Acute Aortic Syndrome • LITFL

OVERVIEW

Chest pain with ischemic symptoms and haemodynamic compromise can occur acutely due to a spectrum of aortic pathologies known as the acute aortic syndrome
the rate of aortic rupture is higher in penetrating atheromatous ulcer (42%) and intramural hematoma (35%) than in aortic dissection (types A 7.5% and type B 4.1%)

TYPES

Penetrating atheromatous ulcer – rupture of an atheromatous plaque through the internal elastic lamina, with subsequent localized medial disruption and potential dissection, pseudoaneurysm formation, or free rupture
Intramural hematoma – rupture of the vasa vasorum or hemorrhage within an atherosclerotic plaque followed by aortic wall infarct
Aortic dissection- an intimal tear with resultant propagation within the middle third of the medial layer of the aorta
Aneurysm leak or rupture – progressive vessel dilation and increased wall tension
Traumatic transection – rapid deceleration forces or direct trauma, commonly shearing distal to left subclavian artery at aortic isthmus where the aorta is fixed by ligamentum arteriosum

References and Links

LITFL

CCC — Acute Aortic Dissection

Journal articles

Sheikh A, Ali K, Mazhar S. Acute Aortic Syndrome. Circulation 2013;128:1122-1127
Ueda T, Chin A, Petrovitch I, Fleischmann D. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights Imaging. 2012 Dec;3(6):561-71. doi: 10.1007/s13244-012-0195-7. Epub 2012 Nov 6. PubMed PMID: 23129238; PubMed Central PMCID: PMC3505562.

Critical Care

Compendium

…more CCC

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

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