Aortic Dissection

Hypertension Exercise Program

How To Prevent Hypertension Naturally

Get Instant Access

Patients with suspected aortic dissection will commonly require antihypertensive treatment, which must be provided without increasing the shear force on the intimal flap of the aorta. Therefore, medications with negative inotropic effects must be given initially. b blockers (esmolol, metoprolol, or propranolol) are commonly used for this purpose. The optimal blood pressure is undefined and must be tailored to each patient. However, systolic pressure of 120 to 130 mmHg may be a convenient starting point.

Esmolol may be given as an infusion of 500 pg/kg over 1 min followed by an infusion of 50 to 150 pg/kg per minute. Metoprolol may be given intravenously in three 5-mg doses every 2 min followed by 2 to 5 mg/h. Labetolol, 20 mg (or 0.25 mg/kg) IV over 2 min, repeated q10 min to desired effect or a total dose of 300 mg; or labetolol 2 mg/min to desired effect or total dose 300 mg, can also be given. Calcium channel blockers may be used if a contraindication to b blockers is present.

Vasodilators (such as nitroprusside) may be added for further antihypertensive treatment after the successful administration of a negative inotrope. Nitroprusside may be infused intravenously at 0.3 to 10 pg/kg per minute. Administration should be provided by a pump to ensure precise measurement of drug. Patients should clearly have evidence of adequate b-receptor or calcium channel blockade prior to starting a vasodilator. Close monitoring of the pulse rate is required, as this is a convenient indicator of blockade in most patients. Aortic dissections may cause hypotension, which requires fluid or blood product resuscitation.

Rapid referral to a surgeon is mandatory. Dissections with involvement of the ascending aorta require prompt surgical repair. Patients with dissecting aneurysms of only the descending aorta are worse surgical risks, and indications for repair are controversial. 18

Asymptomatic abdominal and thoracic aortic aneurysms require prompt outpatient referral. Other interventions are generally not needed. CHAPTER REFERENCES

1. Crawford ED, Hess KR: Abdominal aortic aneurysm. N Engl J Med 321:1040, 1989.

2. Henney AM, Adiseshiah M, et al: Abdominal aortic aneurysm: Report of a meeting of physicians and scientists, University College London Medical School. Lancet 341:215, 1993.

3. Berridge DC, Chamberlain J, Guy A, et al: Prospective audit of abdominal aortic aneurysm surgery in the northern region from 1988 to 1992. Br J Surg 82(7):906-910, 1995.

4. Faggioli GL, Stella A, Gargiulo M, et al: Morphology of small aneurysms: Definition and impact on risk of rupture. Am J Surg 168:131, 1994.

5. Harris JA, Kostaki G, Glover J, et al: Penetrating atherosclerotic ulcers of the aorta. J Vasc Surg 19:90, 1994.

6. Satta J, Laara E, Immonen K, et al: The rupture type determines the outcome for ruptured abdominal aortic aneurysm patients. Ann Chirurg Gynaecol 86:24, 1997.

7. Batounis E, Georgopoulos S: The validity of current vascular imaging methods in the evaluation of aortic anastomotic aneurysms developing after abdominal aortic aneurysm repair. Ann Vasc Surg 10:537, 1996.

8. Jones CS, Reilly MK, Dalsing MC, Glover JL: Chronic contained rupture of abdominal aortic aneurysms. Arch Surg 121:542, 1986.

9. Nevitt MP, Ballard DJ, Hallett JW Jr: Prognosis of abdominal aortic aneurysms: A population-based study. N Engl J Med 321:1009, 1989.

10. Larson EW, Edwards WD: Risk factors for aortic dissection: A necropsy study of 161 cases. Am J Cardiol 53:849, 1984.

11. Graham M, Chan A: Ultrasound screening for clinically occult abdominal aortic aneurysm. Can Med Assoc 138:627, 1988.

12. Cigarroa JE, Isselbacher EM, DeSanctis RW, et al: Medical progress: Diagnostic imaging in the evaluation of suspected aortic dissection—old standards and new directions. N Engl J Med 328:35, 1993.

13. Naidich JB, Crystal KS: Diagnosis of dissecting hematoma of the aorta: A choice between good and better (editorial; comment). Radiology 190:16, 1994.

14. Erbel R, Engberding R, Daniel W, et al: Echocardiography in diagnosis of aortic dissection, Lancet 1:457, 1989.

15. Erbel R, Oelert H, Meyer J, et al: Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography: Implications for prognosis and therapy. Circulation 87:1604, 1993.

16. Blanchard DG, Kimura BJ, Dittrich HC, et al: Transesophageal echocardiography of the aorta. JAMA 272:546, 1994.

17. Hartnell G, Costello P, Goldstein S, et al: The Diagnosis of Thoracic Aortic Dissection by Noninvasive Imaging Procedures. N Engl J Med 328:1637, 1993.

18. Miller DC: The continuing dilemma concerning medical versus surgical management of patients with acute type B dissections. (Review) (60 refs). Seminars in Thoracic & Cardiovascular Surgery, 5(1):33-46, Jan. 1993.

Was this article helpful?

0 0
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook

Post a comment