/min gtt. Titrate q 4 min by increasing bolus (if needed) by 50 mcg/kg/min |
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Dose of Labetolol in Aortic Dissection
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(B-Blocker)
- 20 mg IV pushed over two minutes - Double dose q 10 minutes (max 300 mg) - Consider infusion 1-2mg/min |
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What is the dose of Nitroprusside in Aortic Dissection?
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(Vasodilator)
0.25-10 mcg/kg/min titrate to effect MAX 10 mcg/kg/min >500 mcg/kg - can see cyanide toxicity |
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What is the dose of Fenoldopam in Aortic Dissection?
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(Dopamine Agonist)
0.025-0.5 mcg/kg/min titrate to desired effect -MAX: 1.6 mcg/kg.min |
